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Madar H, Deneux-Tharaux C, Sentilhes L. [What's new in obstetrics and gynecology ? About tranexamic acid for the prevention of postpartum hemorrhage]. Gynecol Obstet Fertil Senol 2022; 50:280-282. [PMID: 35123141 DOI: 10.1016/j.gofs.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Affiliation(s)
- H Madar
- Service de Gynécologie-Obstétrique, CHU de Bordeaux, Place Amélie- Raba-Léon, 33076 Bordeaux, France.
| | - C Deneux-Tharaux
- Université de Paris, CRESS, Équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique, EPOPé, INSERM, INRA, FHU Préma, Paris, France
| | - L Sentilhes
- Service de Gynécologie-Obstétrique, CHU de Bordeaux, Place Amélie- Raba-Léon, 33076 Bordeaux, France
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Derakhshan A, Firoozi J, Esmaeili S, Bakhtiari E, Abbaspour M, Abrishami M, Zia MJ. Systemic prednisolone versus topical tranexamic acid for prevention of rebleeding in patients with traumatic hyphema: A randomized clinical trial. J Fr Ophtalmol 2021:S0181-5512(21)00595-7. [PMID: 34949502 DOI: 10.1016/j.jfo.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare the efficacy of systemic prednisolone and topical tranexamic acid (TA) on the rate of rebleeding in patients with macroscopic traumatic hyphema (MTH). METHOD In a randomized clinical trial, patients with MTH were randomized to receive oral prednisolone (OP group) or topical TA drops (TA group). Comprehensive ophthalmic examinations including slit lamp examination and fundoscopy, intraocular pressure (IOP), best-corrected visual acuity (BCVA) and check for rebleeding were performed in all cases. RESULTS Ninety eyes of 90 patients were included, and 45 patients were allocated into each group. Age, sex, IOP, BCVA and grade of hyphema were not different between groups. Rebleeding in the TA group (2 patients, 4.4%) occurred less frequently than in the OP group (7 patients, 15.6%), but this difference did not reach statistical significance (P=0.081). However, there was a significant difference between the two groups over time in terms of absorption of the MTH (P<0.001). CONCLUSION Topical TA appears promising in the management of macroscopic traumatic hyphema.
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Zenjari L, Elfetoiki FZ, Hali F, Skalli H, Chiheb S. [Oral tranexamic acid in the treatment of lichen planus pigmentosus: A prospective study of 20 cases]. Ann Dermatol Venereol 2020; 147:818-822. [PMID: 32747031 DOI: 10.1016/j.annder.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lichen planus pigmentosus is a variant of lichen planus that is particularly difficult to treat. The aim of this study was to evaluate the efficacy and safety of tranexamic acid in lichen planus pigmentosus. PATIENTS AND METHODS This prospective study, conducted at the University Hospital of Casablanca from August 2017 to June 2019, included 20 patients with histologically confirmed lichen planus pigmentosus. The exclusion criteria were pregnancy, breastfeeding, known hypersensitivity to tranexamic acid, and thromboembolic disease. Evaluation was carried out by means of clinical examination and measurement of the affected area using the Visioface® RD hardware package at 6 and 12 months (M6 and M12). RESULTS Eighteen women and 2 men with an average age of 49 years (range: 26-65 years) were included. All patients were phototype 3 or 4. The average disease duration was 2.9 years (range: 2 months-15 years). Pigmented, slate-grey, well-delineated macules were observed in all patients on the face (n=19), neck (n=14) or arms (n=2). Pruritus was present in 9 patients. All patients received oral tranexamic acid 250mg/d for 4 to 6 months with external photoprotection that was prolonged beyond 6 months. At M6, partial improvement was noted in 10 patients, 3 patients showed no improvement, and 7 patients were lost to follow-up. Pruritus disappeared in all patients and no relapse was seen at M12. DISCUSSION Our study suggests that tranexamic acid could be an effective treatment for lichen planus pigmentosus with a good safety profile. However, the limitations of the study are the limited population and the high number of patients lost to follow-up at M6. Larger-scale studies are needed to provide more detailed results.
