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Reinhardt ME, Mutyala S, Gerald M, Zhao H, Nova V, Araya Cambronero S, Patel S, Baltodano PA. The Critical Blood-Sparing Effect of Tranexamic Acid ( TXA) in Liposuction: A Systematic Review and Meta-Analysis. JPRAS Open 2024; 40:48-58. [PMID: 38425698 PMCID: PMC10904189 DOI: 10.1016/j.jpra.2023.01.002] [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: 12/30/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Tranexamic acid (TXA) has been used to improve bleeding outcomes in many surgical procedures. However, its blood-sparing effect in liposuction is not well established. Methods A systematic literature search was performed using PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, ClinicalTrials.gov, and WorldWideScience.org databases from their inception to October 8, 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors focused on 3 main topics: 1) TXA, 2) liposuction, and 3) complications. We included articles evaluating the potential blood-sparing effects of TXA in liposuction. Studies were excluded if they were systematic review articles or protocol papers, animal studies, conference abstracts, survey studies, or non-English publications. Results A total of 711 articles were identified, with 1 retrospective and 4 prospective (3 randomized) studies meeting our inclusion criteria. TXA was used in various forms: administered intravenously either on induction or after the procedure, mixed into the tumescent solution, or infiltrated into the liposuction sites after lipoaspiration. A significantly smaller reduction in hematocrit was noted in the TXA group compared with that in the non-TXA group (p<0.001) despite a significantly greater amount of lipoaspirate removed in the TXA group (p<0.001). Patients in non-TXA cohorts experienced adverse effects (such as seroma and need for transfusion) that were not seen in TXA cohorts. Conclusion TXA use in patients undergoing liposuction seems to be associated with a beneficial blood-sparing effect, which may enhance safety in this population. Future studies should aim to determine the optimal route and dosing for TXA in liposuction. Evidence Based Medicine Level IV.
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Affiliation(s)
| | | | | | - Huaqing Zhao
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Vitalina Nova
- Temple University, Charles Library, Philadelphia, PA, USA
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Gettleman BS, Liu KC, Richardson MK, Chen M, Talehakimi A, Heckmann ND, Menendez L, Christ AB. Intravenous tranexamic acid reduces complications following surgical treatment of pathologic fractures of the lower extremity. J Surg Oncol 2024; 129:1150-1158. [PMID: 38385654 DOI: 10.1002/jso.27601] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to evaluate the postoperative complications associated with administering intravenous (IV) tranexamic acid (TXA) in patients undergoing surgical fixation for neoplastic pathologic fractures of the lower extremities. METHODS Patients ≥18 years old who underwent surgical intervention for neoplastic pathologic lower extremity fractures from 2015 to 2021 were identified using the Premier Healthcare Database. This cohort was divided by TXA receipt on the index surgery day. Patient demographics, hospital factors, patient comorbidities, and 90-day complications were assessed and compared between the cohorts. RESULTS From 2015 to 2021, 4497 patients met inclusion criteria (769 TXA[+] and 3728 TXA[-]). Following propensity score matching, patients who received TXA had a significantly shorter length of stay than those who did not (7.6 ± 7.3 days vs. 9.0 ± 15.2, p = 0.036). Between the two cohorts, there were no significant differences in comorbidities. Regarding differences in postoperative complications, TXA(+) patients had significantly decreased odds of deep vein thrombosis (DVT) (1.87% vs. 5.46%; odds ratio [OR]:0.33; 95% confidence interval: 0.17-0.62; p = 0.001). CONCLUSION Administration of IV TXA may be associated with a decreased risk of postoperative DVT without an increased risk of other complications. Orthopedic surgeons should consider the utilization of IV TXA in patients treated surgically for neoplastic pathologic fractures of the lower extremity.
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Affiliation(s)
- Brandon S Gettleman
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Kevin C Liu
- Keck School of Medicine of USC, Los Angeles, California, USA
| | | | - Matthew Chen
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Arad Talehakimi
- Kansas City University College of Osteopathic Medicine, Kansas City, Missouri, USA
| | | | | | - Alexander B Christ
- Keck School of Medicine of USC, Los Angeles, California, USA
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Mackeen AD, Sullivan MV, Berghella V. Evidence-based Cesarean Delivery: Preoperative Management (Part 7). Am J Obstet Gynecol MFM 2024:101362. [PMID: 38574855 DOI: 10.1016/j.ajogmf.2024.101362] [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: 01/19/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
The preoperative preparation for cesarean delivery is a multistep approach for which protocols should exist at each hospital system. These protocols should be guided by the findings of this review. The interventions reviewed and recommendations made for this review have a common goal of decreasing maternal and neonatal morbidity and mortality related to cesarean delivery (CD). The preoperative time period starts prior to the patient's arrival to the hospital and ends immediately prior to skin incision. Skin cleansing in addition to CDC recommendations of showering with either soap or an antiseptic solution at least the night prior to a procedure has not been shown to further decrease rates of infection. Hair removal at the cesarean skin incision is not necessary, however if preferred by the surgical team then clipping or depilatory creams should be used rather than shaving. Preoperative enema is not recommended. A clear liquid diet may be ingested up to 2 hours prior and a light meal up to 6 hours prior to CD. Consider giving a preoperative carbohydrate drink to non-diabetic patients up to 2 hours prior to planned CD. Weight-based intravenous (IV) cefazolin is recommended 60 minutes prior to skin incision: 1-2g IV for patients without obesity and 2g for patients with obesity or weight ≥ 80kg. Adjunctive azithromycin 500mg IV is recommended for patients with labor or rupture of membranes. Preoperative gabapentin can be considered as may decrease pain scores with movement in the postoperative period. Tranexamic acid (1g in 10-20mL of saline or 10mg/kg IV) is recommended prophylactically for patients at high-risk of postpartum hemorrhage, and can be considered in all patients. Routine use of mechanical venous thromboembolism prophylaxis is recommended preoperatively and is to be continued until the patient is ambulatory. Music, active warming of the patient, and adequate operating room temperature improves outcomes for the patient and neonate, respectively. Noise levels should allow clear communication between teams, however a specific decibel level has not been defined in the data. Patient positioning with left lateral tilt decreases hypotensive episodes compared to right lateral tilt, which is not recommended. Manual displacers result in fewer hypotensive episodes than left lateral tilt. Both vaginal and skin preparation should be performed with either chlorhexidine (preferred) or povidone-iodine. Placement of an indwelling urinary catheter is not necessary. Non-adhesive drapes are recommended. Cell salvage, while effective for high-risk patients, is not recommended for routine use. Maternal supplemental oxygen does not improve outcomes. A surgical safety checklist (including a timeout) is recommended for all CDs.
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Affiliation(s)
- A Dhanya Mackeen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger, Danville, PA.
| | - Maranda V Sullivan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger, Danville, PA
| | - Vincenzo Berghella
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
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O'Donnell O, Gallagher C, Davey MG, Coulter J, Regan M. A systematic review and meta-analysis assessing the use of tranexamic acid ( TXA) in acute gastrointestinal bleeding. Ir J Med Sci 2024; 193:705-719. [PMID: 37794272 PMCID: PMC10961292 DOI: 10.1007/s11845-023-03517-0] [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: 05/24/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Gastrointestinal bleeding results in significant morbidity, cost and mortality. TXA, an antifibrinolytic agent, has been proposed to reduce mortality; however, many studies report conflicting results. METHODS The aim of the study was to perform the first systematic review and meta-analysis of RCTs to evaluate the efficacy TXA for both upper and lower gastrointestinal bleeding. This was performed per PRISMA guidelines. PubMed, EMBASE, Cochrane and Scopus databases were searched for RCTs. Dichotomous variables were pooled as risk ratios (RR) with 95% confidence intervals (CI) using the MH method with random effects modelling. RESULTS Fourteen RCTs were identified with 14,338 patients and mean age of 58.4 years. 34.9% (n = 5008) were female and 65.1% (n = 9330) male. There was no significant difference in mortality between TXA and placebo (RR 0.86 95% CI (0.74 to 1.00), P: 0.05). The secondary outcomes, similarly, did not yield significant results. These included rebleeding, need for surgical intervention (RR: 0.75 95% CI (0.53, 1.07)), endoscopic intervention (RR: 0.92 95% CI (0.70, 1.22)), transfusion requirement (RR: 1.01 95% CI (0.94, 10.7)) and length of stay (RR: 0.03 95% CI (- 0.03, 0.08)). There was no increased risk of VTE, RR: 1.29 95% CI (0.53, 3.16). One trial (n = 12,009) reported an increased risk of seizure in the TXA group, RR: 1.73 95% CI (1.03-2.93). CONCLUSION TXA does not reduce mortality in patients with acute upper or lower gastrointestinal bleeding and may confer an increased risk of seizures. The authors do not recommend the use of TXA in acute gastrointestinal bleeding.
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Affiliation(s)
- Oisín O'Donnell
- Department of General and Colorectal Surgery, Galway University Hospitals, Saolta University Health Care Group, Newcastle Road, Galway, H91YR71, Ireland.
- School of Postgraduate Studies, Royal College of Surgeon in Ireland, Dublin, D02YN77, Ireland.
| | - Clodagh Gallagher
- University of Limerick, Sreelane, Castletroy, Co., Limerick, V94 T9PX, Ireland
| | - Matthew G Davey
- Department of General and Colorectal Surgery, Galway University Hospitals, Saolta University Health Care Group, Newcastle Road, Galway, H91YR71, Ireland
- The National University of Ireland Galway, University Rd, Galway, H91TK33, Ireland
| | - Jonathan Coulter
- Department of General and Colorectal Surgery, Galway University Hospitals, Saolta University Health Care Group, Newcastle Road, Galway, H91YR71, Ireland
| | - Mark Regan
- Department of General and Colorectal Surgery, Galway University Hospitals, Saolta University Health Care Group, Newcastle Road, Galway, H91YR71, Ireland
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De Silva M, Mizzi G, Potts E, Webb J, Thyer E, Naidoo N. Tranexamic acid versus oxytocin for primary postpartum Haemorrhage in the out-of-hospital setting: A systematic review with implications for rural practice. Aust J Rural Health 2024; 32:227-235. [PMID: 38491718 DOI: 10.1111/ajr.13103] [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: 10/28/2023] [Revised: 02/18/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION Primary postpartum haemorrhage causes approximately 25% of global maternal deaths and accounts for significant maternal morbidity. While high certainty evidence demonstrates that tranexamic acid reduces comparative blood loss in postpartum haemorrhage in hospital settings, limited data exist on the specific pharmacological management of this condition in out-of-hospital settings, and the implications for rural communities. OBJECTIVE To determine the efficacy of oxytocin compared to tranexamic acid in women suffering postpartum haemorrhage in the out-of-hospital environment. DESIGN A systematic review comparing evidence containing patients with postpartum haemorrhage in the out-of-hospital and/or rural setting, in which oxytocin/tranexamic acid were used. Outcome measures were comparative blood loss/haemorrhagic shock, the need for further interventions and maternal/neonatal morbidity/mortality. FINDINGS No randomised control trials have been conducted in an out-of-hospital environment in relation to oxytocin/tranexamic acid. In this setting, there is no difference in outcome measures when using oxytocin compared to no intervention, or oxytocin compared to standard care. Data are lacking on the effect of tranexamic acid on the same outcome measures. DISCUSSION Rural and out-of-hospital management of postpartum haemorrhage is limited by resource availability and practitioner availability, capacity and experience. In-hospital evidence may lack transferability, therefore direct evidence on the efficacy of pharmacological management in these contexts is scant and requires redress. CONCLUSION There is no difference in blood loss, neonatal or maternal mortality or morbidity, or need for further interventions, when using oxytocin or TXA compared to no intervention, or compared to standard care, for PPH. Further studies are needed on the efficacy of these drugs, and alternate or co-drug therapies, for PPH in the out-of-hospital environment and rural clinical practice.
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Affiliation(s)
- Megan De Silva
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Gabrielle Mizzi
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Emily Potts
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Jayden Webb
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Elizabeth Thyer
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Navindhra Naidoo
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Emergency Medical Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
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Edelstein A, McDonald J, Lachance AD, Giro ME, Lee W. The efficacy and safety of tranexamic acid utilization in total ankle arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:641-649. [PMID: 38006436 DOI: 10.1007/s00402-023-05126-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/29/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION There is still a lack of information on the role of Tranexamic acid (TXA) in total ankle arthroplasty (TAA). The purpose of this study is to comprehensively review, consolidate, and analyze findings from existing research on the effectiveness and safety of TXA in TAA. MATERIALS AND METHODS The comprehensive literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, Web of Science, and Cochrane databases, for original, English-language studies investigating the efficacy and safety of TXA in TAA, through February 2023. Evaluated data for the meta-analysis included estimated blood loss (EBL), change in perioperative hemoglobin, need for transfusion, and complications including DVT/PE, and wound complications. RESULTS A total of nine studies were included in this study. In total, 450 TAA were included, with 244 receiving TXA (54.2%) and 206 not receiving TXA (45.8%). TXA in TAA significantly decreased EBL. A significantly lower rate of wound complications in the TXA group with the relative risk (RR) of 0.51. We classified wound complications into wound infection and delayed wound healing/dehiscence. A significant decrease in the rate of wound infection and a tendency showing a decrease in the rate of delayed wound healing/dehiscence in the TXA group were noted: the RR of 0.29, and 0.63, respectively. TXA did not increase the incidence of DVT/PE following TAA. CONCLUSIONS In conclusion, the utilization of TXA during TAA demonstrated a statistically significant reduction in EBL and relative risk for wound complications. However, further RCTs with larger sample sizes will be necessary to establish a more robust conclusion regarding the efficacy and safety of TXA in TAA. LEVEL OF EVIDENCE Level III, systematic review and meta-analysis.
