scholarly journals Evaluation of Role of Tranexamic Acid in Reducing Blood Loss and Transfusion Rate in Patients Undergoing Lower Limb Orthopaedic Surgeries

2020 ◽  
Vol 9 (03) ◽  
pp. 142-147
Author(s):  
Ayushma Jejani ◽  
Ashok Chaudhari ◽  
Amol Singam ◽  
Pratibha Nagpure ◽  
Basant Latwal ◽  
...  
2019 ◽  
Vol 69 (12) ◽  
pp. 3745-3748
Author(s):  
Raluca Costina Barbilian ◽  
Victor Cauni ◽  
Bogdan Mihai ◽  
Ioana Buraga ◽  
Mihai Dragutescu ◽  
...  

The aim of this paper is to assess the efficiency and safety of the tranexamic acid in reducing blood loss and the need for transfusion in patients diagnosed with staghorn calculi treated by percutaneous nephrolithotomy. Percutaneous nephrolithotomy (PCNL) is a minimally invasive technique used for large kidney stones. Hemorrhagic complications and urinary sepsis are serious complications associated with this type of surgery. Tranexamic acid is an antifibrinolytic drug that has the property of reducing intra or postoperative bleeding. The experience with tranexamic acid in preventing blood loss during percutaneous nephrolithotomy for is limited. The use tranexamic acid in percutaneous nephrolithotomy for staghorn type stones is safe and is associated with reduced blood loss and a lower transfusion rate.


2018 ◽  
Vol 9 ◽  
pp. 215145931880385 ◽  
Author(s):  
Wei Liu ◽  
Huangdong Hui ◽  
Yunhai Zhang ◽  
Weilong Lin ◽  
Yongqian Fan

Introduction: The objective was to evaluate the safety and efficacy of intra-articular injection of tranexamic acid (TXA) in patients between 80 and 100 years of age with femoral neck fracture undergoing hip hemi-arthroplasty (HA). Material and Methods: We conducted a retrospective review to assess perioperative blood loss and transfusion rate after intra-articular injection of TXA during HA. This was a single-center, retrospective, single-surgeon, and standard care cohort study covering the period between January and December 2016. One hundred three consecutive patients undergoing HA under spinal or general anesthesia were included. Fifty-four and 49 patients received and did not receive intra-articular injection of TXA during the HA, respectively. After closing the capsule, 50 mL of a TXA solution at a concentration of 1 g/100 mL of saline was injected into joint capsule. We compared the following outcomes: preoperative hemoglobin (HB) level, postoperative day 1 HB level, postoperative day 3 HB level, the net reduction of HB level by postoperative day 3, transfusion rate, and 30- and 90-day postoperative mortality rates. In addition, we use logistic regression to analyze the factors affecting the transfusion rate. Result: Day 3 postoperative HB level and the net reduction in HB level within 3 days following surgery were 93.22 ± 11.70 g/L and 25.98 ± 6.29 g/L in TXA group, respectively, while were 87.10 ± 10.52 g/L and 35.44±8.61 g/L in no-TXA group. Transfusion rate was 9% (5/54) in TXA group and 24% (12/49) in no-TXA group, respectively. The differences were statistically significant between the both groups. Logistic regression indicated that the topical administration of TXA would reduce the risk for transfusion, while in male diabetes mellitus would increase the risk. There were no significant differences in the deep venous thrombosis, pulmonary embolism, and mortality rates of 30 and 90 days postoperatively ( P > .05). Discussion: Because of lower systemic absorption and a higher concentration in the wound, topical use of TXA is safer for elderly patients who may have renal or liver dysfunction. TXA at therapeutic concentration does not affect platelet count, platelet aggregation, or coagulation parameters, and is of value in elderly patients who take antiplatelet drug for secondary prevention of cardiovascular diseases. Conclusion: For patients between 80 and 100 years of age with femoral neck fracture undergoing HA, intra-articular injection of TXA may reduce the perioperative blood loss and transfusion rate without increasing risk of thrombosis.


