scholarly journals THE USE OF ANTIFIBRINOLYTICS IN HIP TRAUMA SURGERY IN A PUBLIC HEALTH SYSTEM: A PROSPECTIVE STUDY

2021 ◽  
Vol 29 (6) ◽  
pp. 304-307
Author(s):  
JOSÉ ALBERTO ALVES OLIVEIRA ◽  
GABRIELLA CRISTINA COELHO DE BRITO ◽  
FRANCISCA MAGNA PRADO BEZERRA ◽  
CARLOS ALFREDO DE CARVALHO NETO ◽  
JONATAS BRITO DE ALENCAR NETO ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Prospective Study ◽  
Surgical Approach ◽  
Trauma Surgery ◽  
Level Of Evidence ◽  
Total Blood ◽  
Significance Level ◽  
Estimated Blood Loss ◽  
Significant Difference

ABSTRACT Objective: To evaluate the use of tranexamic acid (TXA) and ε-aminocaproic acid (EACA) in reducing blood loss in hip and proximal femur trauma surgery. Methods: Prospective study with 49 patients surgically treated in a trauma hospital between Nov/2015 and Feb/2017. The patients were divided in two groups: TXA (n = 24) and EACA (n = 25). The comparison was made according to gender, age at the time of surgery, ASA, fracture and surgery type, estimated blood loss during surgical approach, hemoglobin and hematocrit levels pre and post-operative, and pharmacological cost. The data was processed using SPSS 22.0 with significance level of p < 0,05. Results: No significant difference was found in the variables age, gender, ASA and estimated blood loss during surgical approach. No patient needed blood transfusion. When evaluated post-operatively, the hemoglobin and hematocrit values decrease had no significant difference between the antifibrinolytics (p > 0.05). When analyzing total cost for both pharmacological agents, higher cost was observed in EACA than in TXA (US$ 16.09 - US$ 2.73), resulting in a US$ 13.36 addition per patient. Conclusion: Antifibrinolytic use was efficient on lowering the total blood loss, without the need of blood transfusion. Level of evidence II, Prospective Comparative Study.

scholarly journals The Use of Tranexamic Acid in Total Ankle Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Laura Luick ◽  
Vytas Ringus ◽  
Garrett Steinmetz ◽  
Spencer Falcon ◽  
Shaun Tkach ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
P Value ◽  
Ankle Arthroplasty ◽  
Estimated Blood Loss ◽  
Number Of Patients ◽  
Significant Difference

Category: Ankle Arthritis Introduction/Purpose: The number of total ankle arthroplasties (TAA) is on the rise. Complications associated with TAA include need for blood transfusion, deep vein thrombosis, hematoma, infection, and wound complications. Tranexamic acid (TXA) use in the total knee and total hip population has been found to decrease the rate of blood transfusion. The rate of infections and blood transfusions in TAA was reported to be 3.2% and 1.3%, respectively. In calcaneal fractures TXA was found to decrease wound complications. Our goal was to evaluate the use of TXA in the TAA population to see if its use decreases blood loss or wound complications. Methods: This is a retrospective review of two patient cohorts operated on by a single surgeon from 2010 to 2016. We compared a group of TAA patients that did not receive TXA versus a subsequent group that received TXA. Patients received 1 g IV TXA before tourniquet was inflated and another 1 g following the release of the tourniquet. Pre-operative hemoglobin and hematocrit levels were compared to postoperative levels. Post-operative complications were compared between the two groups. Results: 87 patients were included in the study. 35 patients (40%) received TXA. In patients that received TXA, 18 had postoperative hemoglobin levels available. These patients were compared to a control cohort of 52 patients that did not receive TXA. No significant difference existed between the two groups in gender or age (p=0.9; p=0.7 respectively). Mean estimated blood loss was the same between the two groups. Overall postoperative complications, including wound complications, were higher in the TXA group at 26% vs 12% but this was not statistically significant (p-value = 0.086). The preoperative to postoperative change in hemoglobin/hematocrit levels was not statistically significant between groups (p-value = 0.78). There was one transfusion required in the non-TXA group and no transfusions required in the TXA group (p=0.9). Conclusion: The use of TXA was not found to provide a beneficial effect in total ankle arthroplasty in either decreasing wound complications or blood loss. Given these results, TXA use might not be cost effective in total ankle arthroplasty as opposed to other total joint arthroplasties. Further higher levels studies with increased number of patients are required to further evaluate TXA effectiveness in TAA.