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Affiliation(s)
- Alexander Edelstein
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Square, Sayre, PA, 18840, USA
| | - John McDonald
- Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA, 18510, USA
| | - Andrew D Lachance
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Square, Sayre, PA, 18840, USA
| | | | - Wonyong Lee
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Square, Sayre, PA, 18840, USA.
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Hossain N, Kaur V, Mahran M, Quddus A, Mukhopadhyay S, Shah A, Agrawal S. Intra-operative Tranexamic Acid Administration Significantly Decreases Incidence of Postoperative Bleeding Without Increasing Venous Thromboembolism Risk After Laparoscopic Sleeve Gastrectomy: a Retrospective Cohort Study of Over 400 Patients. Obes Surg 2024; 34:396-401. [PMID: 38168716 DOI: 10.1007/s11695-023-07021-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND There is evidence that tranexamic acid (TXA) reduces surgical bleeding and is widely used in trauma, obstetrics and other specialties. This practice is less well-established in laparoscopic sleeve gastrectomy (LSG) due to concerns surrounding venous thromboembolism (VTE); equally postoperative bleeding is a serious complication often requiring re-operation. METHODS This retrospective cohort study compared 30-day outcomes following primary LSG in patients receiving intra-operative TXA (March 2020-July 2022) to those who did not (March 2011-March 2020). The primary outcome was postoperative bleeding (Hb < 9 g/dL) requiring transfusion or re-operation. Secondary outcomes were incidence of VTE, serious postoperative complications (Clavien-Dindo > grade 3) and death. Patients underwent standardised-protocol LSG without staple line re-enforcement under a single surgeon within the independent sector (private practice). TXA 1 g intravenous was administered immediately after a methylene blue leak test, prior to extubation. RESULTS TXA group had 226 patients and non-TXA group had 192 patients. Mean age was 40.5 ± 10.3 and 39.1 ± 9.8 years, respectively. In the TXA group, no postoperative bleeds [versus 3 (1.6%) in non-TXA group, p = 0.0279] occurred. One staple line leak (0.4%) occurred in the TXA group compared to zero in the non-TXA group (p = ns). There was no VTE or death. CONCLUSIONS This is the largest cohort study of intra-operative TXA in primary LSG to date, which demonstrates significant decrease in postoperative bleeding without increasing VTE risk. The authors recommend administration of TXA immediately following leak test, or removal of bougie to maximise efficacy. Data of TXA in LSG is awaited from the randomised controlled PATAS trial.
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Affiliation(s)
- Naveed Hossain
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Vasha Kaur
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Mostafa Mahran
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Abdul Quddus
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Santanu Mukhopadhyay
- Department of Anaesthesia, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Akshat Shah
- Department of Anaesthesia, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Sanjay Agrawal
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK.
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Wadhwa H, Rohde M, Oquendo Y, Chen MJ, Tigchelaar SS, Bellino M, Bishop J, Gardner MJ. Interaction of preoperative chemoprophylaxis and tranexamic acid use does not affect transfusion in acetabular fracture surgery. Eur J Orthop Surg Traumatol 2024; 34:1025-1029. [PMID: 37865628 DOI: 10.1007/s00590-023-03763-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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE While the effects of tranexamic acid (TXA) use on transfusion rates after acetabular fracture surgery are unclear, previous evidence suggests that holding deep vein thrombosis (DVT) chemoprophylaxis may improve TXA efficacy. This study examines whether holding DVT chemoprophylaxis in patients receiving TXA affects intraoperative and postoperative transfusion rates in acetabular fracture surgery. METHODS We reviewed electronic medical records (EMR) of 305 patients who underwent open reduction and internal fixation of acetabular fractures (AO/OTA 62) and stratified patients per the following perioperative treatment: (1) no intraoperative TXA (noTXA), (2) intraoperative TXA and no preoperative DVT prophylaxis (opTXA/noDVTP), or (3) intraoperative TXA and preoperative DVT prophylaxis (opTXA/opDVTP). The primary outcomes were need for intraoperative or postoperative transfusion. Risk factors for each primary outcome were assessed using multivariable regression. RESULTS Intraoperative or postoperative transfusion rates did not significantly differ between opTXA/opDVTP and opTXA/noDVTP groups (46.2% vs. 36%, p = 0.463; 15.4% vs. 28%, p = 0.181). Median units transfused did not differ between groups (2 ± 1 vs. 2 ± 1, p = 0.515; 2 ± 1 vs. 2 ± 0, p = 0.099). There was no association between preoperative DVT chemoprophylaxis and TXA with intraoperative or postoperative transfusions. EBL, preoperative hematocrit, and IV fluids were associated with intraoperative transfusions; age and Charlson Comorbidity Index (CCI) were associated with postoperative transfusions. CONCLUSION Our findings suggest holding DVT prophylaxis did not alter the effect of TXA on blood loss or need for transfusion.
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Affiliation(s)
- Harsh Wadhwa
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Matthew Rohde
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA.
| | - Yousi Oquendo
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Michael J Chen
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Seth S Tigchelaar
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Michael Bellino
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Julius Bishop
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
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Gulickx M, Lokerman RD, Waalwijk JF, Dercksen B, van Wessem KJP, Tuinema RM, Leenen LPH, van Heijl M. Pre-hospital tranexamic acid administration in patients with a severe hemorrhage: an evaluation after the implementation of tranexamic acid administration in the Dutch pre-hospital protocol. Eur J Trauma Emerg Surg 2024; 50:139-147. [PMID: 37067552 PMCID: PMC10923991 DOI: 10.1007/s00068-023-02262-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/16/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE To evaluate the pre-hospital administration of tranexamic acid in ambulance-treated trauma patients with a severe hemorrhage after the implementation of tranexamic acid administration in the Dutch pre-hospital protocol. METHODS All patients with a severe hemorrhage who were treated and conveyed by EMS professionals between January 2015, and December 2017, to any trauma-receiving emergency department in the eight participating trauma regions in the Netherlands, were included. A severe hemorrhage was defined as extracranial injury with > 20% body volume blood loss, an extremity amputation above the wrist or ankle, or a grade ≥ 4 visceral organ injury. The main outcome was to determine the proportion of patients with a severe hemorrhage who received pre-hospital treatment with tranexamic acid. A Generalized Linear Model (GLM) was performed to investigate the relationship between pre-hospital tranexamic acid treatment and 24 h mortality. RESULTS A total of 477 patients had a severe hemorrhage, of whom 124 patients (26.0%) received tranexamic acid before arriving at the hospital. More than half (58.4%) of the untreated patients were suspected of a severe hemorrhage by EMS professionals. Patients treated with tranexamic acid had a significantly lower risk on 24 h mortality than untreated patients (OR 0.43 [95% CI 0.19-0.97]). CONCLUSION Approximately a quarter of the patients with a severe hemorrhage received tranexamic acid before arriving at the hospital, while a severe hemorrhage was suspected in more than half of the non-treated patients. Severely hemorrhaging patients treated with tranexamic acid before arrival at the hospital had a lower risk to die within 24 h after injury.
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Affiliation(s)
- Max Gulickx
- Department of Surgery, University Medical Center Utrecht, C04.332, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Robin D Lokerman
- Department of Surgery, University Medical Center Utrecht, C04.332, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Job F Waalwijk
- Department of Surgery, University Medical Center Utrecht, C04.332, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bert Dercksen
- Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Karlijn J P van Wessem
- Department of Surgery, University Medical Center Utrecht, C04.332, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rinske M Tuinema
- Regional Ambulance Facilities Utrecht, Bilthoven, The Netherlands
- Department of Emergency Medicine, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, C04.332, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Trauma Center Utrecht, Utrecht, The Netherlands
| | - Mark van Heijl
- Department of Surgery, University Medical Center Utrecht, C04.332, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Trauma Center Utrecht, Utrecht, The Netherlands
- Department of Surgery, DiakonessenhuisUtrecht/Zeist/Doorn, Utrecht, The Netherlands
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Izima C, Sampath SG, Tang AJ, Ambati VS, Chou D, Chan AK. Systematic review and meta-analysis of topical tranexamic acid in spine surgery. Neurosurg Focus 2023; 55:E18. [PMID: 37778051 DOI: 10.3171/2023.7.focus23363] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/26/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Tranexamic acid (TXA) is an antifibrinolytic drug associated with reduced blood loss in a range of surgical specialties, including neurosurgery, orthopedic surgery, and cardiac surgery. Concerns about venous thromboembolism and seizures from intravenous (IV) TXA have led to increased use of topical TXA. Given the relative scarcity of the literature on topical TXA compared with that on IV TXA within neurosurgery, the authors aimed to conduct a systematic review and meta-analysis on the safety, efficacy, and optimal administration of topical TXA in a wide range of spinal procedures and pathologies. METHODS The PRISMA guidelines, Cochrane risk of bias tool, and Newcastle-Ottawa Scale were used to extract randomized controlled trials and high-quality case-control and cross-sectional/cohort studies (adult studies only) from PubMed, Web of Science, Cochrane Library, and Embase published between 2016 and 2023. Studies were analyzed by two independent reviewers for variables including dosage, TXA administration route, type of spine procedure, blood loss, adverse events including thromboembolism and infection, postoperative hemoglobin level, and hospitalization length. Pooled analysis comparing intraoperative and postoperative blood loss, postoperative hemoglobin levels, and hospitalization length of stay on the basis of route of TXA administration was conducted. RESULTS Four cohort studies, 1 cross-sectional study, 1 case-control study, and 12 randomized controlled trials, together involving 2045 patients, were included. The most common route of topical TXA administration was via TXA in saline solution. Other routes of topical TXA included retrograde injection and TXA-soaked Gelfoam. In pooled analysis, topical TXA significantly reduced visible blood loss (standardized mean difference [SMD] -0.22, 95% CI -0.45 to -0.00001), postoperative blood loss (SMD -1.63, 95% CI -2.03 to -1.22), and length of hospital stay (SMD -1.02, 95% CI -1.42 to -0.61), as well as higher postoperative hemoglobin (SMD 0.59, 95% CI 0.34-0.83), compared with non-TXA controls. No significant differences in outcomes were found between topical and IV TXA or between combined (topical and IV) and IV TXA. Thromboembolism and infection rates did not significantly differ between any TXA administration group and non-TXA controls. CONCLUSIONS In pooled analyses, topical TXA was associated with decreased perioperative blood loss in a wide range of scenarios, including cervical spine surgery and thoracolumbar trauma, as well as in patients with a thromboembolic history.
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Affiliation(s)
- Chiemela Izima
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Shailen G Sampath
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Anthony J Tang
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Vardhaan S Ambati
- 2School of Medicine, University of California, San Francisco, California; and
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- 3The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Andrew K Chan
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- 3The Och Spine Hospital at NewYork-Presbyterian, New York, New York
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Miangul S, Oluwaremi T, El Haddad J, Adra M, Pinnawala N, Nakanishi H, Matar RH, Than CA, Stewart TM. Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2023; 33:2179-2190. [PMID: 36156738 PMCID: PMC10275812 DOI: 10.1007/s00590-022-03387-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
AIM The aim of this meta-analysis was to assess the safety and efficacy of tranexamic acid (TXA) in the management of hip fracture surgeries in comparison with placebo. METHODS A systematic search was conducted from August 6, 2021. Eligible studies included randomized clinical trials and prospective studies comparing the use of intravenous TXA in patients treated for hip fractures, in comparison with placebo. Review Manager was used for the meta-analysis. RESULTS Eighteen prospective studies including 14 RCTs met the eligibility criteria. The results favored the TXA group in the quantity of total blood loss (MD = - 196.91 mL, 95% CI - 247.59, - 146.23, I2 = 92%), intraoperative blood loss (MD = - 26.86 mL, 95% CI - 36.96, - 16.78, I2 = 62%), and rate of blood transfusion (OR 0.35, 95% CI 0.28, 0.42, I2 = 0%). TXA also exhibited higher hemoglobin level at day 1 (MD = 6.77 g/L, 95% CI 4.30, 9.24, I2 = 83%) and day 3 (MD = 7.02 g/L, 95% CI 3.30, 10.74, I2 = 82%) postoperatively. There was no significant difference found in the incidence of thromboembolic events from occurring between the two groups, such as deep vein thrombosis (OR 1.22, 95% CI 0.73, 2.02, I2 = 0%) and pulmonary embolism (OR 0.82, 95% CI 0.33, 2.05, I2 = 0%). CONCLUSION Administration of intravenous TXA appears to reduce blood loss, rate of blood transfusions and pose no increased risk of thromboembolic events. Therefore, TXA should be considered by physicians when managing hip fracture patients.
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Affiliation(s)
- Shahid Miangul
- St George's University of London, London, SW17 0RE, UK.
- University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus.
| | - Timothy Oluwaremi
- St George's University of London, London, SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Joe El Haddad
- St George's University of London, London, SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Maamoun Adra
- St George's University of London, London, SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Nathan Pinnawala
- St George's University of London, London, SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Hayato Nakanishi
- St George's University of London, London, SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Reem H Matar
- St George's University of London, London, SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Christian A Than
- St George's University of London, London, SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
- School of Biomedical Sciences, The University of Queensland, St Lucia, Brisbane, 4072, Australia
| | - Thomas M Stewart
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Brown NJ, Pennington Z, Himstead AS, Yang CY, Chakravarti S, Gendreau J, Kurtz J, Shahrestani S, Pham MH, Osorio JA. Safety and Efficacy of High-Dose Tranexamic Acid in Spine Surgery: A Retrospective Single-Institution Series. World Neurosurg 2023:S1878-8750(23)00543-0. [PMID: 37141940 DOI: 10.1016/j.wneu.2023.04.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Alexander S Himstead
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
| | - Chen Yi Yang
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
| | - Sachiv Chakravarti
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Julian Gendreau
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Joshua Kurtz
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
| | - Shane Shahrestani
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Martin H Pham
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Joseph A Osorio
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA.