2020 ◽  
Author(s):  
Fan Yong Yong ◽  
deng bo ◽  
Hong Hai Nan ◽  
Zhu Zhong

Abstract PurposeThe efficacy and safety of topical fibrin sealant (FS) compared with tranexamic acid (TXA) to reduce blood loss after total hip arthroplasty (THA) is not clear. A meta-analysis was conducted to evaluate the efficacy and safety of topical FS versus topical or intravenous TXA for treatment of primary THA.MethodWe searched electronic databases, including PubMed, Embase, and the Cochrane Library to identify studies up to March 2020. The references included in articles were also checked for additional potentially-relevant studies. The language of publication was limited to English. The endpoints included the mean difference (MD) of blood loss, hemoglobin value, and odds ratios (ORs) of transfusion requirements and thrombotic events. Our meta-analysis was performed according to the Guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. The data of the included studies were analyzed using RevMan 5.3.ResultsA total of four studies (two randomized controlled trials and two non-randomized controlled trials) met the inclusion criteria. Our meta-analysis demonstrated that TXA administration led to significantly different outcomes in terms of transfusion rate (RD = -0.12, 95% CI (-0.23, -0.00), P = 0.05, I2 = 74%) and postoperative hemoglobin levels (WMD = -0.47, 95% CI (-0.74, -021), P = 0.0005, I2 = 3%) compared with topical application of FS in patients undergoing THA. No significant difference was seen in total calculated blood loss (WMD = -86.22, 95% CI (-99.13, -73.31), P < 0.00001, I2 = 96%) or complication rate (RR = 0.98, 95% CI (-99.13, -73.31), P = 0.45, I2 = 0%) between the two groups.ConclusionsTXA administration can effectively decrease the transfusion rate and result in higher postoperative hemoglobin levels without increasing the rate of infection.


2015 ◽  
Vol 135 (4) ◽  
pp. 573-588 ◽  
Author(s):  
Hamidreza Shemshaki ◽  
Sayed Mohammad Amin Nourian ◽  
Niloofaralsadat Nourian ◽  
Masoudhatef Dehghani ◽  
Masoud Mokhtari ◽  
...  

2013 ◽  
Vol 4 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Virender Kumar Gautam ◽  
Balaji Sambandam ◽  
Shailendra Singh ◽  
Prince Gupta ◽  
Rajat Gupta ◽  
...  

2020 ◽  
Author(s):  
Yong Yong Fan ◽  
Hai Nan Hong ◽  
Bo Deng ◽  
Zhong Zhu

Abstract Purpose: The efficacy and safety of topical fibrin sealant (FS) compared with tranexamic acid (TXA) to reduce blood loss after total hip arthroplasty (THA) is not clear. A meta-analysis was conducted to evaluate the efficacy and safety of topical FS versus topical or intravenous TXA for treatment of Method: We searched electronic databases, including PubMed, EMBASE, and the Cochrane Library to identify studies up to March 2020. The references included in articles were also checked for additional potentially-relevant studies. The language of publication was limited to English. The endpoints included the mean difference (MD) of blood loss, hemoglobin value, and odds ratios (ORs) of transfusion requirements and thrombotic events. Our meta-analysis was performed according to the Guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. The data of the included studies were analyzed using RevMan 5.3.Results: A total of four studies (two randomized controlled trials and two non-randomized controlled trials) met the inclusion criteria. Our meta-analysis demonstrated that TXA administration led to significantly different outcomes in terms of transfusion rate (RD = -0.12, 95% CI (-0.23, -0.00), P = 0.05, I2 = 74%) and postoperative hemoglobin levels (WMD = -0.47, 95% CI (-0.74, -021), P = 0.0005, I2 = 3%) compared with topical application of FS in patients undergoing THA. No significant difference was seen in total calculated blood loss (WMD = -86.22, 95% CI (-99.13, -73.31), P < 0.00001, I2 = 96%) or complication rate (RR = 0.98, 95% CI (-99.13, -73.31), P = 0.45, I2 = 0%) between the two groups.Conclusions: TXA administration can effectively decrease the transfusion rate and result in higher postoperative hemoglobin levels without increasing the rate of infection.


