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Abdou AM, Eldesouky E, Farag E, Mohammed A, Abdelaziz DFM, Shaaban A, Ellaban M, Elhalim AEMA, Elsror AGA, Marai AAE, Abdel-Hakam F, Abd-ElGawad M, Elrashedy AA, Abdelmonem H, Kamel MA, Afiffi IK, Elsayed HGA, Abdelhamed SA, Bosilah AH, Marie H. Oxytocin versus a combination of tranexamic acid and ethamsylate in reducing intraoperative bleeding during abdominal myomectomy: a randomized clinical trial. BMC Womens Health 2023; 23:398. [PMID: 37516864 PMCID: PMC10387195 DOI: 10.1186/s12905-023-02549-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/15/2023] [Indexed: 07/31/2023] Open
Abstract
OBJECTIVE Myomectomy is the preferred surgical approach to manage uterine fibroids. However, uterine fibroids are highly vascular tumors and, consequently, extremely susceptible to problems from myomectomy-related hemorrhage. Hence, we aim to compare oxytocin efficacy and safety profile versus tranexamic acid (TA) with ethamsylate for reducing bleeding during myomectomy. METHODS This randomized, double-blinded multicenter study was performed between 20th August 2020 and 20th October 2020 at El-Galaa Teaching Hospital, El Hussein University Hospital, Al-Azhar University Hospitals of Assiut, and Al-Azhar University Hospitals of Damietta. One hundred and eighty patients were enrolled and divided into three groups: group (1) received an injection of 30 IU of oxytocin in 500 ml of normal saline; group (2) received injections of 1 g of TA, 250 mg of Ethamsylate, and 110 ml of normal saline IV; and group (3) received an injection of 110 ml of normal saline IV just before surgical incision. RESULTS In 180 premenopausal women, oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy (666.25 ± 183.03, 630.72 ± 145.83, and 646.67 ± 168.92, respectively (P = 0.506)). Non-significant trends were observed for a reduction in operation time (P = 0.760), intra/postoperative blood transfusion (P = 0.624), hospital stay (P = 0.986), postoperative fever (P = 0.659), and wound infection (P = 1). CONCLUSION Oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy which opens a new question about the role of the use of the hemostatic drug during myomectomy especially in centers with limited resources and had higher rates. TRIAL REGISTRATION The study was registered on Pan African Clinical Trials Registry with the following number: PACTR202008739887429 and was approved on 24/08/2020.
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Affiliation(s)
- Ahmed Mahmoud Abdou
- Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Elsayed Eldesouky
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University in Cairo, Cairo, Egypt
| | - Elsayed Farag
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University in Cairo, Cairo, Egypt
| | - Attia Mohammed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University in Cairo, Cairo, Egypt
| | | | - A Shaaban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University in Cairo, Cairo, Egypt
| | - Mostafa Ellaban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University in Cairo, Cairo, Egypt
| | | | - Ahmed Gamal Abo Elsror
- International Islamic Institute for Studies and Population Research Alazhar University in Cairo, Cairo, Egypt
| | | | - Faiza Abdel-Hakam
- Department of Obstetrics and Gynecology, Alazhar University for Girls in Cairo, Cairo, Egypt
| | | | | | | | | | - Ibtesam K Afiffi
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt
- Department of Basic &Clinical Oral Sciences &, Faculty of Dental Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | - Almandouh H Bosilah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Damiata University, Damiata, Egypt
| | - Heba Marie
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Bosilah AH, Eldesouky E, Alghazaly MM, Farag E, Sultan EEK, Alazazy H, Mohamed A, Ali SMS, Elsror AGA, Mahmoud M, Abd Elhalim AEM, Kamel MA, Abd-ElGawad M, Sayed FM, Bakry MS. Comparative study between oxytocin and combination of tranexamic acid and ethamsylate in reducing intra-operative bleeding during emergency and elective cesarean section after 38 weeks of normal pregnancy. BMC Pregnancy Childbirth 2023; 23:433. [PMID: 37308871 PMCID: PMC10259003 DOI: 10.1186/s12884-023-05728-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE Cesarean Section (CS) is associated with an increased risk of hemorrhage. Many drugs are used to decrease this risk. We aim to compare the combination of ethamsylate and tranexamic acid, oxytocin, and placebo in women undergoing CS. METHODS We conducted a double-blinded, randomized, placebo-controlled trial between October and December 2020 in four university hospitals in Egypt. The study included all pregnant women in labor