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Sipos K, Kämäräinen S, Kauhanen S. Topical tranexamic acid reduces postoperative hematomas in reduction mammaplasties. J Plast Reconstr Aesthet Surg 2023; 83:172-179. [PMID: 37276736 DOI: 10.1016/j.bjps.2023.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/12/2023] [Accepted: 04/12/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Postoperative bleeding requiring reoperation is an untoward event in breast surgery. Topical tranexamic acid (TXA) has been routinely used to reduce the risk of postoperative bleeding in some surgical fields. In breast surgery, it is not routinely used owing to scarce information. We investigated whether the intraoperatively applied topical TXA reduces the incidence of postoperative hematoma in reduction mammaplasty surgeries. METHODS This retrospective, single-center cohort study comprises of 415 consecutive patients who underwent reduction mammaplasty between 2019 and 2021. The prophylactic use of topically applied TXA (20 mg/ml) was implemented as a part of the hospital protocol in November 2020. The patients who were rinsed with TXA before the wound closure were compared with those who were not rinsed. The results were analyzed using statistical tests, two-sided Pearson's Chi-Square and Fisher's exact tests. RESULTS Topical TXA significantly reduced the number of postoperative hematomas requiring evacuation (p = 0.008). In the non-TXA control group, 12 (5.8%) hematomas were observed out of 208 patients. In the topical TXA group, only one (0.6%) hematoma occurred among the 168 patients. A tendency towards fewer wound infections, seromas, and other minor wound-healing problems can also be seen in the topical TXA group (ns). No adverse events of topical TXA were detected. CONCLUSIONS The incidence of postoperative hematomas decreased to a tenth after the introduction of topical TXA in reduction mammaplasty surgeries. This simple procedure may save patients from reoperations owing to bleeding. Randomized controlled trials are warranted.
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Affiliation(s)
- Krisztina Sipos
- Department of Musculoskeletal and Plastic Surgery, University of Helsinki and Helsinki University Hospital, Jorvi, Finland.
| | - Satu Kämäräinen
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Jorvi, Finland
| | - Susanna Kauhanen
- Department of Musculoskeletal and Plastic Surgery, University of Helsinki and Helsinki University Hospital, Jorvi, Finland
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Clynch AL, Gillespie CS, Richardson GE, Mustafa MA, Islim AI, Keshwara SM, Bakhsh A, Kumar S, Zakaria R, Millward CP, Mills SJ, Brodbelt AR, Jenkinson MD. Tranexamic acid use in meningioma surgery - A systematic review and meta-analysis. J Clin Neurosci 2023; 110:53-60. [PMID: 36796271 DOI: 10.1016/j.jocn.2023.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
Tranexamic Acid (TXA) has been used in medical and surgical practice to reduce haemorrhage. The aim of this review was to evaluate the effect of TXA use on intraoperative and postoperative outcomes of meningioma surgery. A systematic review and meta-analysis was conducted in accordance with the PRISMA statement and registered in PROSPERO (CRD42021292157). Six databases were searched up to November 2021 for phase 2-4 control trials or cohort studies, in the English language, examining TXA use during meningioma surgery. Studies ran outside of dedicated neurosurgical departments or centres were excluded. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Random effects meta-analysis were performed to delineate differences in operative and postoperative outcomes. Four studies (281 patients) were included. TXA use significantly reduced intraoperative blood loss (mean difference 315.7 mls [95% confidence interval [CI] -532.8, -98.5]). Factors not affected by TXA use were transfusion requirement (odds ratio = 0.52; 95% CI 0.27, 0.98), operation time (mean difference = -0.2 h; 95% CI -0.8, 0.4), postoperative seizures (Odds Ratio [OR] = 0.88; 95% CI 0.31, 2.53), hospital stay (mean difference = -1.2; 95% CI -3.4, 0.9) and disability after surgery (OR = 0.50; 95% CI 0.23, 1.06). The key limitations of this review were the small sample size, limited data for secondary outcomes and a lack of standardised method for measuring blood loss. TXA use reduces blood loss in meningioma surgery, but not transfusion requirement or postoperative complications. Larger trials are required to investigate the impact of TXA on patient-reported postoperative outcomes.
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Affiliation(s)
- Abigail L Clynch
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK.
| | - Conor S Gillespie
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | - George E Richardson
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohammad A Mustafa
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Abdurrahman I Islim
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester, UK; Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sumirat M Keshwara
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Ali Bakhsh
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Siddhant Kumar
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rasheed Zakaria
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher P Millward
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Samantha J Mills
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Baidwan NK, Schauer SG, Dixon JM, Bhaumik S, April MD, April MD, Dengler BA, Mould-Millman NK. Tranexamic Acid Improves Survival in the Setting of Severe Head Injury in Combat Casualties. Med J (Ft Sam Houst Tex) 2023:34-40. [PMID: 36580522] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Approximately 1.7 million people sustain traumatic brain injuries (TBI) annually in the US. To reduce morbidity and mortality, management strategies aim to control progressive intracranial bleeding. This study analyzes the association between Tranexamic Acid (TXA) administration and mortality among casualties within the Department of Defense Trauma Registry, specifically focusing on subsets of patients with varying degree of head injury severities. METHODS Besides descriptive statistics, we used inverse probability weighted (for age, military service category, mechanism of injury, total units of blood units administered), and injury severity (ISS) and Abbreviated Injury Scale (AIS) head score adjusted generalized linear models to analyze the association between TXA and mortality. Specific subgroups of interest were increasing severities of head injury and further stratifying these by Glasgow Coma Score of 3-8 and severe overall bodily injuries (ISS>=15). RESULTS 25,866 patients were included in the analysis. 2,352 (9.1%) received TXA and 23,514 (90.9%) did not receive TXA. Among those with ISS>=15 (n=6,420), 21.2% received TXA. Among those with any head injury (AIS head injury severity score>=1; n=9,153), 7.2% received TXA. The median ISS scores were greater in the TXA versus no-TXA group (17 versus 6). Weighted and adjusted models showed overall, there was 25% lower mortality risk between those who received TXA at any point and those who did not (OR:0.75, 95% CI: 0.59, 0.95). Further, as the AIS severity score increased from >=1 (1.08; 0.80, 1.47) to >=5 (0.56; 0.33, 0.97), the odds of mortality decreased. CONCLUSIONS TXA may potentially be beneficial in patients with severe head injuries, especially those with severe overall injury profiles. There is a need of definitive studies to confirm this association.
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Affiliation(s)
- Navneet K Baidwan
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Steven G Schauer
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Julia M Dixon
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Smitha Bhaumik
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD; and 40th Forward Resuscitative Surgical Detachment, 627th Hospital Center, Fort Carson, CO
| | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD, and 40th Forward Resuscitation and Surgical Detachment, 627th Hospital Center, 1st Medical Brigade, Fort Carson, CO
| | - Bradley A Dengler
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, MD
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16
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Baidwan NK, Schauer SG, Dixon JM, Bhaumik S, April MD, April MD, Dengler BA, Mould-Millman NK. Tranexamic Acid Improves Survival in the Setting of Severe Head Injury in Combat Casualties. Med J (Ft Sam Houst Tex) 2023:34-40. [PMID: 36607296] [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] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Approximately 1.7 million people sustain traumatic brain injuries (TBI) annually in the US. To reduce morbidity and mortality, management strategies aim to control progressive intracranial bleeding. This study analyzes the association between Tranexamic Acid (TXA) administration and mortality among casualties within the Department of Defense Trauma Registry, specifically focusing on subsets of patients with varying degree of head injury severities. METHODS Besides descriptive statistics, we used inverse probability weighted (for age, military service category, mechanism of injury, total units of blood units administered), and injury severity (ISS) and Abbreviated Injury Scale (AIS) head score adjusted generalized linear models to analyze the association between TXA and mortality. Specific subgroups of interest were increasing severities of head injury and further stratifying these by Glasgow Coma Score of 3-8 and severe overall bodily injuries (ISS>=15). RESULTS 25,866 patients were included in the analysis. 2,352 (9.1%) received TXA and 23,514 (90.9%) did not receive TXA. Among those with ISS>=15 (n=6,420), 21.2% received TXA. Among those with any head injury (AIS head injury severity score>=1; n=9,153), 7.2% received TXA. The median ISS scores were greater in the TXA versus no-TXA group (17 versus 6). Weighted and adjusted models showed overall, there was 25% lower mortality risk between those who received TXA at any point and those who did not (OR:0.75, 95% CI: 0.59, 0.95). Further, as the AIS severity score increased from >=1 (1.08; 0.80, 1.47) to >=5 (0.56; 0.33, 0.97), the odds of mortality decreased. CONCLUSIONS TXA may potentially be beneficial in patients with severe head injuries, especially those with severe overall injury profiles. There is a need of definitive studies to confirm this association.
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Affiliation(s)
- Navneet K Baidwan
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Steven G Schauer
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Julia M Dixon
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Smitha Bhaumik
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD; and 40th Forward Resuscitative Surgical Detachment, 627th Hospital Center, Fort Carson, CO
| | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD, and 40th Forward Resuscitation and Surgical Detachment, 627th Hospital Center, 1st Medical Brigade, Fort Carson, CO
| | - Bradley A Dengler
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, MD
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Alsharif SH, Alghamdi AS, Alwayel ZA, Alaklabi SN, Alyamani NA, Sabsabee MA, Bu izran DAA, Alajlan AM. Efficacy and Best Mode of Delivery for Tranexamic Acid in Post-Inflammatory Hyperpigmentation: A Systematic Review. Clin Cosmet Investig Dermatol 2022; 15:2873-2882. [PMID: 36597522 PMCID: PMC9805721 DOI: 10.2147/ccid.s394889] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022]
Abstract
Background Post-inflammatory hyperpigmentation (PIH) is skin hyperpigmentation that occurs due to any inflammatory condition. Triggering the melanocytes by inflammation leads to melanin overproduction and deposition. Tranexamic acid (TXA) is an antifibrinolytic medication prescribed to treat bleeding. Recently, there are some studies about the use of TXA in the treatment of PIH. Objective The aim of this study is to identify the efficacy and the best mode of delivery for tranexamic acid in the treatment of PIH. Methods This systematic review is reported in accordance with PRISMA guidance. We included all relevant English-language studies that were published up to September 2022 in the following electronic databases: Cochrane Library, PubMed, Embase, and Google Scholar. The initial search yielded 61 articles, 9 of which were included after applying inclusion and exclusion criteria. Results The systematic review included a total of 196 patients who were over the age of 16 years old. Tranexamic acid was delivered orally in 4 studies, topically in 2 studies, and both simultaneously in 1 study. In addition, intradermal injection was used in 2 other studies. Almost all studies advocated the use of all routes for accelerating the clearance of hyperpigmentation with more favor towards topical and intradermal routes due to their mild reported side effects when compared to oral routes. Conclusion Intradermal TXA is considered the best route, which exhibits fewer side effects with less cost and excellent outcomes, while oral TXA is found to be less preferable than other routes due to the incidence of undesirable adverse events.
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Affiliation(s)
- Sahar Hasan Alsharif
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia,Correspondence: Sahar Hasan Alsharif, Department of Dermatology, King Saud University, P.O. Box 24353, Riyadh, 11322, Saudi Arabia, Tel +00966555539141, Email
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Ghaith HS, Gabra MD, Ebada MA, Dada OE, Al-Shami H, Bahbah EI, Swed S, Ghaith AK, Kanmounye US, Esene IN, Negida A. Tranexamic acid for patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of 2991 patients. Int J Neurosci 2022:1-14. [PMID: 36463556 DOI: 10.1080/00207454.2022.2148957] [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: 04/24/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE We aimed to synthesize evidence from published clinical trials on the efficacy and safety of tranexamic acid (TXA) administration in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS We followed the standard methods of the Cochrane Handbook of Systematic Reviews for interventions and the PRISMA statement guidelines 2020 when conducting and reporting this study. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until 1 January 2022. We selected observational studies and clinical trials comparing TXA versus no TXA in aSAH patients. Data of all outcomes were pooled as the risk ratio (RR) with the corresponding 95% confidence intervals in the meta-analysis models. RESULTS Thirteen studies with a total of 2991 patients were included in the analysis. TXA could significantly cut the risk of rebleeding (RR 0.56, 95% CI 0.44 to 0.72) and mortality from rebleeding (RR 0.60, 95% CI 0.39 to 0.92, p = 0.02). However, TXA did not significantly improve the overall mortality, neurological outcome, delayed cerebral ischemia, or hydrocephalus (all p > 0.05). In terms of safety, no significant adverse events were reported. No statistical heterogeneity or publication bias was found in all outcomes. CONCLUSION In patients with aSAH, TXA significantly reduces the incidence of rebleeding and mortality from rebleeding. However, current evidence does not support any benefits in overall mortality, neurological outcome, delayed cerebral ischemia, or hydrocephalus.
