scholarly journals The effect of prophylactic use of intravenous tranexamic acid in abdominal hysterectomy

2021 ◽  
Vol 7 (1) ◽  
pp. 1-5
Author(s):  
Dr. Smita Barya ◽  
◽  
Dr. Sameer Goyal ◽  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Abdominal Hysterectomy ◽  
Skin Incision ◽  
Postoperative Blood Loss ◽  
Abdominal Drain ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Prophylactic Use ◽  
Group 1

Introduction: Hysterectomy is one of the frequently performed major gynecological surgicalprocedures for various uterine pathologies. The objective of this study is to assess the effect ofintravenous tranexamic acid in reducing intraoperative and postoperative blood loss in womenundergoing abdominal hysterectomy. Materials and Methods: The study was a randomizeddouble-blind study, involving a total of 120 women undergoing abdominal hysterectomy for benignetiology were randomly assigned to two groups: Group 1 (non TA): (n=60) women receiving normalsaline and Group 2 (TA): (n=60) women receiving prophylactic Tranexamic Acid in 100 ml saline IVjust before skin incision. The primary outcome was intraoperative, postoperative, and all blood lossestimation. Results: Group 2 (TA) showed a great reduction in intraoperative and postoperativeblood loss (blood in the intra-abdominal drain) compared with Group 1 (non TA), (P = 0.0001,0.0001), so the overall estimated blood loss in groups 2 showed significant reduction compared withGroup 1 (P = 0.0001). Conclusion: Intravenous tranexamic acid is a safe and reliable method tohelp decrease blood loss during and after abdominal hysterectomy.

scholarly journals Efficacy of prophylactic tranexamic acid administration in prevention of postpartum hemorrhage in placenta previa cesarean section: an interventional study

2021 ◽  
Vol 11 (1) ◽  
pp. 153
Author(s):  
Monika Rathore ◽  
Anjali Gupta ◽  
Nidhi Kumari
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Intravenous Infusion ◽  
Very Low Birth Weight ◽  
Placenta Previa ◽  
Skin Incision ◽  
Group 2 ◽  
Group 1

Background: Postpartum hemorrhage accounts for the major part of the mortality as well as morbidity like severe anemia, need for blood transfusion, hospital stay and infection. Aim and objectives of the study were to determine the efficacy and safety of prophylactic tranexamic acid and intravenous tranexamic acid in preventing postpartum hemorrhage in women undergoing caesarean section for placenta previa.Methods: Seventy women with placenta previa over 1 year, randomized into 2 groups: group 1 (n=35): Women who received 10 IU oxytocin intravenous infusion after placental delivery and group 2 (n=35): Women who received 1 gm (10 ml) tranexamic acid IV before skin incision plus 10 IU oxytocin intravenous infusion after placental delivery.Results: The mean age was similar in 2 groups i.e., 26.34±4.78 years in group 1 and 27.31±5.62 years in group 2. Most women in the present study presented with type IV placenta previa i.e., 34.3% in group 1 and 48.6% in group 2. Mean pre-operative hemoglobin was 9.57±1.54 g/dl in group 1 and 9.59±1.35 g/dl in group 2. Intra-operative mean blood loss was 729.31±172.45 ml in intravenous oxytocin group and 464.86±28.00 ml in intravenous tranexamic acid group. A total of 74.3% women in group 1 and 20% women in group 2 developed postpartum hemorrhage. Mean post-operative hemoglobin was 8.04±1.34 g/dl in group 1 and 8.85±1.26 g/dl in group 2. In group 1, 5.7% neonates were born with very low birth weight and while none in group 2. 51.4% neonates in group 1 and 45.7% in group 2 had low birth weight.Conclusions: It is concluded that tranexamic acid used prophylactically intravenously before skin incision in patients undergoing cesarean section for placenta previa significantly reduces intra-operative blood loss. 