Tranexamic Acid Effectively Reduces Blood Loss and Transfusion Rates during Simultaneous Bilateral Total Knee Arthroplasty

2017 ◽  
Vol 31 (03) ◽  
pp. 270-276 ◽  
Author(s):  
Hernan Prieto ◽  
Heather Vincent ◽  
Justin Deen ◽  
Dane Iams ◽  
Hari Parvataneni
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Control Group ◽  
Level Of Evidence ◽  
Estimated Blood Loss ◽  
Flexion Extension ◽  
Total Knee

AbstractTranexamic acid (TXA) can reduce blood loss and decrease transfusion rates after total knee arthroplasty (TKA). The purpose of our study was to evaluate the efficacy of TXA in a homogenous, consecutive cohort of patients undergoing simultaneous bilateral primary TKA. This was a retrospective study of 50 consecutive patients who underwent bilateral simultaneous primary TKA between 2011 and 2015. Of these, 20 patients received TXA and 30 patients did not receive TXA and served as the control group. Primary outcome measurements were intraoperative estimated blood loss, hemoglobin (Hb) and Hematocrit (Hct) levels on postoperative day (POD) 1 and POD2, and blood transfusion rates. Secondary outcomes included length of stay (LOS), knee flexion/extension range of motion (ROM), and postoperative complications. There was no difference between groups for preoperative Hb and Hct (all p > 0.05). The TXA group demonstrate higher Hb levels at POD1 (11.7 in TXA vs. 10.4 controls; p < 0.001) and POD2 (10.5 in TXA vs. 9.6 controls; p < 0.001), as well as higher Hct levels at POD1 (35.6 in TXA vs. 32.1 controls; p < 0.001) and POD2 (31.9 in TXA vs. 29.3 controls; p < 0.001). There was less percentage variation in Hb levels in the TXA group from preoperative to POD1 (17.7% in TXA vs. 25.7% controls; p < 0.0001) and POD2 (26.1% TXA vs. 31.8% controls; p = 0.019). Similarly, less percentage variation in Hct levels in the TXA group from presurgery to POD1 (17.0% TXA vs. 25.7% controls; p < 0.0001) and POD2 (25.0% TXA vs. 31.3% controls; p = 0.005). A total of 23.3% of patients in the control group required transfusions compared with no patients in the TXA (p = 0.044). There were no differences in LOS, knee ROM, or number of complications. No thromboembolic events occurred. TXA in bilateral simultaneous TKA effectively reduces blood loss, maintains postoperative Hb and Hct levels, and significantly decreases blood transfusion rates. The level of evidence is level III (therapeutic study).

scholarly journals Safe and effective performance of pediatric spinal deformity surgery in patients unwilling to accept blood transfusion: a clinical study and review of literature

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alexander Mihas ◽  
Subaraman Ramchandran ◽  
Sebastian Rivera ◽  
Ali Mansour ◽  
Jahangir Asghar ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Spinal Deformity ◽  
Intraoperative Complications ◽  
Spine Deformity ◽  
Blood Conservation ◽  
Level Of Evidence ◽  
Estimated Blood Loss ◽  
Spinal Deformity Surgery

Abstract Background Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah’s witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion. Methods After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018. We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up). Results Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (14), juvenile idiopathic (1), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.4° to 11.2° (80% correction, p <  0.001) at the latest follow-up. A mean of 11.4 levels were fused and 5.6 levels of Pontes osteotomies were performed. One patient underwent L1 hemivertebra resection and three patients had fusion to pelvis. Estimated blood loss, percent estimated blood volume loss, and cell saver returned averaged 307.9 mL, 8.5%, and 80 mL, respectively. Average operative time was 214 min. The average drop in hemoglobin after surgery was 2.9 g/dL. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative complications were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis. Conclusions Blood conservation techniques allow for safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications, when performed by an experienced multidisciplinary team. Level of evidence Level IV.