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Affiliation(s)
- Hazem S Ghaith
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Diaa Gabra
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mahmoud Ahmed Ebada
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Resident Physician, Egyptian Fellowship of Neurology, Nasr City Hospital for Health Insurance, Cairo, Egypt
| | | | - Hieder Al-Shami
- Department of Neurosurgery, National Bank Hospital, Nasr City, Egypt
| | - Eshak I Bahbah
- Faculty of Medicine, Al Azhar University, New Damietta, Egypt
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Syria
| | - Abdul Karim Ghaith
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Ahmed Negida
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, United Kingdom
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Chevala NT, Dsouza JA, Saini H, Kumar L. Design and development of tranexamic acid loaded film-forming gel to alleviate melasma. J Cosmet Dermatol 2022; 21:6863-6874. [PMID: 36181344 DOI: 10.1111/jocd.15426] [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: 09/02/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Melasma is a skin condition that causes increased epidermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymph histiocytic infiltrates. OBJECTIVE To develop the film-forming gel to alleviate melasma. Tranexamic acid was used as a model drug to evaluate the suitability of formulation to prevent symmetric hyperpigmentation. METHODS FFG is a hydrophilic polymeric cross-linked system loaded with an active moiety. Nine different formulations of 2% TXA were formulated using polyvinyl alcohol and hydroxypropyl methylcellulose 50 cP as film-forming polymers. Sodium carboxymethylcellulose, methylcellulose, and carbopol were used as gelling agents. RESULTS F7, F8, and F9 showed shorter DT, that is, 11, 8, and 12 min, respectively. The folding endurance of F7, F8, and F9 was >100 folds, and the pH of F7, F8, and F9 was >6. Among three formulations, F8 was further analyzed for in vitro drug diffusion, which showed >95% drug diffusion within 48 h. In vivo, the skin irritation potential of F8 was estimated using BAL/C mice, which confirmed the absence of skin irritation. CONCLUSION From the obtained results, we conclude that the FFG can be a strategic attempt to deliver the cosmeceutical drugs like TXA to alleviate Melasma with improved sustainability of the drug.
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Affiliation(s)
- Naga Thirumalesh Chevala
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Udupi, India
| | - Jenica Alwin Dsouza
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Udupi, India
| | - Hitesh Saini
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Udupi, India
| | - Lalit Kumar
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Udupi, India.,Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
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Clohisy JCF, Lenke LG, Dafrawy MHE, Wolfe RC, Frazier E, Kelly MP. Randomized, controlled trial of two tranexamic acid dosing protocols in adult spinal deformity surgery. Spine Deform 2022; 10:1399-1406. [PMID: 35751772 DOI: 10.1007/s43390-022-00539-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/28/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tranexamic acid (TXA) is an anti-fibrinolytic effective in reducing blood loss in orthopedic surgery. The appropriate dosing protocol for adult spinal deformity (ASD) surgery is not known. The purpose of this study was to evaluate two TXA protocols [low dose (L): 10 mg/kg bolus, 1 mg/kg/hr infusion; high dose (H): 50 mg/kg, 5 mg/kg/hr] in complex ASD surgery. METHODS Inclusion criteria were ASD reconstructions with minimum 10 fusion levels or planned 3-column osteotomy (3CO). Standard demographic and surgical data were collected. Intraoperative estimated blood loss (EBL) was calculated by suction canisters minus irrigation plus estimated blood lost in sponges, estimated to the nearest 50 mL. Serious adverse events (SAE) were defined a priori as: venothromboembolic event (VTE), cardiac arrhythmia, myocardial infarction, renal dysfunction, and seizure. All SAE were recorded. Simple t tests compared EBL between groups. Mean EBL by total blood volume (TBV), transfusion volume, complications related to TXA were secondary outcomes. RESULTS Sixty-two patients were enrolled and 52 patients completed the study; 25 were randomized to H and 27 to L. Demographic and surgical variables were not different between the two groups. EBL was not different between groups (H: 1596 ± 933 cc, L: 2046 ± 1105 cc, p = 0.12, 95% CI: - 1022 to 122 cc). EBL as a percentage of TBV was lower for the high-dose group (H: 29.5 ± 14.8%, L: 42.5 ± 26.2%, p = 0.03). Intraoperative transfusion volume (H: 961 ± 505 cc, L: 1105 ± 808 cc, p = 0.5) and post-operative transfusion volume (H: 513 ± 305 cc, L: 524 ± 245 cc, p = 0.9) were not different. SAE related to TXA were not different (p = 0.7) and occurred in 2 (8%) H and 3 (11%) L. There was one seizure (H), 2 VTE, and 2 arrhythmias. CONCLUSION No differences in EBL, transfusion volume, nor SAE were observed between H and L dose TXA protocols. High dose was associated with decreased TBV loss (13%). Further prospective study, with pharmacologic analysis, is required to determine appropriate TXA dosage in ASD surgeries. LEVEL OF EVIDENCE Therapeutic Level II. TRIAL REGISTRATION The study was registered at Clinicaltrials.gov (NCT02053363) February 3, 2014.
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Affiliation(s)
- John C F Clohisy
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | | | - Rachel C Wolfe
- Perioperative Services and Surgical Critical Care, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Elfaridah Frazier
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael P Kelly
- Rady Children's Hospital, University of California, 3020 Children's Way, San Diego, CA, 92123, USA.
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21
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Salameh M, Attia AK, El Khatib S, Hantouly A, Hsu R, Blankenhorn B. Tranexamic Acid Utilization in Foot and Ankle Surgery: A Meta-analysis. Foot Ankle Int 2022; 43:1370-1378. [PMID: 35979939 DOI: 10.1177/10711007221114139] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) has been widely used in various orthopaedic subspecialities to decrease blood loss, transfusions, and wound complications. However, the role of TXA in foot and ankle surgery is not clearly delineated. This meta-analysis aims to report the efficacy and safety of TXA in relation to foot and ankle surgical procedures. METHODS Database searches were conducted for eligible studies from data inception through January 2022. Clinical studies on the use of TXA in foot and ankle procedures reporting the desired outcomes were included. Outcomes were estimated blood loss, change in hemoglobin, and overall complications. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale and the Joanna Briggs Institute (JBI) critical appraisal tool. RESULTS Nine studies met the inclusion criteria. A total of 752 foot and ankle procedures were included, in which 511 (67.95%) procedures received TXA whereas 241 (32.05%) served as controls and did not receive TXA. The pooled data of change in hemoglobin and overall complications showed no difference between the TXA and control group. Estimated blood loss was significantly lower in the patients who received TXA. CONCLUSION In conclusion, TXA use was associated with lower estimated blood loss in foot and ankle surgeries without increased risk of thromboembolic events, wound complications, or changes in hemoglobin. LEVEL OF EVIDENCE Level IV, meta-analysis.
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Affiliation(s)
- Motasem Salameh
- Department of Orthopedic Surgery, the Warren Alpert Medical School at Brown University, Providence, RI, USA
| | | | | | - Ashraf Hantouly
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Raymond Hsu
- Department of Orthopedic Surgery, the Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Brad Blankenhorn
- Department of Orthopedic Surgery, the Warren Alpert Medical School at Brown University, Providence, RI, USA
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22
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Petersen W, Bentzin M, Bierke S, Park HU, Häner M. Use of tranexamic acid in medial open wedge high tibial osteotomy. Arch Orthop Trauma Surg 2022; 142:2287-2293. [PMID: 34698931 DOI: 10.1007/s00402-021-04219-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Aim of this study was to evaluate the effect of tranexamic acid (TXA) on the outcome after medial open wedge osteotomy. MATERIAL AND METHODS A prospective non-randomized comparative study with 52 patients has been performed. In both treatment groups, the same surgical technique for the medial open wedge HTO was used. In group 1 (N: 26) the patients received 1 g TXA i.v. preoperatively, in group 2 (N: 26) no TXA was given. Primary outcome measure was the decrease in hemoglobin concentration. Secondary outcome criteria were postoperative pain, intraarticular effusion (measured by ultrasound), range of motion (ROM) at discharge, peri- and postoperative complications and the KOOS PS (pre- and postoperatively at 1 year follow up). RESULTS Hemoglobin decrease was significantly less in the TXA group compared to the non TXA group. Postoperative pain and intraarticular effusion was also significantly lower and ROM at discharge was higher in the TXA group. There was no group difference in peri- and postoperative complications and the pre- and postoperatively KOOS PS. CONCLUSIONS The results of the present study show the systemic application of 1 g TXA reduces hemoglobin drop and postoperative morbidity (pain, intraarticular effusion, and ROM) after tibial open wedge HTO.
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Affiliation(s)
- Wolf Petersen
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, Grunewald, 14193, Berlin, Germany.
| | - Mats Bentzin
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, Grunewald, 14193, Berlin, Germany
| | - Sebastian Bierke
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, Grunewald, 14193, Berlin, Germany
| | - Hi Un Park
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, Grunewald, 14193, Berlin, Germany
| | - Martin Häner
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, Grunewald, 14193, Berlin, Germany
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Lech P, Michalik M, Waczyński K, Osowiecka K, Dowgiałło-Gornowicz N. Effectiveness of prophylactic doses of tranexamic acid in reducing hemorrhagic events in sleeve gastrectomy. Langenbecks Arch Surg 2022; 407:2733-2737. [PMID: 35920900 DOI: 10.1007/s00423-022-02630-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/04/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) is currently the most common bariatric surgery in the world. Although it appears to be a safe treatment for obesity, it is still at risk of complications. The latest literature shows that postoperative bleeding occurs in 2-4% of cases, and up to 3% of cases requires reoperation for hemostasis. The aim of the study is to assess the effect of tranexamic acid (TXA) on hemorrhagic events and the reoperation rate in patients undergoing LSG. METHODS The study was designed as a retrospective analysis of patients undergoing LSG. We investigate the patients 6 months before and 6 months after introducing the prophylaxis doses of TXA into our bariatric protocol (non-TXA group vs TXA group). RESULTS Three hundred fourteen patients underwent LSG in a high-volume center from 2016 to 2017. After introducing TXA, a statistically significant reduction in the incidence of hemorrhage during surgery was observed (22.3% vs 10.8%, p = 0.006). There was a statistically significant reduction in the need for the staple line oversewing (10.2% vs 1.9%, p = 0.002). The mean operating time and the mean length of hospital stay were significantly higher in the non-TXA group than TXA group (63.1 vs 53.7 min, p < 000.1; 2.3 vs 2.1, p = 0.02). In both groups of patients, no venous thromboembolism or other complications occurred within 6 months after the surgery. CONCLUSIONS The prophylactic doses of TXA may be useful in reducing the hemorrhagic events during LSG. It may also shorten the length of hospital stay and the operating time.
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Affiliation(s)
- Paweł Lech
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Niepodległości 44 St, 10-045, Olsztyn, Poland
| | - Maciej Michalik
- Department of General, Colorectal and Oncologic Surgery, Collegium Medicum, Nicolaus Copernicus University in Torun, Ujejskiego 75 St, 85-168, Bydgoszcz, Poland
| | - Kamil Waczyński
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Niepodległości 44 St, 10-045, Olsztyn, Poland
| | - Karolina Osowiecka
- Department of Psychology and Sociology of Health and Public Health, School of Public Health, University of Warmia and Mazury, Warszawska 30 St, 10-041, Olsztyn, Poland
| | - Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Niepodległości 44 St, 10-045, Olsztyn, Poland.
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Baucom MR, Wallen TE, Singer KE, Youngs J, Schuster RM, Blakeman TC, McGuire JL, Strilka R, Goodman MD. Postinjury Treatment to Mitigate the Effects of Aeromedical Evacuation After TBI in a Porcine Model. J Surg Res 2022; 279:352-360. [PMID: 35810552 DOI: 10.1016/j.jss.2022.05.019] [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: 12/29/2021] [Revised: 04/14/2022] [Accepted: 05/21/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Early aeromedical evacuation after traumatic brain injury (TBI) has been associated with worse neurologic outcomes in murine studies and military populations. The goal of this study was to determine if commonly utilized medications, including allopurinol, propranolol, or tranexamic acid (TXA), could mitigate the secondary traumatic brain injury experienced during the hypobaric and hypoxic environment of aeromedical evacuation. METHODS Porcine TBI was induced via controlled cortical injury. Twenty nonsurvival pigs were separated into four groups (n = 5 each): TBI+25 mL normal saline (NS), TBI+4 mg propranolol, TBI+100 mg allopurinol, and TBI+1g TXA. The pigs then underwent simulated AE to an altitude of 8000 ft for 4 h with an SpO2 of 82-85% and were sacrificed 4 h later. Hemodynamics, serum cytokines, and hippocampal p-tau accumulation were assessed. An additional survival cohort was partially completed with TBI/NS (n = 5), TBI/propranolol (n = 2) and TBI/allopurinol groups (n = 2) survived to postinjury day 7. RESULTS There were no significant differences in hemodynamics, tissue oxygenation, cerebral blood flow, or physiologic markers between treatment groups and saline controls. Transient differences in IL-1b and IL-6 were noted but did not persist. Neurological Severity Score (NSS) was significantly lower in the TBI + allopurinol group on POD one compared to NS and propranolol groups. P-tau accumulation was decreased in the nonsurvival animals treated with allopurinol and TXA compared to the TBI/NS group. CONCLUSIONS Allopurinol, propranolol, and TXA, following TBI, do not induce adverse changes in systemic or cerebral hemodynamics during or after a simulated postinjury flight. While transient changes were noted in systemic cytokines and p-tau accumulation, further investigation will be needed to determine any persistent neurological effects of injury, flight, and pharmacologic treatment.
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Affiliation(s)
- Matthew R Baucom
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Taylor E Wallen
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | - Jackie Youngs
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Richard Strilka
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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25
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Mackenzie SP, Spasojevic M, Smith M, Mattern O, Piggott RP, Patel SS, Bedaiwy N, Cass B, Young A. The effect of single-dose, preoperative intravenous tranexamic acid on early postoperative pain scores after rotator cuff repair: a double-blind, randomized controlled trial. J Shoulder Elbow Surg 2022; 31:1399-1408. [PMID: 35346849 DOI: 10.1016/j.jse.2022.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/30/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is commonly used in upper and lower limb arthroplasty to limit blood loss and postoperative hematoma formation. The role of TXA in rotator cuff repair (RCR) surgery is less defined. This trial assessed the effect of preoperative TXA on early postoperative pain scores. METHODS A randomized double-blind trail was conducted in 89 patients undergoing RCR. Patients were randomized to either 2 g of intravenous TXA or placebo at induction. The primary outcome was visual analog scale (VAS)-pain score at day 3 postoperation, with secondary outcomes including VAS-pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Constant scores at 2, 8, 24, and 52 weeks. RESULTS There was no significant difference in VAS-pain scores between groups at day 3 postoperation. Pain scores were significantly better in the TXA group at 8 weeks. There was no difference between groups at any time point in the ASES or Constant score. The TXA group had improved motion at 6 months with a reduced rate of secondary adhesive capsulitis. CONCLUSION TXA did not improve postoperative pain scores after RCR, however, patients who received the intervention demonstrated greater range of motion at 6 months with lower rates of secondary adhesive capsulitis.