Pharmacological reduction of bleeding during hip endoprosthetic replacement

2012 ◽  
Vol 153 (41) ◽  
pp. 1607-1612 ◽  
Author(s):  
Tamás de Jonge
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Red Cells ◽  
Postoperative Blood Loss ◽  
Total Hip ◽  
Group 2 ◽  
Primary Total Hip Arthroplasty ◽  
Group 1

Introduction: Endoprosthetic replacement of the large joints is accompanied by major bleeding. During the last few years several authors reported the perioperative administration of tranexamic acid and its beneficial effect on reducing the blood loss. Objectives: In the present study, the author studied the effect of intravenously administered tranexamic acid in patients undergoing primary total hip arthroplasty in order to examine whether this treatment could reduce postoperative blood loss, the amount of transfused packed red cells, and the cost of the blood saving and/or transfusion. Methods: The author compared retrospectively the data of 104 patients undergoing primary total hip arthroplasty between April, 2010 and December, 2011. 54 patients were administered tranexamic acid (Group 1) and 50 patients were treated without tranexamic acid (Group 2). The amount of postoperative bleeding, haemoglobin, hematocrit, red blood cell count, and the number of units of the transfused packed red cells were recorded. Cost effectiveness of treatment with tranexamic acid was calculated. Results: Postoperative blood loss in Group 1 was 732 ml (210–1280 ml), and in Group 2 1092 ml (420–2640 ml). Ten of the 54 patients in Group 1 had to be transfused, and the all-over need was 20 units of packed red cells. 49 of the 50 patients in Group 2 received 98 units of allogenic blood. Thromboembolic complication was not observed in connection with the use of tranexamic acid. The reduction of blood loss with the application of tranexamic acid and the transfused packed red cells cost in average 5,180 HUF per patient in Group 1 and 15,850 HUF in Group 2. Conclusions: Intravenous administration of tranexamic acid reduces effectively the transfusion rate and the blood loss in the postoperative period in patients undergoing primary total hip arthroplasty. More than 1.5 million HUF and 240 units of packed red cells could be yearly saved with the introduction of this simple, safe and cheap method of drug administered blood conservation. Orv. Hetil., 2012, 153, 1607–1612.

Influence of aspirin or heparin on platelet function and postoperative blood loss after coronary artery bypass surgery

Perfusion ◽  
2006 ◽  
Vol 21 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Edmundas Sirvinskas ◽  
Audrone Veikutiene ◽  
Pranas Grybauskas ◽  
Jurate Cimbolaityte ◽  
Ausra Mongirdiene ◽  
...  
Keyword(s):  
Platelet Count ◽  
Coronary Artery ◽  
Platelet Aggregation ◽  
Blood Loss ◽  
Platelet Function ◽  
Artery Bypass ◽  
Postoperative Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of the study was to assess the effect of aspirin or heparin pretreatment on platelet function and bleeding in the early postoperative period after coronary artery bypass grafting (CABG) surgery. Seventy-five male patients with coronary artery disease who underwent CABG with cardiopulmonary bypass (CPB) were studied. The patients were divided into three groups: Group 1 ( n = 25) included patients receiving aspirin pretreatment, Group 2 ( n = 22) received heparin pretreatment, and Group 3 ( n = 28) included patients who received no antiplatelet or anticoagulant pretreatment. Twenty-four hours after surgery, all patients were administered aspirin therapy that was continued throughout their hospitalization period. We assessed the following preoperative blood coagulation indices: activated partial thromboplastin time (aPTT), international normalized ratio (INR), and fibrinogen. We compared platelet count and platelet aggregation induced by adenosinediphosphate (ADP) before surgery, 1 h after surgery, 20 h after surgery and on the seventh postoperative day. We assessed drained blood loss within 20 postoperative hours. Preoperative blood coagulation indices did not differ among the groups. Platelet count was also similar. One hour after surgery, platelet count significantly decreased in all groups ( p <0.001), after 20 postoperative hours it did not undergo any marked changes, and on the seventh postoperative day, it significantly increased in all groups ( p <0.001). Before surgery, the lowest index of ADP-induced platelet aggregation was found in Group 1 ( p <0.05). One hour after surgery, platelet aggregation significantly decreased in all groups, most markedly in Group 3 ( p <0.001), yet after 20 h, its restitution tendency and a significant increase in all groups was noted. On the seventh day, a further increase in the statistical mean platelet aggregation value was noted in Groups 2 and 3. Comparison of platelet aggregation after 20 postoperative hours and on the seventh day after surgery revealed a significantly higher than 10% increase of the index in 32% of patients in Group 1 ( p <0.05), 27.3% of patients in Group 2 ( p <0.05) and in 35.7% of patients in Group 3 ( p <0.001). The lowest statistically significant value of postoperative blood loss was noted in Group 2 ( p <0.01). Our study has shown that aspirin or heparin pretreatment had no impact on the dynamics of platelet function in the early postoperative period after CABG. The lowest postoperative blood loss was noted in patients pretreated with heparin.

