Effect of sodium nitroprusside on postoperative blood loss in the cardiac surgical patient

SummaryThe effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials, with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in placebo-treated patients fell in the upper third of distribution (>1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.

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Tranexamic acid versus Aprotinin: Effects on postoperative blood loss and transfusion requirements in patients undergoing elective primary coronary artery bypass grafting

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-967380 ◽

2007 ◽

Vol 55 (S 1) ◽

Author(s):

J Kobba ◽

A Rinas ◽

F Beyersdorf

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Blood Loss ◽

Tranexamic Acid ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Postoperative Blood Loss ◽

Bypass Grafting ◽

Acid Versus ◽

Transfusion Requirements

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DEPOSITION - Decreasing Postoperative Blood Loss by Topical vs. Intravenous Tranexamic Acid in Open Cardiac Surgery

Case Medical Research ◽

10.31525/ct1-nct03954314 ◽

2019 ◽

Author(s):

Keyword(s):

Cardiac Surgery ◽

Blood Loss ◽

Tranexamic Acid ◽

Postoperative Blood Loss

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The effectiveness of tranexamic acid at reducing postoperative blood loss following cesarean section: a systematic review of quantitative evidence protocol

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/jbisrir-2015-1991 ◽

2015 ◽

Vol 13 (6) ◽

pp. 72-81

Author(s):

Jaime Henry ◽

Allison McFarland

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Cesarean Section ◽

Tranexamic Acid ◽

Postoperative Blood Loss ◽

Quantitative Evidence

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High-dose Aprotinin in Cardiac Surgery—A Prospective, Randomized Study

Anaesthesia and Intensive Care ◽

10.1177/0310057x9402200505 ◽

1994 ◽

Vol 22 (5) ◽

pp. 529-533 ◽

Cited By ~ 20

Author(s):

M. J. Swart ◽

P. C. Gordon ◽

P. B. Hayse-Gregson ◽

R. A. Dyer ◽

A. L. Swanepoel ◽

...

Keyword(s):

Cardiac Surgery ◽

Placebo Group ◽

Blood Loss ◽

Artery Bypass ◽

Randomized Study ◽

Postoperative Blood Loss ◽

High Dose ◽

Maintenance Infusion ◽

Transfusion Requirements ◽

High Dose Aprotinin

Fifty patients undergoing primary coronary artery bypass surgery and 50 patients undergoing valve surgery received either high-dose aprotinin (2 million units loading dose, 2 million units added to the CPB prime, and 500,000 units/hr maintenance infusion) or placebo. Mean postoperative blood loss in the first six hours was reduced from 321 ml in the placebo group to 172 ml in the aprotinin group (95% confidence interval (CI) for difference = 95 to 189 ml). Seven patients in the placebo group and 16 patients in the aprotinin group did not require transfusion with homologous blood. This study adds to the growing body of evidence that the administration of high-dose aprotinin reduces blood loss and blood transfusion requirements associated with primary cardiac surgery.

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Normovolemic modified ultrafiltration is associated with better preserved platelet function and less postoperative blood loss in patients undergoing complex cardiac surgery: A randomized and controlled study

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2010.09.057 ◽

2011 ◽

Vol 141 (5) ◽

pp. 1298-1304 ◽

Cited By ~ 13

Author(s):

Christian Friedrich Weber ◽

Csilla Jámbor ◽

Christian Strasser ◽

Anton Moritz ◽

Nestoras Papadopoulos ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Loss ◽

Platelet Function ◽

Postoperative Blood Loss ◽

Controlled Study

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The association between bone mineral density and postoperative drainage volume following cruciate-substituting primary total knee arthroplasty: a cross-sectional study

Knee Surgery and Related Research ◽

10.1186/s43019-021-00107-1 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Yuthasak Peerakul ◽

Jirapong Leeyaphan ◽

Karn Rojjananukulpong

Keyword(s):