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Affiliation(s)
| | - Miloš Spasojevic
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia.
| | - Margaret Smith
- Institute of Bone and Joint Research (University of Sydney) at Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Owen Mattern
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia
| | | | - Shaan S Patel
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia
| | - Najla Bedaiwy
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia
| | - Benjamin Cass
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia
| | - Allan Young
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia
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Gibson BHY, Duvernay MT, McKeithan LJ, Benvenuti TA, Warhoover TA, Martus JE, Mencio GA, Emerson BR, Moore-Lotridge SN, Borst AJ, Schoenecker JG. Variable Response to Antifibrinolytics Correlates with Blood-loss and Transfusion in Posterior Spinal Fusion. Spine Deform 2022; 10:841-851. [PMID: 35247191 PMCID: PMC9891390 DOI: 10.1007/s43390-022-00489-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 02/19/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Posterior spinal fusion (PSF) activates the fibrinolytic protease plasmin, which is implicated in blood loss and transfusion. While antifibrinolytic drugs have improved blood loss and reduced transfusion, variable blood loss has been observed in similar PSF procedures treated with the same dose of antifibrinolytics. However, both the cause of this and the appropriate measures to determine antifibrinolytic efficacy during high-blood-loss spine surgery are unknown, making clinical trials to optimize antifibrinolytic dosing in PSF difficult. We hypothesized that patients undergoing PSF respond differently to antifibrinolytic dosing, resulting in variable blood loss, and that specific diagnostic markers of plasmin activity will accurately measure the efficacy of antifibrinolytics in PSF. METHODS A prospective study of 17 patients undergoing elective PSF with the same dosing regimen of TXA was conducted. Surgery-induced plasmin activity was exhaustively analyzed in perioperative blood samples and correlated to measures of inflammation, bleeding, and transfusion. RESULTS While markers of in vivo plasmin activation (PAP and D-dimer) suggested significant breakthrough plasmin activation and fibrinolysis (P < 0.01), in vitro plasmin assays, including TEG, did not detect plasmin activation. In vivo measures of breakthrough plasmin activation correlated with blood loss (R2 = 0.400, 0.264; P < 0.01), transfusions (R2 = 0.388; P < 0.01), and complement activation (R2 = 0.346, P < 0.05). CONCLUSIONS Despite all patients receiving a high dose of TXA, its efficacy among patients was variable, indicated by notable intra-operative plasmin activity. Markers of in vivo plasmin activation best correlated with clinical outcomes. These findings suggest that the efficacy of antifibrinolytic therapy to inhibit plasmin in PSF surgery should be determined by markers of in vivo plasmin activation in future studies. LEVEL OF EVIDENCE Level II-diagnostic.
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Affiliation(s)
| | - Matthew T Duvernay
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Teresa A Benvenuti
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tracy A Warhoover
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey E Martus
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, 1155 MRBIV, 2215B Garland Ave, Nashville, TN, 37232, USA
| | - Gregory A Mencio
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, 1155 MRBIV, 2215B Garland Ave, Nashville, TN, 37232, USA
| | - Brian R Emerson
- Department of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephanie N Moore-Lotridge
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandra J Borst
- Department of Pediatrics, Vanderbilt University Medical Center, 1155 MRBIV, 2215B Garland Ave, Nashville, TN, 37232, USA
- Department of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan G Schoenecker
- Department of Pharmacology, Vanderbilt University, Nashville, TN, USA.
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Pediatrics, Vanderbilt University Medical Center, 1155 MRBIV, 2215B Garland Ave, Nashville, TN, 37232, USA.
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Torres E, Johnson MY, Seebald K, Kachhi P. Is Tranexamic Acid ( TXA) Effective Compared with Anterior Nasal Packing (ANP) in Achieving Cessation of Bleeding in Patients with Anterior Epistaxis? J Emerg Med 2022; 62:820-825. [PMID: 35545485 DOI: 10.1016/j.jemermed.2022.01.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/29/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Erick Torres
- UHS SoCal Medical Education Consortium, Temecula, California
| | | | | | - Pranav Kachhi
- UHS SoCal Medical Education Consortium, Temecula, California
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Fan D, Ma J, Liu X, Zhang L. Peri-articular administration of tranexamic acid is an alternative route in total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:211. [PMID: 35392961 PMCID: PMC8991716 DOI: 10.1186/s13018-022-03095-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background As an antifibrinolytic agent, tranexamic acid (TXA) is increasingly used in total knee arthroplasty (TKA) to reduce blood loss. The administration of intravenous and intra-articular TXA has been well explored, but the most efficient way to administer TXA remains in question. Peri-articular injection (PAI) of TXA is a recently mentioned method. A meta-analysis of the efficacy of PAI TXA in patients after TKA should be performed.
Methods A systematic search was performed within PubMed, Embase, and the Cochrane Library up to November 8, 2021. Two authors independently screened studies for eligibility and extracted data for analysis. The primary outcome was haemoglobin change. The secondary outcomes were haematocrit change, total drainage volume, thromboembolic events, and blood transfusion. Results A total of ten studies were included in this meta-analysis. The results indicated that there was a significant decrease in haemoglobin change when using PAI TXA compared with no TXA (mean difference − 1.05; 95% CI − 1.28 to − 0.81; P < 0.00001; I2 = 0%), but it had no significant differences compared with IA and IV (mean difference − 0.01; 95% CI − 0.17 to − 0.14; P = 0.85; I2 = 39%). There were no significant differences between the TXA < 1.5 g subgroup (0.10, 95% CI − 0.27 to 0.46; P = 0.60; I2 = 0%) and the TXA ≥ 1.5 g subgroup (0.18, 95% CI − 0.12 to 0.48; P = 0.24; I2 = 74%). In addition, the combined group (PAI plus IV or IA) was superior to the IV or IA group in terms of haemoglobin change (mean difference − 0.51; 95% CI − 0.76 to − 0.27; P < 0.0001; I2 = 19%). Regarding haematocrit change, the pooled result showed it was significantly less in the PAI group than the non-TXA group. Similarly, comparing it against the IV subgroup, the result revealed a difference in favour of the PAI group, with a mean difference of − 1.89 g/dL (95% CI − 2.82 to − 0.95; P < 0.0001; I2 = 67%). For total drainage volume, the pooled result was in favour of PAI TXA over no TXA (297 ml, 95% CI − 497.26 to − 97.23; P = 0.004; I2 = 87%), but it had no significant difference compared with IA and IV (mean difference − 37.98; 95% CI − 115.68 to 39.71; P = 0.34; I2 = 95%). There was no significant difference in thromboembolic events (OR 0.74; 95% CI 0.25 to 2.21; P = 0.59; I2 = 0%). Blood transfusion was not significantly different between the PAI group and the non-TXA group (OR 0.50; 95% CI 0.23 to 1.06; P = 0.07; I2 = 21%), and there was no significant difference between PAI and the other two TXA injection methods (OR 0.72; 95% CI 0.41 to 1.25; P = 0.24; I2 = 19%). Conclusion PAI has comparable effects to IV and IA injections. PAI is an alternative injection route of TXA for patients who have undergone TKA.
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Affiliation(s)
- DingYuan Fan
- Department of Joint Surgery and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No. 6, South Zhonghuan Road, Chaoyang district, Beijing, 100102, People's Republic of China.,Beijing University of Chinese Medicine (BUCM), Beijing, People's Republic of China
| | - Jia Ma
- Department of Joint Surgery and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No. 6, South Zhonghuan Road, Chaoyang district, Beijing, 100102, People's Republic of China
| | - XiaoHua Liu
- Department of Joint Surgery and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No. 6, South Zhonghuan Road, Chaoyang district, Beijing, 100102, People's Republic of China
| | - Lei Zhang
- Department of Joint Surgery and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No. 6, South Zhonghuan Road, Chaoyang district, Beijing, 100102, People's Republic of China.
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Tarazi JM, Zois TP, Bohm A, Mont MA, Scuderi GR. Elevated Pre-operative D-Dimer Levels Do Not Impact the Effect of Tranexamic Acid on Revision Total Knee Arthroplasty. Orthop Clin North Am 2022; 53:139-143. [PMID: 35365258 DOI: 10.1016/j.ocl.2021.12.001] [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] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to determine if elevated pre-operative D-dimer levels in patients undergoing revision total knee arthroplasty (rTKA) pose an increased risk of: (1) post-operative venous thromboemboli (VTE); (2) intra-operative blood loss; and (3) need for transfusion of blood products. Eighty-nine patients who underwent rTKA by a single surgeon between January 1, 2017, and December 31, 2019, met the inclusion criteria. Elevated pre-operative D-dimer levels did not pose an increased risk of VTE, blood loss, or transfusion of blood products, demonstrating that elevated pre-operative D-dimer is not a contraindication to the use of tranexamic acid for rTKA.
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Affiliation(s)
- John M Tarazi
- Department of Orthopaedics, Northwell Health-Huntington Hospital, 270 Park Avenue, Huntington, NY, 11743, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA
| | - Theofanis P Zois
- Department of Orthopaedics, Northwell Health-Lenox Hill Hospital, 130 East 77th Street, 11th Floor, Black Hall, New York, NY, 10075, USA
| | - Andrew Bohm
- Department of Orthopaedics, Northwell Health-Lenox Hill Hospital, 130 East 77th Street, 11th Floor, Black Hall, New York, NY, 10075, USA
| | - Michael A Mont
- Department of Orthopaedics, Northwell Health-Lenox Hill Hospital, 130 East 77th Street, 11th Floor, Black Hall, New York, NY, 10075, USA; Rubin Institute of Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
| | - Giles R Scuderi
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA; Department of Orthopaedics, Northwell Health-Lenox Hill Hospital, 130 East 77th Street, 11th Floor, Black Hall, New York, NY, 10075, USA
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Long B, Gottlieb M. Tranexamic acid for aneurysmal subarachnoid hemorrhage. Acad Emerg Med 2022; 29:798-800. [PMID: 35266599 DOI: 10.1111/acem.14482] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Brit Long
- Department of Emergency Medicine Brooke Army Medical Center Fort Sam Houston Texas USA
| | - Michael Gottlieb
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
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Electricwala AJ, Dasgupta R, Kulkarni S, Electricwala JT. A Comparison of Oral vs Intravenous Tranexamic Acid in Patients Undergoing Staggered Bilateral Total Knee Arthroplasty. Arch Bone Jt Surg 2022; 10:261-266. [PMID: 35514760 PMCID: PMC9034799 DOI: 10.22038/abjs.2021.49561.2459] [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] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/03/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND All previous studies comparing the blood sparing efficacy oral and intravenous tranexamic acid (TXA) in total knee arthroplasty have involved two or more patient cohorts, outcomes of which may be limited by inter-individual variability in human drug response. The purpose of this study was to evaluate if both oral and intravenous preparations of TXA are equivalent at reducing blood loss in the same patients undergoing staggered bilateral total knee arthroplasty. METHODS 40 patients undergoing staggered bilateral total knee replacement were recruited. They received 2 g of oral TXA 2 hours preoperatively for the first knee and 1 g of bolus intravenous TXA 15 minutes before skin incision for the second knee. 7 patients were excluded for protocol deviation, leaving 33 participants for the study. The second knee was operated within 5-6 days of the first knee. The primary outcome was reduction in hemoglobin. Equivalence was tested with a two one-sided test (TOST) and a P < 0.05 indicated equivalence between oral and intravenous modes of TXA administration. RESULTS The mean reduction in hemoglobin was similar between oral and intravenous mode of TXA administration (2.18 and 2.16 g/dl respectively, P<0.0001, equivalence). There was no significant difference in the total hemoglobin loss and total red blood cell volume loss {(104 and 102 g, P=0.86) and (865 and 863 ml, P=0.53) respectively}. CONCLUSION Oral and intra venous TXA have equal blood sparing properties in patients undergoing staggered bilateral total knee arthroplasty.
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Affiliation(s)
| | - Rumi Dasgupta
- Essence Medical Centre, Westwinds, Westwinds Dr. NE, Calgary, Alberta, Canada
| | - Sameer Kulkarni
- Electricwala Hospital, Pleasant Park D Building, Pune, Maharashtra, India
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Huynh PAN, Miller M, Will R. Intravenous Tranexamic Acid Decreases Blood Transfusions and Blood Loss for Patients with Surgically Treated Hip Fractures. Geriatr Orthop Surg Rehabil 2022; 12:21514593211063668. [PMID: 34992894 PMCID: PMC8725030 DOI: 10.1177/21514593211063668] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Tranexamic acid can decrease blood loss related to surgery and trauma. The primary objective of this study is to examine if the use of a single dose of peri-operative TXA significantly decreases the rate of allogenic blood transfusions in the setting of operative care of hip fractures. Secondary objectives included examining if total blood loss was decreased by TXA in operative hip fractures as well as examining the safety of TXA by measuring the rates venous thromboembolism (VTE). Methods Retrospective chart review of 505 patients who were operatively treated for hip fractures at a single facility was performed. In a non-randomized fashion, 307 patients received TXA and 198 patients did not. Patients received 1 gram of TXA prior to incision. Blood transfusion was the primary end point. Blood loss was calculated using the hemoglobin balance method. Chart was reviewed for VTE events during hospitalization. Results 505 patients were analyzed. The use of single perioperative dose of TXA in the surgical management of hip fracture resulted in absolute risk reduction of transfusion of 7.7% and relative risk reduction of transfusion by 29%. This was statistically significant with P =.04. Patients who received TXA on average lost 235 ml less blood compared to those who did not receive TXA (P <.0001). No increase in VTE events were found in either group during hospitalization. Conclusion This study supports the use of TXA is decrease blood loss and transfusion rates in patients with hip fractures. TXA can be used routinely to decrease complications in this usually fragile population.