Role of Frameless Stereotaxy in the Surgical Treatment of Cerebral Arteriovenous Malformations: Technique and Outcomes in a Controlled Study of 44 Consecutive Patients

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1108-1118 ◽  
Author(s):  
Stephen M. Russell ◽  
Henry H. Woo ◽  
Seth S. Joseffer ◽  
Jafar J. Jafar
Keyword(s):  
Blood Loss ◽  
Arteriovenous Malformations ◽  
Operative Time ◽  
Controlled Study ◽  
Frameless Stereotaxy ◽  
Complication Rates ◽  
Cerebral Arteriovenous Malformations ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Group 1

Abstract OBJECTIVE To describe a frameless stereotactic technique used to resect cerebral arteriovenous malformations (AVMs) and to determine whether frameless stereotaxy during AVM resection could decrease operative times, minimize intraoperative blood losses, reduce postoperative complications, and improve surgical outcomes. METHODS Data for 44 consecutive patients with surgically resected cerebral AVMs were retrospectively reviewed. The first 22 patients underwent resection without stereotaxy (Group 1), whereas the next 22 patients underwent resection with the assistance of a frameless stereotaxy system (Group 2). RESULTS The patient characteristics, AVM morphological features, and percentages of preoperatively embolized cases were statistically similar for the two treatment groups. The mean operative time for Group 1 was 497 minutes, compared with 290 minutes for Group 2 (P = 0.0005). The estimated blood loss for Group 1 was 657 ml, compared with 311 ml for Group 2 (P = 0.0008). Complication rates, residual AVM incidences, and clinical outcomes were similar for the two groups. CONCLUSION Frameless stereotaxy allows surgeons to 1) plan the optimal trajectory to an AVM, 2) minimize the skin incision and craniotomy sizes, and 3) confirm the AVM margins and identify deep vascular components during resection. These benefits of stereotaxy were most apparent for small, deep AVMs that were not visible on the surface of the brain. Frameless stereotaxy reduces the operative time and blood loss during AVM resection.

scholarly journals How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

2020 ◽  
pp. 1-9
Author(s):  
Ralph T. Schär ◽  
Shpend Tashi ◽  
Mattia Branca ◽  
Nicole Söll ◽  
Debora Cipriani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Elderly Patients ◽  
Age Groups ◽  
Head Ct ◽  
Estimated Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

OBJECTIVEWith global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery.METHODSFor this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed.RESULTSIn total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001).CONCLUSIONSMortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

scholarly journals 1439 A Change in The Use of Post-Operative Drains in Total Knee Arthroplasty (TKA)

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Erdman ◽  
R Ali ◽  
R Bhattacharya
Keyword(s):  
Blood Loss ◽  
Statistical Significance ◽  
Length Of Hospital Stay ◽  
Social Barriers ◽  
Estimated Blood Loss ◽  
Relevant Variables ◽  
Total Knee ◽  
Group 2 ◽  
Haematoma Formation ◽  
Group 1