Author(s):  
Anne J. Brouwer ◽  
Dagmar R.J. Kempink ◽  
Pieter Bas de Witte

Purpose Proximal femoral and/or pelvic osteotomies (PFPO) are associated with significant blood loss, which can be harmful, especially in paediatric patients. Therefore, considering methods to reduce blood loss is important. The purpose of this study was to examine the efficacy of tranexamic acid (TXA) in reducing intraoperative estimated blood loss (EBL) in paediatric patients undergoing a PFPO. Methods Paediatric patients who had a PFPO between 2014 and 2019 were retrospectively reviewed. Outcome measures included patient demographics, TXA use (none, preoperative and/or intraoperative bolus, pump), EBL, transfusion rate and thromboembolic complications. Univariate and multivariate analyses were performed to assess associations between investigated outcome measures and EBL. Results A total of 340 PFPO (263 patients) were included. Mean age at surgery was 8.0 years (sd 4.3). In all, 269 patients received no TXA, 20 had a preoperative bolus, 43 had an intraoperative bolus and eight patients had other TXA regimes (preoperative and intraoperative bolus or pump). Overall, mean blood loss was 211 ml (sd 163). Multivariate analysis showed significant associations between higher EBL and higher age at surgery, male sex, higher body mass index and longer procedure time. There was a significant association between lower EBL and a preoperative TXA bolus: 66 ml (33%) less EBL compared with patients without TXA (95% confidence interval -129 to -4; p = 0.04). No thromboembolic complications were reported in any of the studied patients. Conclusion Preoperative TXA administration is associated with a decreased EBL in PFPO. No thromboembolic events were reported. Administering TXA preoperatively appears to be effective in paediatric patients undergoing a PFPO. Level of evidence Level III – retrospective comparative study.


Author(s):  
Ryan S. Charette ◽  
Jenna A. Bernstein ◽  
Matthew Sloan ◽  
Corbyn M. Nchako ◽  
Atul F. Kamath ◽  
...  

AbstractTranexamic acid (TXA) has been shown to reduce blood loss and postoperative transfusions in total knee arthroplasty (TKA). There is no consensus on the ideal dosing regimen in the literature, although there is a growing body of literature stating there is little benefit to additional doses. Our study compared one versus two doses of TXA in primary TKA and its effect on postoperative transfusion rate. We retrospectively reviewed patients undergoing primary TKA at our two high-volume arthroplasty centers between 2013 and 2016. Patients were included if they underwent unilateral primary TKA, and received one or two doses of intravenous TXA. Patients receiving therapeutic anticoagulation were excluded. Our primary outcome was postoperative transfusion rate. Secondary outcomes included blood loss, length of stay, rate of deep vein thrombosis or pulmonary embolism (DVT/PE), readmission and reoperation.A total of 1,191 patients were included: 891 received one dose and 300 received two doses. There was no significant difference in rate of transfusion, deep vein thrombosis or pulmonary embolism (DVT/PE), blood volume loss, and reoperation. There was a significantly higher risk of readmission (6.7 vs. 2.4%, odds ratio [OR] 2.96, p < 0.001) and reoperation (2.0 vs. 0.6%, OR 3.61, p = 0.024) in patients receiving two doses. These findings were similar with subgroup analysis of patients receiving only aspirin prophylaxis.In unilateral TKA, there is no difference in transfusion rate with one or two doses of perioperative TXA. There was no increased risk of thromboembolic events between groups, although the two-dose group had a higher rate of readmission and reoperation. Given the added cost without clear benefit, these findings may support administration of one rather than two doses of TXA during primary TKA.


2019 ◽  
Vol 218 (5) ◽  
pp. 876-880
Author(s):  
Fabian Grass ◽  
Signe Braafladt ◽  
Jasim Alabbad ◽  
Jenna K. Lovely ◽  
Scott R. Kelley ◽  
...  

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