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Affiliation(s)
| | - Megan Miller
- Department of Pharmacy, Providence St Peter Hospital, Olympia, WA, USA
| | - Ryan Will
- Olympia Orthopaedic Associates, Olympia, WA, USA
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Chen Y, Tian J, Chi B, Zhang S, Wei L, Wang S. Factors Associated with the Development of Coagulopathy after Open Traumatic Brain Injury. J Clin Med 2021; 11:jcm11010185. [PMID: 35011926 PMCID: PMC8745860 DOI: 10.3390/jcm11010185] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The incidence of coagulopathy after open traumatic brain injury (TBI) is high. Coagulopathy can aggravate intracranial hemorrhage and further increase morbidity and mortality. The purpose of this study was to determine the clinical characteristics of coagulopathy after open TBI and its relationship with the prognosis. Methods: This study retrospectively evaluated patients with isolated open TBI from December 2018 to December 2020. Coagulopathy was defined as international normalized ratio (INR) > 1.2, activated thromboplastin time (APTT) > 35 s, or platelet count <100,000/μL. We compared the relationship between the clinical, radiological, and laboratory parameters of patients with and without coagulopathy, and the outcome at discharge. Logistic regression analysis was used to evaluate the risk factors associated with coagulopathy. We then compared the effects of treatment with and without TXA in open TBI patients with coagulopathy. Results: A total of 132 patients were included in the study; 46 patients developed coagulopathy. Patients with coagulopathy had significantly lower platelet levels (170.5 × 109/L vs. 216.5 × 109/L, p < 0.001), and significantly higher INR (1.14 vs. 1.02, p < 0.001) and APTT (30.5 s vs. 24.5 s, p < 0.001) compared to those with no coagulopathy. A Low Glasgow Coma Scale (GCS) score, high neutrophil/lymphocyte ratio (NLR), low platelet/lymphocyte ratio (PLR), and hyperglycemia at admission were significantly associated with the occurrence of coagulopathy. Conclusions: Coagulopathy often occurs after open TBI. Patients with a low GCS score, high NLR, low PLR, and hyperglycemia at admission are at greater risk of coagulopathy, and therefore of poor prognosis. The efficacy of TXA in open TBI patients with coagulopathy is unclear. In addition, these findings demonstrate that PLR may be a novel indicator for predicting coagulopathy.
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Pecold J, Al-Jeabory M, Krupowies M, Manka E, Smereka A, Ladny JR, Szarpak L. Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. J Clin Med 2021; 11:48. [PMID: 35011788 PMCID: PMC8745038 DOI: 10.3390/jcm11010048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= -0.15; 95%CI: -0.23 to -0.07; p < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= -0.51; 95%CI: -0.57 to -0.44; p < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= -1.43; 95%CI: -2.27 to -0.59; p < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change.
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Affiliation(s)
- Jaroslaw Pecold
- Department of Trauma and Orthopedic Surgery, Ruda Slaska City Hospital, 41-703 Ruda Slaska, Poland; (J.P.); (M.A.-J.)
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland; (M.K.); (J.R.L.)
| | - Mahdi Al-Jeabory
- Department of Trauma and Orthopedic Surgery, Ruda Slaska City Hospital, 41-703 Ruda Slaska, Poland; (J.P.); (M.A.-J.)
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland; (M.K.); (J.R.L.)
| | - Maciej Krupowies
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland; (M.K.); (J.R.L.)
| | - Ewa Manka
- Department of Internal Medicine, Angiology and Physical Medicine in Bytom, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland;
| | - Adam Smereka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Wroclaw Medical University, 53-126 Wroclaw, Poland;
| | - Jerzy Robert Ladny
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland; (M.K.); (J.R.L.)
- Department of Emergency Medicine, Bialystok Medical University, 15-026 Bialystok, Poland
| | - Lukasz Szarpak
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland; (M.K.); (J.R.L.)
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
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MacDonald M, Ilie G, Power L, Whalen S, Parker R, Skinner TAA, Powers AGL. Effect of Tranexamic Acid on Bleeding Outcomes After Percutaneous Nephrolithotomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Endourol 2021; 36:589-597. [PMID: 34861768 DOI: 10.1089/end.2021.0762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/12/2022] Open
Abstract
Purpose: We performed a systematic review and meta-analysis of the literature to evaluate the efficacy of the routine use of tranexamic acid (TXA) during percutaneous nephrolithotomy (PCNL). Methods: This systematic review was conducted following the updated reporting guidelines from PRISMA 2020. Results: In total, 275 titles and abstracts were reviewed, of which 20 were screened to be eligible for full text review. Of these 20 articles, 11 were selected for inclusion after full article evaluations. Seven of these 11 studies were seen as having a low risk of bias with a Jadad score of ≥3. These studies were included for data extraction. Once data were extracted, 964 patients were included. The primary outcome, blood transfusion rate, showed significant reduction with a ratio for transfusion rate of 0.34 [95% confidence interval (CI) (0.19 to 0.61), z = 3.61, p = 0.0003]. Mean hemoglobin (Hgb) drop and operative time were both shown to be reduced with the use of TXA. The mean difference for Hgb drop was -0.86 [95% CI (-1.26 to -0.46), z = 4.23, p < 0.0001]. Reduction in operative time showed a mean difference of -8.45 minutes [95% CI (-15.04 to -1.86), z = 2.51, p = 0.01]. Stone clearance was not shown to differ significantly between experimental and control groups, with a risk ratio of 1.28 [95% CI (0.89 to 1.84), z = 1.31, p = 0.19]. Conclusions: This meta-analysis revealed that the routine use of TXA at time of PCNL reduces the rates of blood transfusion, mean Hgb drop, and operative time. With the low cost of TXA and strong safety profile, stronger consideration should be given to the routine use of TXA during PCNL by endoscopic surgeons.
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Affiliation(s)
| | - Gabriella Ilie
- Department of Urology, Dalhousie University, Halifax, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.,Department of Radiation Oncology, and Dalhousie University, Halifax, Canada.,Department of Psychology, Dalhousie University, Halifax, Canada
| | - Liam Power
- Dalhousie University, Faculty of Medicine, Halifax, Canada
| | - Stewart Whalen
- Department of Urology, Dalhousie University, Halifax, Canada
| | - Robin Parker
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.,Dalhousie University Libraries, Halifax, Canada
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Yan L, Yang H, Jiang H, Yu M, Tan J, Su T, Xu G. Impact of the Tranexamic Acid on Bleeding Amount of Surgical Patient With Degenerative Spinal Disease: A Randomized Blinded Study. Front Surg 2021; 8:655692. [PMID: 34778351 PMCID: PMC8589467 DOI: 10.3389/fsurg.2021.655692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: This study aims to explore the effectiveness and safety of tranexamic acid (TXA) in reducing the bleeding amount of surgical patients with degenerative spinal disease in the perioperative period. Methods: A total of 80 cases of patients, who underwent elective posterior lumbar interbody fusion surgeries under general anesthesia, were enrolled in this study. The age of these patients ranged within 41–69 years old, and the surgical vertebral body segments were ≥2. The ASA classification was Level I or Level II. These patients were divided into two groups using the random number table (n = 40): TXA group and control group (S group). In the TXA group, the skin was incised after the anesthesia induction, and 20 mg/kg of TXA was immediately injected into the vein. The injection continued at a rate of 10 mg·kg−1·h−1 during the surgery, until the surgery was finished. In the S group, IV and pump injection with an equal amount of normal saline (NS) were performed. Then, the RBC, Hb, HCT, AST, ALT, BUN, Cr, PT, TT, APTT, FIB, and D-dimer were measured before the surgery and at 1 day after the surgery, and the SSFQ, intraoperative bleeding amount, homologous transfusion volume, urine volume, infusion quantity, surgical duration, drainage volume at 24 h after the surgery, total bleeding amount and adverse event occurrence at 1 week after the surgery were recorded. Results: The RBC, Hb and HCT at 1 day after the surgery were higher in TXA group than in the S group (average P < 0.05). Intraoperative bleeding, drainage volume at 24 h after surgery, and total blood loss were lower in the TXA group than in the S group (average P < 0.05). The SSFQ score and length of stay were lesser in the TXA group than in the S group (average P < 0.05). The differences in AST, ALT, BUN, Cr, PT, TT, APTT, FIB, and D-dimer at 1 day after the surgery for these two groups of patients had no statistical significance (average P > 0.05). Conclusion: TXA can reduce the bleeding amount of surgical patients with degenerative spinal disease in the perioperative period and decrease the length of stay, but does not increase the occurrence rate of adverse events, thereby promoting postoperative rehabilitation. Clinical Trial Registration:www.chictr.org.cn/index.aspx, identifier: ChiCTR2000033597.
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Affiliation(s)
- Lei Yan
- Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Huihong Yang
- Medical School, Shihezi University, Xinjiang Uygur Autonomous Region, Shihezi, China
| | - Haibin Jiang
- Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumqi, China
| | - Mingshan Yu
- Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumqi, China
| | - Jie Tan
- Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Tao Su
- Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Guiping Xu
- Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Hemani M, Parihar K, Gervais N, Morais M. Tranexamic Acid Use in the Postpartum Period Since the WOMAN Trial: A retrospective chart review. J Obstet Gynaecol Can 2021; 44:279-285.e2. [PMID: 34742944 DOI: 10.1016/j.jogc.2021.10.014] [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: 06/29/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the use of tranexamic acid (TXA) in postpartum patients since the WOMAN trial. METHODS A retrospective recrods review was conducted from May 2017 to March 2020 at a tertiary care centre to identify all patients who received TXA for postpartum bleeding. The primary outcome was to identify the proportion of patients who received TXA as per World Health Organization guidelines using the results of the WOMAN trial. RESULTS A total of 231 patients were included in our analysis. Use increased over time with 18 patients in 2017, 51 in 2018, and 134 in 2019 receiving TXA. In all, 203 patients (87.9%) received TXA within recommended guidelines, and these patients were less likely to require surgery or interventional radiology (12.3% vs. 42.9%, P < 0.001) or blood transfusion (23.6% vs. 42.9%, P = 0.030), and they had a lower likelihood of overall adverse events (LR 1.62 (1.6) vs. 2.60 (2.0), P = 0.024). TXA was commonly used as the first-line agent for postpartum bleeding (48.9% of patients), and was administered at cesarean section (77.0%) and when estimated blood loss did not meet criteria for "true" postpartum hemorrhage (41.6% of patients). Use of TXA as the first medication was associated with fewer adverse outcomes overall than misoprostol (P = 0.035). A shorter time to administration of the first medication was associated with shorter postpartum admission time (P = 0.042). CONCLUSIONS The majority of patients received TXA within guidelines and experience fewer adverse outcomes. Further study is needed to identify the best order of TXA administration with additional uterotonics and whether TXA should be used prophylactically in some groups for postpartum bleeding.
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Affiliation(s)
- Mehdiya Hemani
- Department of Obstetrics and Gynecology, McMaster University Medical Centre, Hamilton, Ontario, Canada.
| | - Kavita Parihar
- Department of Obstetrics and Gynecology, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Nicole Gervais
- Department of Obstetrics and Gynecology, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Michelle Morais
- Department of Obstetrics and Gynecology, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Janapala RN, Tran QK, Patel J, Mehta E, Pourmand A. Efficacy of topical tranexamic acid in epistaxis: A systematic review and meta-analysis. Am J Emerg Med 2021; 51:169-75. [PMID: 34763235 DOI: 10.1016/j.ajem.2021.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/17/2021] [Accepted: 10/24/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Epistaxis is a very common presentation in the emergency department (ED), accounting for approximately 1 in 200 ED visits in the United States. Currently, standard practice includes the initial use of topical anesthetics and vasoconstrictors, followed by more invasive treatments such as nasal packing, cauterization or surgical ligation for refractory cases. Over the years several studies have investigated the potential use of topical Tranexamic Acid (TXA) in the management of epistaxis. We have conducted a meta-analysis to assess the efficacy of topical TXA versus other standard practices or placebo in the management of epistaxis. METHODS PubMed and Scopus databases were searched from inception to April 2021. We included randomized controlled trials and observational studies investigating the efficacy of TXA in bleeding cessation in epistaxis in adults. The primary outcome measured was the prevalence of bleeding cessation after treatment at first assessment. Other outcomes were bleeding reoccurrence between 24 and 72 h and at 7-8 days. A random-effects model was used to estimate odds ratio (OR) for outcomes. RESULTS A total of eight studies were included in the analysis, including seven randomized trials and one retrospective study. We included a total of 1299 patients, 596 (46%) received TXA while 703 (54%) received control treatment (placebo, lidocaine plus vasoconstrictors or local anesthetics). Patients who were treated with TXA were 3.5 times (OR 3.5, 95% CI 1.3-9.7) more likely to achieve bleeding cessation at the first assessment. Patients treated with TXA had 63% (OR 0.37, 95% CI 0.20-0.66) less likelihood of returning due to rebleeding at 24-72 h. CONCLUSION Topical TXA is associated with better bleeding cessation rates after treatment compared to the standard practices.