Blood Loss ◽

Primary Total Knee Arthroplasty ◽

Cross Sectional Study ◽

Postoperative Blood Loss ◽

Mineral Density ◽

Cross Sectional ◽

Total Hip ◽

Drainage Volume ◽

Hip Bmd ◽

Postoperative Drainage

Abstract Background The prevalence of osteoporosis in patients who undergo a primary total knee arthroplasty (TKA) is increasing. Low bone mineral density (BMD) is related to unfavorable outcomes following TKA such as migration of uncemented tibial components. Postoperative blood loss in TKA is an important complication. Non-modifying predicting factors for postoperative blood loss in patients undergoing primary TKA need further elucidation. Studies on the association between BMD and blood loss after TKA are limited. We aimed to demonstrate the relationship between BMD and postoperative drainage volume following primary TKA. Methods A cross-sectional study was conducted between January 2014 and August 2020. A total of 119 primary varus osteoarthritis knees with BMD results were included in the study. Patients with secondary causes of osteoporosis were excluded. Results The median postoperative drainage volume of participants in the normal total hip BMD group and the normal trochanter BMD group was higher than that of patients in the low total hip BMD group and the low trochanter BMD group (285.0 ml vs 230.0 ml, P = 0.003; 282.5 ml vs 240.0 ml, P = 0.013, respectively). Multivariate regression analyses showed that operative time, spinal anesthesia, and normal total hip BMD status were significant predictive factors associated with increased postoperative drainage volume (P = 0.014, 0.022, and 0.013, respectively). No association was identified between the lumbar spine BMD status and postoperative drainage volume. Conclusions The relationship between BMD and postoperative blood loss in primary TKA was identified in this study. Normal total hip BMD was found to be associated with an increased postoperative drainage volume after primary TKA compared with low BMD.

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Effect of tranexamic acid in arthroscopic anterior cruciate ligament repair: A systematic review and meta-analysis of randomised clinical trials

Journal of Orthopaedic Surgery ◽

10.1177/23094990211017352 ◽

2021 ◽

Vol 29 (2) ◽

pp. 230949902110173

Author(s):

Tze Khiang Tan ◽

Ka Ting Ng ◽

Hui Jane Lim ◽

Ross Radic

Keyword(s):

Clinical Trials ◽

Anterior Cruciate Ligament ◽

Blood Loss ◽

Tranexamic Acid ◽

Cruciate Ligament ◽

Meta Analysis ◽

Lysholm Score ◽

Randomised Clinical Trials ◽

Postoperative Blood Loss ◽

Anterior Cruciate

Purpose: Perioperative blood loss remains a major challenge to surgeons in anterior cruciate ligament reconstruction (ACLR) surgery, despite of the introduction of minimally invasive approach. Tranexamic acid (TXA) is believed to reduce blood loss, which may minimise the complication of postoperative haemarthrosis with insufficient evidence on its effectiveness in ACLR. The primary aim of this study was to examine the effect of TXA on postoperative blood loss and other secondary outcomes in patients undergoing arthroscopic ACLR surgery. Method: PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched from its inception until November 2020. All randomised clinical trials (RCTs) comparing TXA (intravenous or intra-articular) versus placebo in the arthroscopic ACLR surgery were included. Case series, case report and editorials were excluded. Results: Five RCTs comprising of a total of 580 patients (291 in TXA group, 289 in control group) were included for qualitative and quantitative meta-analysis. In comparison to placebo, TXA group was significantly associated with lower postoperative blood loss (mean difference (MD): −81.93 ml; 95% CI −141.80 to −22.05) and lower incidence of needing knee aspiration (odd ratio (OR): 0.19; 95% CI 0.08 to 0.44). Patients who randomised to TXA were also reported to have better range of movement (MD: 2.86; 95% CI 0.54 to 5.18), lower VAS Pain Score (MD: −1.39; 95% CI −2.54 to −0.25) and higher Lysholm Score (MD: 7.38; 95% CI 2.75 to 12.01). Conclusion: In this meta-analysis, TXA reduced postoperative blood loss with lesser incidence of needing knee aspiration along with better range of knee movement and Lysholm score in patients undergoing arthroscopic ACLR surgery.

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