scholarly journals Safe and Effective Performance of Pediatric Spinal Deformity Surgery in Patients Unwilling to Accept Blood Transfusion: A Clinical Study and Review of Literature

2020 ◽  
Author(s):  
Alexander Mihas ◽  
Ramchandran Subaraman ◽  
Sebastian Rivera ◽  
Ali Mansour ◽  
Jahangir Asghar ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Spinal Deformity ◽  
Intraoperative Complications ◽  
Spine Deformity ◽  
Blood Conservation ◽  
Level Of Evidence ◽  
Estimated Blood Loss ◽  
Spinal Deformity Surgery

Abstract Background: Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah’s witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion Methods: After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018.We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up).Results: Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (15), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.40 to 11.20 (80% correction, p< 0.001) at the latest follow-up. A mean of 11.4 levels were fused, 5.6 levels of Pontes osteotomies and 2.8 levels of thoracoplasty performed. 1 patient underwent L1 VCR and 3 patients had fusion to pelvis. Estimated blood loss and cell saver returned an average of 307.9 ml and 80ml, respectively. Operative times average at 214 min. The average drop in hemoglobin after surgery was 2.1mg/dl. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative compilations were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis.Conclusions: Blood conservation techniques allow safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications.Level of Evidence: Level IV.

scholarly journals Does prophylactic tranexamic acid reduce blood loss in Indian women following vaginal delivery?

2021 ◽  
Vol 10 (2) ◽  
pp. 497
Author(s):  
Nivedhana Arthi P. ◽  
Indu N. R. ◽  
Jalakandan B.
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Vaginal Delivery ◽  
Controlled Study ◽  
Reduce Blood Loss ◽  
Indian Women ◽  
Estimated Blood Loss ◽  
Transfusion Requirements ◽  
Significant Difference

Background: Postpartum hemorrhage (PPH) accounts for 25% to 33% of obstetric deaths every year. Anemia is a cause and consequence of PPH. Despite intense efforts to prevent anemia, many Indian women labour with low hemoglobin levels. Tranexamic acid (TXA), an antifibrinolytic, have been demonstrated to reduce blood loss and transfusion requirements in various surgeries including cesarean section. Objectives were to study the efficacy of TXA in effectively reducing blood loss in Indian women following vaginal delivery.Methods: This randomized, double-blind, placebo-controlled study was conducted on 200 patients scheduled for vaginal delivery. In addition to oxytocin 10 units, group T received TXA 15 mg/kg and group P received normal saline administered over 5 minutes. Estimated blood loss, Hemoglobin deficit, need for additional uterotonics, need for blood transfusion, incidence of PPH and adverse events were noted.Results: The fall in hemoglobin was significantly higher in group P (p<0.00001). Estimated 24 hour blood loss was significantly higher by a mean blood volume of 86.99 ml in group P compared to group T (p<0.00001). The incidence of PPH was lower in group T (2.8% versus 11.3%). There were no significant difference in the need for supplementary uterotonics (9.9% versus 15.5%) and the incidence of blood transfusion (2.8% versus 8.5%). No adverse maternal and fetal outcomes were noted.Conclusions: To reduce blood loss following vaginal delivery, TXA may be safely recommended as standard adjunct to Oxytocin for regular management of third stage of labour, especially in developing countries like India.

scholarly journals Tranexamic acid and reduction of blood transfusion in lower limb trauma surgery: a randomized controlled study

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 53
Author(s):  
Gurleen Kaur ◽  
Harpal Singh Selhi ◽  
Naresh Jyoti Delmotra ◽  
Jaspreet Singh
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Lower Limb ◽  
Trauma Surgery ◽  
Controlled Study ◽  
Not Given ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Limb Trauma ◽  
Lower Limb Trauma