without any complications who accepted to participate in the study between October and December 2020. The participants were divided into three groups. The subjects were randomly allocated to receive either oxytocin (30 IU in 500 ml normal saline during cesarean section), combined one gram of tranexamic acid with 250 mg of ethamsylate once before skin incision, or distilled water. Our main outcome was the amount of blood loss during the operation. The secondary outcomes were the need for blood transfusion, hemoglobin and hematocrit changes, hospital stay, operative complications, and the need for a hysterectomy. The one-way ANCOVA test was used to compare the quantitative variables between the three groups while the Chi-square test was used to compare the qualitative variables. Post hoc analysis then was performed to compare the difference between every two groups regarding the quantitative variables. RESULTS Our study included 300 patients who were divided equally into three groups. Tranexamic acid with ethamsylate showed the least intra-operative blood loss (605.34 ± 158.8 ml) compared to oxytocin (625.26 ± 144.06) and placebo (669.73 ± 170.69), P = 0.015. In post hoc analysis, only tranexamic acid with ethamsylate was effective in decreasing the blood loss compared to placebo (P = 0.013); however, oxytocin did not reduce blood loss compared to saline (P = 0.211) nor to tranexamic acid with ethamsylate (P = 1). Other outcomes and CS complications showed no significant difference between the three groups except for post-operative thrombosis which was significantly higher in the tranexamic and ethamsylate group, P < 0.00001 and the need for a hysterectomy which was significantly increased in the placebo group, P = 0.017. CONCLUSION The combination of tranexamic acid and ethamsylate was significantly associated with the least amount of blood loss. However, in pairwise comparisons, only tranexamic acid with ethamsylate was significantly better than saline but not with oxytocin. Both oxytocin and tranexamic acid with ethamsylate were equally effective in reducing intra-operative blood loss and the risk of hysterectomy; however, tranexamic acid with ethamsylate increased the risk of thrombotic events. Further research with a larger number of participants is needed. TRIAL REGISTRATION The study was registered on Pan African Clinical Trials Registry with the following number: PACTR202009736186159 and was approved on 04/09/2020.
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Affiliation(s)
- Almandouh H Bosilah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Damietta University, Damietta, Egypt
| | - Elsayed Eldesouky
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University, Cairo, Egypt
| | - Moatazza Mahdy Alghazaly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University for Girls, Cairo, Egypt
| | - Elsayed Farag
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University, Cairo, Egypt
| | | | - Hosam Alazazy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University, Cairo, Egypt
| | - Attia Mohamed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University, Cairo, Egypt
| | - Soliman Mohamed Said Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University, Domiata, Egypt
| | | | - Mohamed Mahmoud
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University, Cairo, Egypt
| | | | | | | | | | - Mohamed Sobhy Bakry
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Murdaca G, Greco M, Vassallo C, Gangemi S. Tranexamic acid adverse reactions: a brief summary for internists and emergency doctors. Clin Mol Allergy 2020; 18:16. [PMID: 32908455 PMCID: PMC7473809 DOI: 10.1186/s12948-020-00131-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022] Open
Abstract
Tranexamic acid (TXA) is a synthetic lysine analogue that is well known as antifibrinolytic agent. It can reduce blood loss in clinical use, especially in conditions where fibrinolysis or hyperfibrinolysis are involved, such as trauma or surgery. Moreover, TXA has been approved as second-line prophylactic therapy for hereditary angioedema and further data have been published about a possible use of TXA as maintenance treatment for nonhistaminergic angioedema and treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors. TXA can be administered through several routes: orally, topically, or intravenously. Although, it is a drug with a very high safety profile, in few cases hypersensitivity reactions have been described occurring with different clinical manifestations. Ethamsylate can be an alternative in TXA sensitized patients. In this brief article we describe TXA adverse reactions and current protocols which have been proposed to help clinicians to diagnose TXA hypersensitivity.