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Affiliation(s)
- L Zenjari
- Service de dermatologie et vénérologie, CHU Ibn Rochd, Casablanca, Maroc.
| | - F Z Elfetoiki
- Service de dermatologie et vénérologie, CHU Ibn Rochd, Casablanca, Maroc
| | - F Hali
- Service de dermatologie et vénérologie, CHU Ibn Rochd, Casablanca, Maroc
| | - H Skalli
- Service de dermatologie et vénérologie, CHU Ibn Rochd, Casablanca, Maroc
| | - S Chiheb
- Service de dermatologie et vénérologie, CHU Ibn Rochd, Casablanca, Maroc
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Abstract
This year, many publications have focused on understanding, avoiding and treating vascular complications when injecting fillers. New protocols for the use of hyaluronidase have shown their effectiveness in preventing skin necrosis or blindness after vascular embolism when injecting hyaluronic acid. Other areas of interventional dermatology have been well documented: myomodulation is an interesting concept that describes the impact of the injection depth of a filler on muscle forces in order to correct the balances between the lowering and elevators during congenital or acquired defcits with aging. Treatment of melasma remains diffcult but the prescription of oral tranexamic acid could be useful. Botulinum toxin is expanding its feld of activity for both aesthetic and medical treatments. Pulsed dye laser remains the reference treatment for port wine stains, but the rate of recurrence by post laser neo-angiogenesis justifes the need of reliable and effective adjuvant treatments.
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Affiliation(s)
- C Raimbault
- Dermatologue libérale, 30, rue des Clercs, 57000 Metz, France, présidente du Groupe de dermatologie esthétique et correctrice (gDEC) de la Société française de dermatologie, past présidente de l'Association de dermatologie esthétique et laser de l'Est (ADELE).
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Jendoubi A, Malouch A, Bouzouita A, Riahi Y, Necib H, Ghedira S, Houissa M. [Safety and efficacy of intravenous tranexamic acid in endoscopic transurethral resections in urology: Prospective randomized trial]. Prog Urol 2017; 27:1036-1042. [PMID: 29074352 DOI: 10.1016/j.purol.2017.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 07/15/2017] [Accepted: 09/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endoscopic urological procedures (transurethral resection of the prostate TURP/transurethral resection of bladder tumor TURBT) are not without risk of significant bleeding. This risk is due to the vascular nature of the tissues and their high levels of fibrinolytic enzymes in the tissues and urine. This study was conducted to evaluate the safety and efficacy of the antifibrinolytic agent tranexamic acid (TXA) in reducing blood loss in patients undergoing TURP/TURBT and transfusion requirement. METHODS This study was a prospective, randomized, double-blind, placebo controlled clinical trial. One hundred and thirty-one patients of ASA physical status I or II, undergoing TURP (60 patients) or TURBT (71 patients) were randomly allocated to receive IV TXA: bolus of 10mg/kg at the induction of anesthesia followed by infusion of 1mg/kg/h intraoperatively and for 24h postoperatively or an equal volume of saline (control group). Blood loss was evaluated in terms of reduction in the serum hemoglobin level (delta Hb=Hb H24-Hb H0). RESULTS There was no difference between two groups in terms of transfusion requirements and episodes of retention. TXA did not significantly reduce mean blood loss compared with placebo during TURP (1.37±0.69 vs. 1.72±1.23g/dL respectively, P=0.256) or TURBT (1.15±0.95 vs. 1.07±0.88g/dL; P=0.532). No thrombotic complications were noted in any patient. CONCLUSION Tranexamic acid did not reduce transfusion requirements or perioperative blood loss in transurethral resection of the prostate or bladder tumor. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A Jendoubi
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - A Malouch
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - A Bouzouita
- Department of urology, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - Y Riahi
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - H Necib
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - S Ghedira
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - M Houissa
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
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Essola L, Kouégnigan Rérambiah L, Obame R, Issembè H, Sima Zué A. [Can venous iron and tranexamic acid reduce the transfusion need? Report on a non randomized, case control study]. Transfus Clin Biol 2017; 24:52-55. [PMID: 28341003 DOI: 10.1016/j.tracli.2017.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate if the association of injectable iron and tranexamic acid allows a significant saving in transfusion, in cases of myomectomies and hysterectomies. PATIENTS AND METHOD This is a prospective, non randomized study done over 8 months (from January 2013 to August 2013). Were included, patients undergoing hysterectomy or myomectomy who had a hemoglobin level greater than or equal to 8g/dl and less than 12g/dl. Two groups were compared: group A consisting of patients for whom a pack red cells was ordered and the group B which patients received intravenous iron preoperatively and tranexamic acid perioperatively. The level of hemoglobin, pre- and postoperative, the average number of blood units per patient and estimated blood loss was compared. The transfusion economy was evaluated. RESULTS During this period, 87 patients with a mean age of 40±9 years (range: 23 and 70years) were included according to our criteria: 44 patients in group A and 43 patients in group B. Initial mean hemoglobin in both groups was 9.1±0.7g/dl. In group B, after iron administration, the mean hemoglobin was 11.3±0.7g/dl. The average number of red blood cells received intraoperative patient in group A was 1.54±0.51. The estimated blood loss was significant greater (P=0.0002) in group A (571.6±237.1ml) than in group B (213.7±131.7ml). No transfusion was performed in group B. CONCLUSION The association intravenous iron and tranexamic acid resulted in the reduction of transfusion requirements in our setting. It could be integrated in the strategy for sparing blood transfusion in scheduled surgery with hemorrhagic risks.