Introduction: Post-operative blood loss in lower limb trauma fractures increases morbidity. Very few studies have evaluated the efficacy of Tranexamic Acid (TXA) in reducing blood loss and the consequent requirement of blood transfusion in the Indian population. Methods: This was a randomized controlled study of 100 patients with lower limb trauma. Fifty patients were given 1 g of TXA before surgery, and 50 patients were not given TXA. The requirement of blood transfusion, fall in Hb, the number of days admitted in the hospital after surgery were recorded, and evidence of deep vein thrombosis (DVT) was monitored. Results: Baseline demographics between the groups were comparable. The required blood transfusion and fall in Hb in patients receiving intra-operative TXA were significantly lower than those not given TXA (p < 0.0001). There was no significant difference in the length of hospital stay between the two groups (p = 0.6). There was no significant difference in the incidence of DVT in both groups. Discussion: TXA helps reduce the morbidity of trauma patients by reducing the requirement for blood transfusion. Its use is safe in lower limb trauma surgery and lowers the cost of therapy to the patient.

scholarly journals Use of blood-sparing surgical techniques and transfusion algorithms: association with decreased blood administration in children undergoing primary open craniosynostosis repair

2015 ◽  
Vol 16 (5) ◽  
pp. 556-563 ◽  
Author(s):  
Thanh T. Nguyen ◽  
Sarah Hill ◽  
Thomas M. Austin ◽  
Gina M. Whitney ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Postoperative Period ◽  
Surgical Techniques ◽  
Perioperative Period ◽  
Fresh Frozen Plasma ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Frozen Plasma

OBJECT Craniofacial reconstruction surgery (CFR) is often associated with significant blood loss, coagulopathy, and perioperative blood transfusion. Due to transfusion risks, many different approaches have been used to decrease allogeneic blood transfusion for these patients during the perioperative period. Protocols have decreased blood administration during the perioperative period for many types of surgeries. The object of this study was to determine if a protocol involving blood-sparing surgical techniques and a transfusion algorithm decreased intraoperative blood transfusion and blood loss. METHODS A protocol using transfusion algorithms and implementation of blood-sparing surgical techniques for CFR was implemented at Vanderbilt University on January 1, 2013. Following Institutional Review Board approval, blood loss and transfusion data were gathered retrospectively on all children undergoing primary open CFR, using the protocol, for the calendar year 2013. This postprotocol cohort was compared with a preprotocol cohort, which consisted of all children undergoing primary open CFR during the previous calendar year, 2012. RESULTS There were 41 patients in the preprotocol and 39 in the postprotocol cohort. There was no statistical difference between the demographics of the 2 groups. When compared with the preprotocol cohort, intraoperative packed red blood cell transfusion volume decreased from 36.9 ± 21.2 ml/kg to 19.2 ± 10.9 ml/kg (p = 0.0001), whereas fresh-frozen plasma transfusion decreased from 26.8 ± 25.4 ml/kg to 1.5 ± 5.7 ml/kg (p < 0.0001) following implementation of the protocol. Furthermore, estimated blood loss decreased from 64.2 ± 32.4 ml/kg to 52.3 ± 33.3 ml/kg (p = 0.015). Use of fresh-frozen plasma in the postoperative period also decreased when compared with the period before implementation of the protocol. There was no significant difference in morbidity and mortality between the 2 groups. CONCLUSIONS The results of this study suggested that using a multidisciplinary protocol consisting of transfusion algorithms and implementation of blood-sparing surgical techniques during major CFR in pediatric patients is associated with reduced intraoperative administration of blood product, without shifting the transfusion burden to the postoperative period.

Evaluating the Role of Anesthesia on Intraoperative Blood Loss and Visibility during Endoscopic Sinus Surgery: A Meta-analysis

2021 ◽  
pp. 194589242198915
Author(s):  
David C. Moffatt ◽  
Robert A. McQuitty ◽  
Alex E. Wright ◽  
Tawanda S. Kamucheka ◽  
Ali L. Haider ◽  
...  
Keyword(s):  
Heart Rate ◽  
Blood Loss ◽  
Endoscopic Sinus Surgery ◽  
Average Rate ◽  
Meta Analysis ◽  
Sinus Surgery ◽  
Total Blood Loss ◽  
Total Blood ◽  
Intraoperative Bleeding ◽  
Significant Difference