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Haratian A, Shelby T, Hasan LK, Bolia IK, Weber AE, Petrigliano FA. Utilization of Tranexamic Acid in Surgical Orthopaedic Practice: Indications and Current Considerations. Orthop Res Rev 2021; 13:187-199. [PMID: 34703327 PMCID: PMC8541761 DOI: 10.2147/orr.s321881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/13/2021] [Accepted: 10/05/2021] [Indexed: 01/16/2023] Open
Abstract
Tranexamic acid (TXA) is a lysine analog that exhibits an anti-fibrinolytic effect by directly preventing the activation of plasminogen as well as inhibiting activated plasmin from degrading fibrin clots, thereby promoting hemostasis and reducing the duration and quantity of blood loss. The aims of this study were to summarize the indications, routes of administration, safety, and clinical outcomes of TXA use throughout the different subspecialities in orthopedic surgery. Given that orthopedic procedures such as TKA, THA, fracture fixation, and various spine surgeries involve significant intraoperative blood loss, TXA is indicated in providing effective perioperative hemostasis. Additionally, use of TXA in orthopedic trauma has been indicated as a measure to reduce blood loss especially in a group with potential for hemodynamic compromise. TXA has been implicated in reducing the risk of blood transfusions in orthopedic trauma, joint surgery, and spine surgery, although this effect is not seen as prominently in sports medicine procedures. There remains disagreement in literature as to whether TXA via any route of administration can improve other clinically significant outcomes such as hospital length of stay and total operative time. Procedures that rely extensively on clarity on visualization of the surgical field such as knee and shoulder arthroscopies can greatly benefit from the use of TXA, thereby leading to less intraoperative bleeding, with better visual clarity of the surgical field. While most studies agree thrombosis due to TXA is unlikely, new research in cells and animal models are evaluating whether TXA can negatively impact other aspects of musculoskeletal physiology, however with conflicting results thus far. As of now, TXA remains a safe and effective means of promoting hemostasis and reducing intraoperative blood loss in orthopedic surgery.
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Affiliation(s)
- Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Tara Shelby
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Li S, Ahmadzia HK, Guo D, Dahmane E, Miszta A, Luban NL, Berger JS, James AH, Wolberg AS, van den Anker JN, Gobburu JV. Population pharmacokinetics and pharmacodynamics of Tranexamic acid in women undergoing caesarean delivery. Br J Clin Pharmacol 2021; 87:3531-3541. [PMID: 33576009 PMCID: PMC8355246 DOI: 10.1111/bcp.14767] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/21/2020] [Revised: 01/21/2021] [Accepted: 02/03/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS The population pharmacokinetics (PK) and pharmacodynamics (PD) of tranexamic acid (TXA) have not been studied to prevent postpartum haemorrhage (PPH) in pregnant women. It is unclear which TXA dose assures sufficient PPH prevention. This study investigated population PK/PD of TXA in pregnant women who underwent caesarean delivery to determine the optimal prophylactic doses of TXA for future studies. METHODS We analysed concentration (PK) and maximum lysis (PD) data from 30 pregnant women scheduled for caesarean delivery who received 5, 10 or 15 mg/kg of TXA intravenously using population approach. RESULTS TXA PK was best described by a two-compartment model with first-order elimination and the following parameters: clearance (between-subject variability) of 9.4 L/h (27.7%), central volume of 10.1 L (47.4%), intercompartmental clearance of 22.4 L/h (66.7%), peripheral volume of 14.0 L (13.1%) and additive error of 1.4 mg/L. The relationship between TXA concentration and maximum lysis was characterized by a sigmoid Emax model with baseline lysis of 97%, maximum inhibition of 89%, IC50 of 6.0 mg/L (65.3%), hill factor of 8.5 (86.3%) and additive error of 7.3%. Simulations demonstrated that 500 and 650 mg of TXA maintained therapeutic targets for 30 minutes and 1 hour, respectively, in 90% of patients. CONCLUSION This is the first population PK and PD study of TXA in pregnant women undergoing caesarean delivery. Our analysis suggests that a 650 mg dose provides adequate PPH prophylaxis up to 1 hour, which is less than the currently used 1000 mg of TXA in pregnant women.
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Affiliation(s)
- Shuhui Li
- Center for Translational Medicine, School of Pharmacy, University of Maryland, Baltimore, M.D., USA
| | - Homa K. Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA
| | - Dong Guo
- School of Pharmacy, University of Maryland, Baltimore, M.D., USA
| | - Elyes Dahmane
- Center for Translational Medicine, School of Pharmacy, University of Maryland, Baltimore, M.D., USA
| | - Adam Miszta
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill N.C., USA
- Synapse Research Institute, Maastricht, the Netherlands
| | - Naomi L.C. Luban
- Division of Hematology, Children’s National Hospital, Washington D.C., USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jeffrey S. Berger
- Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA
| | - Andra H. James
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Duke University, Durham N.C., USA
| | - Alisa S. Wolberg
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill N.C., USA
| | - John N. van den Anker
- Division of Clinical Pharmacology, Children’s National Hospital, Washington D.C., USA
- Division of Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, Switzerland
| | - Jogarao V.S. Gobburu
- Center for Translational Medicine, School of Pharmacy, University of Maryland, Baltimore, M.D., USA
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Abstract
BACKGROUND Tranexamic acid (TXA) is widely used across surgical specialties to reduce perioperative bleeding. It has been shown to be effective in spinal surgery and lower limb arthroplasty. Among all languages, there are no systematic reviews or meta-analyses investigating its clinical effectiveness for all types of shoulder surgery. PURPOSE To investigate the clinical effectiveness of TXA in all types of shoulder surgery, including open and arthroscopic procedures. To investigate the effect of TXA on bleeding and non-bleeding-related outcomes. STUDY DESIGN Systematic review and meta-analysis. METHODS A protocol for the study was designed and registered with PROSPERO (CRD42020185482). The literature search included the MEDLINE, Embase, PsycINFO, and Cochrane Library databases. All randomized controlled trials evaluating the use of TXA against placebo, in all types of shoulder surgery, were included. Assessments were undertaken for risk of bias and certainty of evidence. The primary outcome was total blood loss. Secondary outcomes included those not directly related to bleeding. Data from comparable outcomes were pooled and analyzed quantitatively or descriptively, as appropriate. RESULTS Eight randomized controlled trials were included in the systematic review, and data from 7 of these studies were pooled in the meta-analysis. Pooled analysis demonstrated a significant reduction in 2 of 3 outcomes measuring perioperative bleeding with TXA compared with controls: estimated total blood loss (mean difference, -209.66 mL; 95% CI, -389.11 to -30.21; P = .02) and postoperative blood loss as measured by drain output (mean difference, -84.8 mL; 95% CI, -140.04 to -29.56; P = .003). Hemoglobin reduction was reduced but not statistically significant (mean difference, -0.33 g/dL; 95% CI -0.69 to 0.03; P = .07). This result became significant with sensitivity analysis excluding arthroscopic procedures. CONCLUSION This systematic review and meta-analysis indicated that TXA was effective in reducing blood loss in shoulder surgery. Larger randomized controlled trials with low risk of bias for specific surgical shoulder procedures are required. CLINICAL RELEVANCE TXA can be used across shoulder surgery to reduced perioperative blood loss. The use of TXA may have other beneficial features, including reduced postoperative pain and reduced operative time.
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Affiliation(s)
| | - Kar H. Teoh
- Princess Alexandra Hospital, Harlow,
Essex, UK
| | - Mustafa S. Rashid
- Nuffield Department of Orthopaedics,
Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Mustafa S. Rashid, MB ChB,
MSc, PhD, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal
Sciences, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK (
)
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Imach S, Wafaisade A, Lefering R, Böhmer A, Schieren M, Suárez V, Fröhlich M. The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU®. Crit Care 2021; 25:277. [PMID: 34348782 PMCID: PMC8336395 DOI: 10.1186/s13054-021-03701-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022]
Abstract
Background Outcome data about the use of tranexamic acid (TXA) in civilian patients in mature trauma systems are scarce. The aim of this study was to determine how severely injured patients are affected by the widespread prehospital use of TXA in Germany. Methods The international TraumaRegister DGU® was retrospectively analyzed for severely injured patients with risk of bleeding (2015 until 2019) treated with at least one dose of TXA in the prehospital phase (TXA group). These were matched with patients who had not received prehospital TXA (control group), applying propensity score-based matching. Adult patients (≥ 16) admitted to a trauma center in Germany with an Injury Severity Score (ISS) ≥ 9 points were included. Results The matching yielded two comparable cohorts (n = 2275 in each group), and the mean ISS was 32.4 ± 14.7 in TXA group vs. 32.0 ± 14.5 in control group (p = 0.378). Around a third in both groups received one dose of TXA after hospital admission. TXA patients were significantly more transfused (p = 0.022), but needed significantly less packed red blood cells (p ≤ 0.001) and fresh frozen plasma (p = 0.023), when transfused. Massive transfusion rate was significantly lower in the TXA group (5.5% versus 7.2%, p = 0.015). Mortality was similar except for early mortality after 6 h (p = 0.004) and 12 h (p = 0.045). Among non-survivors hemorrhage as leading cause of death was less in the TXA group (3.0% vs. 4.3%, p = 0.021). Thromboembolic events were not significantly different between both groups (TXA 6.1%, control 4.9%, p = 0.080). Conclusion This is the largest civilian study in which the effect of prehospital TXA use in a mature trauma system has been examined. TXA use in severely injured patients was associated with a significantly lower risk of massive transfusion and lower mortality in the early in-hospital treatment period. Due to repetitive administration, a dose-dependent effect of TXA must be discussed.
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Affiliation(s)
- Sebastian Imach
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany.
| | - Arasch Wafaisade
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Andreas Böhmer
- Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | - Victor Suárez
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matthias Fröhlich
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
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Cunningham G, Hughes J, Borner B, Mattern O, Taha ME, Smith MM, Young AA, Cass B. A single dose of tranexamic acid reduces blood loss after reverse and anatomic shoulder arthroplasty: a randomized controlled trial. J Shoulder Elbow Surg 2021; 30:1553-1560. [PMID: 33421559 DOI: 10.1016/j.jse.2020.11.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hematoma formation and the need for blood transfusions are commonly reported complications after shoulder arthroplasty. Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to decrease perioperative blood loss. The role of TXA is still being established in shoulder arthroplasty. MATERIALS AND METHODS We conducted a double-blind randomized controlled trial comparing intravenous TXA vs. placebo in 60 patients undergoing primary anatomic or reverse shoulder arthroplasty. Of these patients, 29 received a placebo whereas 31 received a single dose of 2 g of intravenous TXA. Patient demographic characteristics, as well as drain tube output, blood loss, hematoma formation, transfusion requirement, length of hospital stay, and pain score, were recorded. Patients were followed up for 12 weeks to assess for complications. RESULTS Patients who received TXA had a lower drain tube output at all time points: 41 mL vs. 133 mL at 6 hours, 75 mL vs. 179 mL at 12 hours, and 94 mL vs. 226 mL at 24 hours (P < .001 for all). They also had a higher postoperative hemoglobin (Hb) level (12.3 g/dL vs. 11.4 g/dL, P = .009), lower change in Hb level (1.7 g/dL vs. 2.3 g/dL, P = .011), lower total Hb loss (0.078 g vs. 0.103 g, P = .042), lower blood volume loss (0.55 L vs. 0.74 L, P = .021), higher postoperative hematocrit level (36.7% vs. 34.6%, P = .020), and lower hematocrit change (5.4% vs. 7.6%, P = .022). There was no significant difference in pain score or length of hospital stay, and no patients required a transfusion. CONCLUSION A single dose of 2 g of intravenous TXA decreases blood loss and drain tube output in primary anatomic and reverse arthroplasty of the shoulder. No differences were detected in the occurrence of complications, need for transfusion, pain score, or length of hospital stay. With the mounting evidence now available, patients undergoing elective primary shoulder arthroplasty should be given intravenous TXA to decrease perioperative blood loss.
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Affiliation(s)
- Gregory Cunningham
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland; Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland
| | - Jeffery Hughes
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | - Benoit Borner
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland.
| | - Owen Mattern
- The Orthopaedic Group, Melbourne, VIC, Australia
| | - Mohy E Taha
- Division of Orthopaedics and Trauma Surgery, Basel University Hospital, Basel, Switzerland
| | - Margaret M Smith
- Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Allan A Young
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | - Benjamin Cass
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
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Saad BN, Menken LG, Elkattaway S, Liporace FA, Yoon RS. Tranexamic acid lowers transfusion requirements and hospital length of stay following revision total hip or knee arthroplasty. Patient Saf Surg 2021; 15:21. [PMID: 33975621 PMCID: PMC8111901 DOI: 10.1186/s13037-021-00295-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Backgroud Intravenous tranexamic acid (TXA) has been shown to reduce blood loss in patients undergoing total joint arthroplasty without systemic complications. There is limited evidence of its effectiveness in revision procedures. This study evaluated intravenous TXA effect on blood loss, transfusion rates, and length of hospital stay in revision joint replacement. Methods One-hundred revision total joint arthroplasty patients were retrospectively reviewed [44 revision total hip arthroplasty (THA) and 54 revision total knee arthroplasty (TKA)] who underwent surgery from 2013 to 2016. Fifty-four revision joint patients (23 THA and 31 TKA) received intravenous TXA intra-operatively, while 46 revision joint patients (23 THA/TKA) did not. Primary outcome measures were blood loss, transfusion rates, and length of hospital stay. Results The mean blood loss difference between revision THA patients who received TXA vs. not receiving TXA was 180ml in revision THA patients (p < .005). Mean length of hospital stay was 6 days in non-TXA vs. 3 days in TXA patients (p < .001). Eighteen patients received transfusions in the non-TXA revision TKA group compared to nine patients in the TXA revision TKA group (p < .001). Average length of hospital stay was 5 days in the non-TXA revision TKA group compared to 3 days in the TXA revision TKA group (p < .003). There was no increased risk of thromboembolic complications in TXA groups for either procedure. Conclusions Intravenous TXA reduced length of hospital stay in both revision cohorts, decreased blood loss in revision THA and decreased the rate of transfusion in revision TKA without an increase in thromboembolic complications. Level of Evidence Level III (Case-control study)
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Affiliation(s)
- Bishoy N Saad
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, NJ, 07302, Jersey City, USA
| | - Luke G Menken
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, NJ, 07302, Jersey City, USA
| | - Sherif Elkattaway
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, NJ, 07302, Jersey City, USA
| | - Frank A Liporace
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, NJ, 07302, Jersey City, USA
| | - Richard S Yoon
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, NJ, 07302, Jersey City, USA.
