The effect of tranexamic acid on blood loss and maternal outcome in the treatment of persistent postpartum hemorrhage: A nationwide retrospective cohort study

Objectives: This study aims to clarify the role of prophylactic TXA on blood loss and transfusion requirements in a subgroup of trauma patients undergoing major orthopaedic surgery on a non-urgent basis. Study design: This is a retrospective cohort study Setting: Tertiary University Hospital of Crete (2017-2018) Patients/participants: Polytrauma patients who underwent delayed major orthopaedic surgery Main outcome measurement: Significant haemorrhage occurrence in relation to TXA administration. In a subgroup of patients Rotational Thromboelastometry (ROTEM) was used to reveal their haemostatic profile prior to TXA administration. Methods: Data from anaesthetic and ICU records were analyzed regarding age, sex, body mass index, ASA physical status, Injury Severity Score, Caprini Score, intraoperative blood loss, number of packed red blood cells units transfused, volume of crystalloids administered, operation duration, preoperative and postoperative haemoglobin values, and days from hospital admission to surgery. ROTEM analysis in a subgroup of patients revealed their haemostatic profile prior to TXA administration. Results: Twenty five out of 46 patients received prophylactic TXA treatment. After adjustment for confounding factors, the odds ratio for the composite endpoint for prophylactic TXA (n=25) vs no TXA (n=21) was 1.27 (95% confidence interval, CI 0.39-4.16). Propensity matched analysis confirmed the absence of a difference between patients with and without TXA. In all patients analyzed with ROTEM normal or hypercoagulable status was revealed. Conclusions: In trauma patients undergoing major orthopaedic surgery more than 12 hours after the initial injury, TXA has no effect on blood loss and transfusion requirements. Keywords: tranexamic acid; blood loss; transfusion; orthopaedic trauma surgery; spine surgery; pelvis surgery; significant bleeding in orthopaedic surgery

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Quantification of Blood Loss Improves Detection of Postpartum Hemorrhage and Accuracy of Postpartum Hemorrhage Rates: A Retrospective Cohort Study

Cureus ◽

10.7759/cureus.13591 ◽

2021 ◽

Author(s):

Colleen Blosser ◽

Alisha Smith ◽

Aaron T Poole

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Retrospective Cohort Study ◽

Postpartum Hemorrhage ◽

Retrospective Cohort

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Retrospective Cohort Study Comparing Current Third Stage Management to Expedient Squatting Third Stage Management

10.21203/rs.3.rs-142795/v1 ◽

2021 ◽

Author(s):

Judy Slome Cohain ◽

Rina Buxbaum

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Retrospective Cohort Study ◽

Postpartum Hemorrhage ◽

Retrospective Cohort ◽

Active Management ◽

Stage Management ◽

Inclusion Criteria ◽

Manual Removal ◽

Third Stage

Abstract Background: Active management of the delivery of the placenta results in 5% postpartum hemorrhage, 1% blood transfusions and an average blood loss of 500 cc. Shorter third stages are associated with decreased hemorrhage rates. The third stage can be shortened by instructing the birthing woman to squat and push out the placenta at 3 minutes postpartum. The objective of this study was to compare blood loss and PPH rates using Judy's 3,4,5 minute third stage expedient squatting protocol to variations of active and expectant third stage management among similar populations.Methodology: A retrospective cohort study was carried out comparing 1,098 planned homebirths attended in Israel, in which Judy’s 3,4,5 expedient squatting third stage technique was practiced, to 2,899 planned homebirths attended by midwives in British Columbia, Canada, where currently accepted third stage management was used. The inclusion criteria for both groups were: Singleton fetus in cephalic presentation; gestational age 37+0 to 41+6 weeks; spontaneous onset of labor; history of up to one previous cesarean; absence of significant pre-existing disease and absence of significant disease arising during pregnancy. The main outcomes were postpartum hemorrhage and manual removal of the placenta. Results: Using identical inclusion criteria and similar management, variations of active and expectant management resulted in 4% PPH over 1000 cc and 1.0% manual removal. Expedient squatting resulted in 2/1098 cases of PPH>500 cc, zero cases of PPH over 1000 cc and 0.7% manual removal. Conclusion: Judy’s 3,4,5 minute third stage management minimizes postpartum bleeding compared to other third stage protocols, reproducing postpartum hemorrhage rates indigenous to primates.