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Affiliation(s)
- Giuseppe Murdaca
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Viale Benedetto XV, n. 6, 16132 Genoa, Italy
| | - Monica Greco
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Viale Benedetto XV, n. 6, 16132 Genoa, Italy
| | - Chiara Vassallo
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Viale Benedetto XV, n. 6, 16132 Genoa, Italy
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
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Ramos-Sánchez TA, Ramos-Morales T, Morales-Avalos R, Blázquez-Saldaña J, Peña-Martínez VM, Vílchez-Cavazos F. [Uso de etamsilato para reducir el sangrado posoperatorio y el índice de transfusión en la artroplastia total de cadera. Ensayo clínico controlado]. CIR CIR 2019; 86:270-276. [PMID: 29950742 DOI: 10.24875/ciru.m18000043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antecedentes El sangrado secundario es una de las principales causas de morbilidad después de la cirugía. El etamsilato se ha utilizado con buenos resultados para disminuir el sangrado en diversas patologías, como metrorragias, sangrado intraventricular, prostatectomías, cirugías de catarata y amigdalectomías. El objetivo de este estudio fue evaluar la efectividad del etamsilato para disminuir el sangrado en la cirugía de reemplazo total de cadera. Método La población se dividió en dos grupos. En el grupo control se realizó la hemostasia de manera convencional; en el grupo experimental se administró etamsilato. Resultados Se incluyeron 34 pacientes, de los cuales 17 fueron aleatorizados al grupo de etamsilato y 17 al grupo control. No hubo diferencias en las características de la población entre los dos grupos. Al comparar los valores de hemoglobina preoperatoria y a las 24, 48 y 72 horas posquirúrgicas entre ambos grupos, no se encontraron diferencias estadísticamente significativas. Tampoco hubo diferencia en el hematocrito ni en la cuantificación del gasto por drenaje a las 24 y 48 horas. Hubo tres pacientes transfundidos en el grupo de etamsilato y siete en el grupo de control, lo cual no difirió significativamente (p = 0.62). Conclusión En este estudio no se demostró un efecto sobre la reducción de la hemorragia en pacientes sometidos a reemplazo total de cadera con el uso de etamsilato. Background Secondary bleeding is one of the leading causes of morbidity after the surgery. Ethamsylate has been used with good results to decrease bleeding in various pathologies such as metrorrhagia, intraventricular bleeding, prostatectomies, cataract surgeries and tonsillectomies. The objective of this study was to evaluate the effectiveness of the hemostatic agent ethamsylate to decrease bleeding in total hip replacement surgery. Method The population were divided into two groups, in the control group was performed the hemostasis conventionally; in the experimental group ethamsylate was administered. Results A total of 34 patients were included, of whom 17 were randomized to the group of ethamsylate and 17 randomized to the control group. There were no differences in the characteristics of the population between the two groups. Comparing preoperative hemoglobin levels and at 24, 48 and 72 postsurgical hours between the control group and ethamsylate group there was no statistically significant difference. There was also no difference in the levels of hematocrit. In the quantification of expenditure by the drainage there was no difference between the groups at 24 and 48 hours. There were three patients transfused in the ethamsylate group and seven in the control group, which did not differ significantly (p = 0.62). Conclusion An effect on the reduction of bleeding in patients undergoing total hip replacement with the use of hemostatic agent ethamsylate was not demonstrated in this study.
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Affiliation(s)
- Tomás A Ramos-Sánchez
- Módulo de Cadera, Miembro Inferior y Remplazo Articular, Servicio de Ortopedia y Traumatología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, N.L. México
| | - Tomás Ramos-Morales
- Módulo de Cadera, Miembro Inferior y Remplazo Articular, Servicio de Ortopedia y Traumatología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, N.L. México
| | - Rodolfo Morales-Avalos
- Módulo de Cadera, Miembro Inferior y Remplazo Articular, Servicio de Ortopedia y Traumatología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, N.L. México
| | - Jaime Blázquez-Saldaña
- Módulo de Cadera, Miembro Inferior y Remplazo Articular, Servicio de Ortopedia y Traumatología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, N.L. México
| | - Víctor M Peña-Martínez
- Módulo de Cadera, Miembro Inferior y Remplazo Articular, Servicio de Ortopedia y Traumatología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, N.L. México
| | - Félix Vílchez-Cavazos
- Módulo de Cadera, Miembro Inferior y Remplazo Articular, Servicio de Ortopedia y Traumatología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, N.L. México
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Goyal A, Singhvi I. Spectrophotometric estimation of ethamsylate and mefenamic Acid from a binary mixture by dual wavelength and simultaneous equation methods. Indian J Pharm Sci 2011; 70:108-11. [PMID: 20390094 PMCID: PMC2852046 DOI: 10.4103/0250-474x.40345] [Citation(s) in RCA: 12] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Revised: 08/10/2007] [Accepted: 02/03/2008] [Indexed: 11/16/2022] Open
Abstract
Two simple, accurate, economical and reproducible spectrophotometric methods for simultaneous estimation of two-component drug mixture of ethamsylate and mefenamic acid in combined tablet dosage form have been developed. The first developed method involves formation and solving of simultaneous equation using 287.6 nm and 313.2 nm as two wavelengths. Second developed method is based on two wavelength calculation. Two wavelengths selected for estimation of ethamsylate were 274.4 nm and 301.2 nm while that for mefenamic acid were 304.8 nm and 320.4 nm. Both the developed methods obey Beer's law in the concentration ranges employed for the respective methods. The results of analysis were validated statistically and by recovery studies.
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Affiliation(s)
- Anju Goyal
- Department of Pharmaceutical Chemistry, B. N. P. G. College of Pharmacy, Udaipur - 313 002, India
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