Background Previous studies and meta analyses have led to incongruent and incomplete results respectively when total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are compared in endoscopic sinus surgeries in regards to intraoperative bleeding and visibility. Objective To perform a more comprehensive meta-analysis on randomized controlled trial (RCTs) comparing TIVA with IA in endoscopic sinus surgery to evaluate their effects on intraoperative bleeding and visibility. Methods A systematic review and meta-analysis of studies comparing TIVA and IA in endoscopic sinus surgery for chronic rhinosinusitis was completed in May 2020. Utilizing databases, articles were systematically screened for analysis and 19 studies met our inclusion criteria. The primary outcome included intraoperative visibility scores combining Boezaart, Wormald and Visual Analogue Scale (VAS). Secondary outcomes included rate of blood loss (mL/kg/min), estimated total blood loss (mL), Boezaart, Wormald scores, VAS, heart rate, and mean arterial pressure (MAP). Results 19 RCTs with 1,010 patients were analyzed. TIVA had a significantly lower intraoperative bleeding score indicating better endoscopic visibility (Boezaart, VAS, and Wormald) than IA (−0.514, p = 0.020). IA had a significantly higher average rate of blood loss than TIVA by 0.563 mL/kg/min (p = 0.016). Estimated total blood loss was significantly lower in TIVA than IA (−0.853 mL, p = 0.002). There were no significant differences between TIVA and IA in the mean heart rate (−0.225, p = 0.63) and MAP values (−0.126, p = 0.634). The subgroup analyses revealed no significant difference between TIVA and IA when remifentanil was not utilized and whenever desflurane was the IA agent. Conclusion TIVA seemed to have superior intraoperative visibility scores and blood loss during endoscopic sinus surgery when compared to IA. However, the results are not consistent when stratifying the results based on the use of remifentanil and different inhaled anesthetics. Therefore, the conclusion cannot be made that one approach is superior to the other.

scholarly journals THE INFLUENCE OF PASSIVE TOBACCO EXPOSURE AND PHYSICAL EXERCISE ON BONE TISSUE OF YOUNG RATS

2017 ◽  
Vol 25 (2) ◽  
pp. 77-80 ◽  
Author(s):  
Regina Celi Trindade Camargo ◽  
Regiane Rocha Costalonga ◽  
Mário Jefferson Quirino Louzada ◽  
Rômulo Araújo Fernandes ◽  
José Carlos Silva Camargo Filho ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Bone Mineral ◽  
Passive Smoking ◽  
Density Ratio ◽  
Tobacco Exposure ◽  
Mineral Density ◽  
Level Of Evidence ◽  
Significance Level ◽  
Passive Smoker ◽  
Significant Difference

ABSTRACT Objective: The objective of this study is to investigate the effect of passive smoking during pregnancy and associated with swimming on bone area growth, bone mineral density (BMD), and bone mineral content (BMC). Methods: The offspring was grouped by control matrices (G1) and passive smokers (G2). The offspring was regrouped in eight subgroups, with exposure to smoking (2x/day) and physical exercise (1 session/day), respecting the group of matrices in: sedentary control (G1CS and G2CS), swimming control (G1CN and G2CN), sedentary passive smoker (G1FS and G2FS), and passive smoker swimmer (G1FN and G2FN). The area, BMD and BMC were measured by the tibia and femur and analyzed by densitometer. The results were analyzed by One-Way ANOVA test with Tukey post-test, with a significance level of 5%. Results: In the tibia BMC study, a better rate was observed in G2CN group when compared to G1CS, G1CN and G1FN (p ≤ 0.023). When assessing BMD in the femur, a higher density ratio was observed in G1FS group when compared to G2CS, G2CN, G2FS and G2FN (p<0.008). In the tibia study, the animals of the G1FS group had higher rates when compared to G2CS and G2FN groups (p≤0.007). Conclusions: The model of male offspring exposed to passive smoking during fetal development showed a strong decrease in the analyzed parameters. Level of Evidence I, Randomized High Quality Clinical Trial With or Without Statistically Significant Difference, But Narrow Confidence Intervals.

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