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Outcome of pregnancies after pelvic artery embolization for postpartum hemorrhage: retrospective cohort study

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2015.06.063 ◽

2015 ◽

Vol 213 (4) ◽

pp. 576.e1-576.e5 ◽

Cited By ~ 7

Author(s):

Sarah H. Poggi ◽

Andrew Yaeger ◽

Yesmean Wahdan ◽

Alessandro Ghidini

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Postpartum Hemorrhage ◽

Retrospective Cohort ◽

Artery Embolization ◽

Pelvic Artery

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Post-Tonsillectomy Hemorrhage Control with Nebulized Tranexamic Acid: A Retrospective Cohort Study

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2021.110802 ◽

2021 ◽

pp. 110802

Author(s):

Dylan Z. Erwin ◽

Philip D. Heichel ◽

Laura M. Wright ◽

Nira A. Goldstein ◽

Timothy P. McEvoy ◽

...

Keyword(s):

Cohort Study ◽

Tranexamic Acid ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hemorrhage Control

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Predictors of intra-operative blood loss and blood transfusion in orthognathic surgery: a retrospective cohort study in 92 patients

Patient Safety in Surgery ◽

10.1186/s13037-014-0041-6 ◽

2014 ◽

Vol 8 (1) ◽

Cited By ~ 10

Author(s):

Maisa O Al-Sebaei

Keyword(s):

Cohort Study ◽

Blood Transfusion ◽

Blood Loss ◽

Retrospective Cohort Study ◽

Orthognathic Surgery ◽

Retrospective Cohort ◽

Operative Blood Loss

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Comparison Between Bilateral Simultaneous Total Hip Arthroplasty With and Without Drainage; a Retrospective Cohort Study

10.21203/rs.3.rs-625749/v1 ◽

2021 ◽

Author(s):

Min-Gwang Kim ◽

Taek-Rim Yoon ◽

Kyung-Soon Park

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Postoperative Bleeding ◽

Total Blood Loss ◽

Postoperative Blood Loss ◽

Consecutive Series ◽

Transfusion Rate ◽

Total Blood

Abstract BackgroundThere are many reports staged bilateral THA without drainage is a better method than with drainage in many ways. However, there is little report regarding bilateral simultaneous THA (BSTHA) without drainage. This study aimed to evaluate the differences in the clinical outcomes and complication rate of BSTHA with drainage and without drainage.MethodsBetween October 2015 and April 2019, a retrospective cohort study was conducted with modified minimally invasive two-incision method and a consecutive series of 41 BSTHA performed with drainage were compared to 37 BSTHA performed without drainage. It was assessed clinically and radiographically for a mean of 2.1 ± 0.8 years (range, 1.0-4.8 years). Postoperative hematologic values (Hgb drop, Hct drop, total blood loss, transfusion rate), pain susceptibility, functional outcome, and complication were compared in the drained group and the non-drained group. All patients preoperatively received intravenous tranexamic acid (TXA) and intraoperatively received intra-articular TXA on each hip. Statistical analyses were performed using the independent t tests, Chi-squared or Fisher’s exact tests. A significance level of ≤ 0.05 was used for all statistical tests.Results Mean postoperative Hgb (g/dL, p < 0.001) & Hct drop (%, p < 0.001), mean total blood loss (ml, p < 0.001) and mean transfusion unit (IU, p < 0.001) were significantly lower in the BSTHA without drainage than in the BSTHA with drainage group. But the mean dose of morphine equivalent (mg, p < 0.001) was significantly larger in BSTHA without drainage.ConclusionBSTHA without drainage can reduce postoperative blood loss and the requirement for transfusion without increasing other complication. But BSTHA without drainage is more painful method than BSTHA with drainage. Therefore, BSTHA without drainage will be a good option to reduce the burden on the patient by reducing postoperative bleeding if it can control pain well after surgery.

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