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Affiliation(s)
- L Essola
- Unité de soins intensifs du centre hospitalier universitaire de Libreville, 7919 Libreville, Gabon.
| | | | - R Obame
- Unité de soins intensifs du centre hospitalier d'Angondjé, Gabon
| | - H Issembè
- Unité de soins intensifs du centre hospitalier universitaire de Libreville, 7919 Libreville, Gabon
| | - A Sima Zué
- Unité de soins intensifs du centre hospitalier universitaire de Libreville, 7919 Libreville, Gabon
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Vardon F, Bounes V, Ducassé JL, Minville V, Lapostolle F. [Out-of-hospital equipment of emergency medical services for hemorrhagic shock management: can do better!]. ACTA ACUST UNITED AC 2014; 33:621-5. [PMID: 25443039 DOI: 10.1016/j.annfar.2014.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 09/08/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Hemorrhagic shock is an emergency, which may benefit from a medicalized prehospital care. Our goal was to survey the means available in the 370 French prehospital medicalized emergency services (SMUR) for hemorrhagic situations. METHODS Multicenter descriptive observational study by email then phone with all the 370 French SMUR leaders. The questionnaire was created by investigators of the project through a Delphi method, and was about service protocols concerning hemorrhagic patient care, hemorrhagic parameters measure equipment available, intravenous solutes and drugs as well as various medical devices useful or perceived to be useful to support prehospital hemorrhagic shock. The results are expressed in numbers and percentages. RESULTS The overall response rate was 48% (n=178). Protocols were established in between 43% (n=76) and 47% (n=83) according to etiology, measuring devices were available in 5% (n=9) of the Smur for hemostasis up to 89% (n=158) for hemoglobin measurement. Available intravenous solutes were mainly isotonic salty serum (95%, n=169), hydroxylethylstarch (83%, n=148) and Ringer lactate (73%, n=130). Tranexamic acid was available in 84 (47%) Smur. The teams had access to erythrocytes concentrates, fresh frozen plasma and platelets in 84% (n=150), 44% (n=79) and 23% (n=41) respectively. Eighty-one (46%) Smur had tourniquets and 127 (71%) anti-shock trousers. Finally, 57 (32%) had a pelvic restraint belt. CONCLUSION There is a great disparity in the means available in the French Smur for the support of prehospitalization bleeding. The majority the Smur physicians can transfuse in a prehospital setting. On the other hand, a minority of teams can actively warm patients, employ tranexamic acid or use pelvic restraint belts.
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Faraoni D, Carlier C, Samama CM, Levy JH, Ducloy-Bouthors AS. [Efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of post-partum haemorrhage: a systematic review with meta-analysis]. ACTA ACUST UNITED AC 2014; 33:563-71. [PMID: 25450729 DOI: 10.1016/j.annfar.2014.07.748] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/10/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE(S) Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage. STUDY DESIGN Systematic review with meta-analysis. MATERIAL AND METHODS Systematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage. RESULTS Prophylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: -177.9mL, IC 95%: -189.51 to -166.35, total blood loss: -183.94, IC 95%: -198.29 to -169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74). None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30 minutes after randomisation (P=0.03) and confirmed after 6 hours (median: 170mL (58-323) vs 221mL (110-543), P=0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration. CONCLUSION Although tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. Those studies should assess the pharmacokinetic profile and the safety of this drug in pregnant women.
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Affiliation(s)
- D Faraoni
- Service d'anesthésie, hôpital universitaire des enfants Reine-Fabiola, centre hospitalier universitaire (CHU) Brugmann, avenue Jean-Joseph-Crocq 15, 1020 Bruxelles, Belgique.
| | - C Carlier
- Service d'anesthésie, hôpital universitaire des enfants Reine-Fabiola, centre hospitalier universitaire (CHU) Brugmann, avenue Jean-Joseph-Crocq 15, 1020 Bruxelles, Belgique
| | - C M Samama
- Service d'anesthésie-réanimation, CHU Cochin, Assistance-publique-Hôpitaux de Paris, 27, rue du Faubourg-St-Jacques, 75014 Paris, France
| | - J H Levy
- Service d'anesthésie-réanimation, Duke University School of Medicine, Durham, 27710 Caroline du Nord, États-Unis
| | - A S Ducloy-Bouthors
- Service d'anesthésie-réanimation, CHRU de Lille Jeanne-de-Flandre, avenue Oscar-Lambret, 59037 Lille, France
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