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Kozhimala M, Asselin N, Zonfrillo MR. A Cross-sectional Survey on the Use of Tranexamic Acid in the Pre-hospital Setting. R I Med J (2013) 2021; 104:71-75. [PMID: 33648325] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
STUDY OBJECTIVE Tranexamic Acid (TXA), an anti- fibrinolytic, has been used in military trauma cases and civilian Emergency Departments for several years. This study aims to evaluate protocols for the administration of TXA across Emergency Medical Services (EMS) regions in the United States. METHODS An anonymous survey was distributed by the National Association of Emergency Medical Technicians (NAEMT) to its members. RESULTS A total of 264 eligible responses were received. Respondents included paramedics (62.5%), emergency medical technicians (EMTs) (9%), critical care paramedics (11%), and other health care professionals (19%). The majority of protocols included criteria for blood pressure (67%), heart rate (53%), and age (66%). Notable variations included TXA dilution and indications for traumatic brain injury. CONCLUSION TXA has been widely implemented in EMS protocols since the CRASH (Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage) trials. However, there remains significant variations in indications and dose concentrations.
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Affiliation(s)
| | - Nicholas Asselin
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI
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Belay ES, O'Donnell J, Flamant E, Hinton Z, Klifto CS, Anakwenze O. Intravenous tranexamic acid vs. topical thrombin in total shoulder arthroplasty: a comparative study. J Shoulder Elbow Surg 2021; 30:312-316. [PMID: 32592848 DOI: 10.1016/j.jse.2020.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Blood loss and transfusions have been highlighted as a significant predictor of postoperative morbidity. Tranexamic acid (TXA) has been shown to decrease blood loss and transfusion in shoulder arthroplasty. However, the utility of topical thrombin in total shoulder arthroplasty (TSA) is unknown. The purpose of this study was to assess the utility of topical thrombin in TSA and compare the effectiveness of topical thrombin to intravenous (IV) TXA. METHODS An institutional database was used to query shoulder arthroplasty patients from January 2017 to July 2019. Patients undergoing TSA were identified with CPT (Current Procedural Terminology) code (23742). After excluding reverse shoulder arthroplasty, arthroplasty for fracture or revision, the study groups were stratified based on intervention with IV TXA, topical thrombin, or neither. Patient demographics, American Society of Anesthesiologists (ASA) class, baseline coagulopathy, preoperative and postoperative hemoglobin levels, operative time, transfusion, length of stay, and 90-day readmission for each treatment group was obtained. RESULTS A total of 283 TSA cases were included for final analysis. There was no statistically significant difference in the baseline characteristics with age, body mass index, or ASA class. The postoperative hemoglobin level (mg/dL) was higher in the group that received either IV TXA or thrombin compared with no hemostatic agents (P = .001). Calculated blood loss in TSA was significantly higher in the group without hemostatic agents, 369.8 mL (standard deviation [SD] 59.5), compared with IV TXA or topical thrombin, 344.3 mL (SD 67.1) and 342.9 mL (SD 65.6) (P = .03). Operative time was highest in the group that received no hemostatic agents, 2.3 hours (SD 0.6) (P = .01). The transfusion rate for TSA treated with IV TXA or topical thrombin was equivalent (2.2%) but significantly lower than the no intervention group (12%) (P = .01). The odds ratio for transfusion with IV TXA was 0.16 (95% confidence interval [CI] 0.07-0.40, P = .001) and for topical thrombin, 0.1 (95% CI 0.02-0.42, P = .02). CONCLUSION Topical thrombin is an effective adjunct to reduce blood loss and transfusion risk after TSA and a reasonable intraoperative alternative for TXA for patients with contraindication to IV TXA.
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Affiliation(s)
- Elshaday S Belay
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Jeffrey O'Donnell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Zoe Hinton
- Duke University School of Medicine, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Alabdrabalnabi F, Alshahrani M, Ismail N. Nebulized tranexamic acid for recurring hemoptysis in critically ill patients: case series. Int J Emerg Med 2020; 13:45. [PMID: 32819268 PMCID: PMC7439666 DOI: 10.1186/s12245-020-00304-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/20/2020] [Accepted: 08/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hemoptysis is a clinical condition encountered in the emergency department (ED) and must be managed and investigated urgently to maintain the patient's hemostasis. The management of hemoptysis depends on treating the underlying cause. Tranexamic acid (TXA) is an anti-fibrinolytic drug used to systemically control bleeding. There are a few studies available that investigate the use of nebulized tranexamic acid for hemoptysis with contradictory results. Our paper demonstrates three cases where patients presented with significant hemoptysis and had significant improvement in symptoms following the administration of nebulized tranexamic acid. The overall need for blood transfusion was reduced. RESULTS Three patients presented to the emergency room for evaluation of hemoptysis. All three patients had different underlying pathologies resulting in their hemoptysis and were monitored in the ICU. Initial conventional medical therapies including the correction of coagulopathy and discontinuing offending agents were utilized for treatment. After persistent symptoms, nebulized TXA at a dose of 500 mg three times a day was administered. The patients were all discharged from the hospital with improvement in their symptoms. CONCLUSION Tranexamic acid may be considered in the treatment of hemoptysis regardless of the underlying cause. This may be utilized pending further workup and investigation into the underlying source of the bleeding.
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Affiliation(s)
- Fatimah Alabdrabalnabi
- Imam Abdulrahman Bin Faisal University and King Fahad University hospital, Dammam, Saudi Arabia
| | - Mohammed Alshahrani
- Imam Abdulrahman Bin Faisal University and King Fahad University hospital, Dammam, Saudi Arabia
| | - Nadia Ismail
- Imam Abdulrahman Bin Faisal University and King Fahad University hospital, Dammam, Saudi Arabia
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Cuff DJ, Simon P, Gorman RA. Randomized prospective evaluation of the use of tranexamic acid and effects on blood loss for proximal humeral fracture surgery. J Shoulder Elbow Surg 2020; 29:1627-1632. [PMID: 32713466 DOI: 10.1016/j.jse.2020.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is an antifibrinolytic agent that has been used to reduce blood loss in orthopedic surgery. It has been shown to decrease blood loss in upper- and lower-extremity arthroplasty, as well as lower-extremity fracture surgery. The use of TXA for proximal humeral fracture surgery has yet to be evaluated. The purpose of this study was to examine the effects of TXA on blood loss in patients undergoing open reduction-internal fixation (ORIF) or arthroplasty for the treatment of proximal humeral fractures. MATERIALS AND METHODS A total of 101 patients were randomized to receive either a single preoperative dose of intravenous TXA (53 patients) or a control dose of saline solution (48 patients) at the time of proximal humeral fracture surgery. On the basis of patient age and fracture pattern, ORIF was performed in 57 patients (30 TXA and 27 control patients) and reverse shoulder arthroplasty (RSA) was performed in the other 44 patients (23 TXA and 21 control patients). Intraoperative blood loss plus 24-hour drain output was used to calculate total blood loss for each procedure. The preoperative-to-postoperative change in hemoglobin level was also evaluated for each patient. Further stratification of blood loss and change in hemoglobin level based on procedure (ORIF or RSA) was performed as well. RESULTS Compared with the control group, the TXA group had less average intraoperative blood loss (178 mL vs. 129 mL, P < .0001), less postoperative drain output (103 mL vs. 62 mL, P < .0001), and less total blood loss (280 mL vs. 188 mL, P < .0001). Compared with the control group, the TXA group had a smaller average preoperative-to-postoperative change in hemoglobin level (-2.6 g/dL vs. -1.5 g/dL, P < .0001). Further stratification based on procedure showed that among patients undergoing ORIF and patients undergoing RSA, those receiving TXA had less average total blood loss and a smaller decrease in hemoglobin level than the control group. No identifiable intraoperative or postoperative complications associated with the use of TXA occurred in any patient. CONCLUSION TXA was effective in reducing total blood loss and led to a smaller preoperative-to-postoperative decrease in hemoglobin level compared with control in patients undergoing surgery for proximal humeral fractures. This effect was consistent in patients treated with either ORIF or arthroplasty as the surgical procedure. TXA can be used to decrease blood loss in the surgical treatment of proximal humeral fractures.
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Affiliation(s)
- Derek J Cuff
- Suncoast Orthopaedic Surgery and Sports Medicine, Venice, FL, USA.
| | - Peter Simon
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA
| | - R Allen Gorman
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
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Hartland AW, Teoh KH, Rashid MS. The use of intra-operative tranexamic acid in shoulder surgery: Protocol for a systematic review and meta-analysis. Int J Surg Protoc 2020; 22:15-18. [PMID: 32671310 PMCID: PMC7338573 DOI: 10.1016/j.isjp.2020.06.003] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Blood loss is an important consideration in all types of shoulder surgery. Excessive bleeding is associated with increased morbidity. Tranexamic acid (TXA) is an antifibrinolytic agent. It has been demonstrated to be effective in reducing blood loss across multiple surgical specialties. The aim of this systematic review and meta-analysis is to review the literature evaluating clinical outcomes associated with the use of TXA in shoulder surgery. METHODS The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Literature search will include the MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. Randomised controlled trials (RCTs) evaluating the use of TXA against placebo, in all types of shoulder surgery, will be included. Our primary outcome is total blood loss (ml). Secondary outcomes include patient-reported outcome measures (PROMs), adverse events, and number of blood transfusions required. Risk of bias will be assessed within each study using The Cochrane Risk of Bias Tool 2.0 and the Jadad score. Inconsistency and bias across included studies will be assessed statistically. Data from comparable outcomes will be pooled and analysed quantitatively or descriptively as appropriate. ETHICS AND DISSEMINATION No ethical clearances required for this study. This systematic review and meta-analysis will be published in a peer-reviewed journal. It will be presented a various national and international conferences.
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Affiliation(s)
- Alexander W. Hartland
- Trauma and Orthopaedics, Princess Alexandra Hospital, Hamstel Road, Harlow, Essex CM20 1QX, UK
| | - Kar H. Teoh
- Trauma and Orthopaedics, Princess Alexandra Hospital, Hamstel Road, Harlow, Essex CM20 1QX, UK
| | - Mustafa S. Rashid
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Windmill Road, Oxford OX3 7LD, UK
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Walker PF, Bozzay JD, Johnston LR, Elster EA, Rodriguez CJ, Bradley MJ. Outcomes of tranexamic acid administration in military trauma patients with intracranial hemorrhage: a cohort study. BMC Emerg Med 2020; 20:39. [PMID: 32410581 PMCID: PMC7222426 DOI: 10.1186/s12873-020-00335-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Tranexamic acid (TXA) may be a useful adjunct for military patients with severe traumatic brain injury (TBI). These patients are often treated in austere settings without immediate access to neurosurgical intervention. The purpose of this study was to evaluate any association between TXA use and progression of intracranial hemorrhage (ICH), neurologic outcomes, and venous thromboembolism (VTE) in TBI. Methods This was a retrospective cohort study of military casualties from October 2010 to December 2015 who were transferred to a military treatment facility (MTF) in the United States. Data collected included: demographics, types of injuries, initial and interval head computerized tomography (CT) scans, Glasgow Coma Scores (GCS), and six-month Glasgow Outcome Scores (GOS). Results were stratified based on TXA administration, progression of ICH, and VTE. Results Of the 687 active duty service members reviewed, 71 patients had ICH (10.3%). Most casualties were injured in a blast (80.3%), with 36 patients (50.7%) sustaining a penetrating TBI. Mean ISS was 28.2 ± 12.3. Nine patients (12.7%) received a massive transfusion within 24 h of injury, and TXA was administered to 14 (19.7%) casualties. Patients that received TXA had lower initial reported GCS (9.2 ± 4.4 vs. 12.5 ± 3.4, p = 0.003), similar discharge GCS (13.3 ± 4.0 vs. 13.8 ± 3.2, p = 0.58), and a larger improvement between initial and discharge GCS (3.7 ± 3.9 vs. 1.3 ± 3.1, p = 0.02). However, there was no difference in mortality (7.1% vs. 7.0%, p = 1.00), progression of ICH (45.5% vs. 14.7%, p = 0.09), frequency of cranial decompression (50.0% vs. 42.1%, p = 0.76), or mean GOS (3.5 ± 0.9 vs. 3.8 ± 1.0, p = 0.13). Patients administered TXA had a higher rate of VTE (35.7% vs. 7.0%, p = 0.01). On multivariate analysis, however, TXA was not independently associated with VTE. Conclusions Patients that received TXA were associated with an improvement in GCS but not in progression of ICH or GOS. TXA was not independently associated with VTE, although this may be related to a paucity of patients receiving TXA. Decisions about TXA administration in military casualties with ICH should be considered in the context of the availability of neurosurgical intervention as well as severity of extracranial injuries and need for massive transfusion.
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Affiliation(s)
- Patrick F Walker
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
| | - Joseph D Bozzay
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA
| | - Luke R Johnston
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA
| | - Eric A Elster
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA
| | | | - Matthew J Bradley
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA
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