Abstract Aim Closed suction drains (CSD) are routinely used to reduce the risk of haematoma formation and wound infections in TKA. Our study aims to determine if the use of drains has any impact on estimated blood loss, transfusion rates and length of stay in hospital. Method Elective TKA cases performed under a single consultant between February 2018-March 2020 were identified. Electronic medical records were reviewed, and data collected on relevant variables. Estimated blood loss was calculated using Ward’s formula. Mann-Whitney U test was applied to assess for statistical significance. Results A total of 86 elective TKA cases were included in the study. In 41 cases patients had a CSD insitu post-operatively (group 1), in the other 45 cases a drain was not used (group 2). Both groups had similar distributions of age, BMI, and sex. We found no statistically significant differences in mean change (+/-SD) in haemoglobin post-operatively between group 1 (21.3 (+/- 9.4)) and group 2 (19 (+/- 10)), (p = 0.34). Mean estimated blood loss was 915mls (+/-365) for group 1 and 871mls (+/-455) for group 2, (p = 0.45). Group 1 had a higher rate of transfusion (4.8% vs 2.2%); however, this was not statistically significant (p = 0.51). After accounting for unrelated medical complications or social barriers to discharge, the length of hospital stay was 4.7 (+/- 2.27) and 4.9 (+/- 3.14) for group 1 and 2 respectively, (p = 0.84). There were no reported cases of wound infection in both groups. Conclusions We found the use of drains in TKA confers no benefits in the outcomes evaluated.

scholarly journals A non-randomized prospective study of the blood sparing effect of tranexamic acid in total knee replacement

2016 ◽  
Vol 3 (1) ◽  
pp. 12
Author(s):  
Anand Gupta ◽  
Ashok Nagla ◽  
Vinay Tantuway ◽  
Rishi Gupta ◽  
Vivek Patel ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Subcutaneous Tissue ◽  
Skin Incision ◽  
Total Blood Loss ◽  
Postoperative Blood Loss ◽  
Total Blood ◽  
Total Knee

<p class="abstract"><strong>Background:</strong> Several techniques are available to minimize the likelihood of blood transfusion following total knee arthroplasty. Tranexamic acid, an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin has been reported to reduce intraoperative and postoperative blood loss in patients undergoing total hip and total knee arthroplasties with or without cement. The objective of this study was to assess the efficacy of antifibrinolytic treatment along with other measures like saline adrenaline infusion, no drain, no tourniquet and hypotensive anaesthesia in reducing perioperative blood loss during total knee replacement<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Between January 2011 to January 2016,  seventy five consecutive patients who had given written informed consent, undergoing a TKR received tranexamic acid 15 mg/kg body weight intravenous 5 minutes before the skin incision and two doses afterwards (3 and 6 hours after the first dose respectively). TKR was performed in a routine fashion without tourniquet. The saline adrenaline (1:200000) was infiltrated into the skin subcutaneous tissue and capsule before skin incision. A routine closure was carried out without drain. Total blood loss including the hidden blood loss was calculated. All patients were monitored for anemia and postoperative thromboembolic complications.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average total blood loss in study group is 433 ± 148 ml. This is much lesser than what other studies have reported. Mean reduction in hemoglobin levels (gm/dl) between preoperative and postoperative readings is 1.6 gm/dl. One patient had a postoperative DVT which was treated with rivaroxaban 20 mg OD for 6 weeks (oral anticoagulant)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Antifibrinolytic agents like tranexamic acid used along with other measures reported in this study produces a significant decrease in blood loss in patients undergoing total knee replacement<span lang="EN-IN">.</span></p>

Correction of antithrombin deficiency in perioperative period in cardiac surgery patients

2020 ◽  
Author(s):  
М.М. Рыбка ◽  
Е.А. Рогальская ◽  
Б.В. Мещанов ◽  
О.В. Лагутина ◽  
К.В. Мумладзе
Keyword(s):  
Blood Loss ◽  
Perioperative Period ◽  
Skin Incision ◽  
Postoperative Blood Loss ◽  
Antithrombin Deficiency ◽  
Cardiac Pathology ◽  
Second Stage ◽  
Intraoperative Period ◽  
Moderate Negative Correlation ◽  
Group 2

Введение: В качестве антикоагулянта у пациентов с сочетанием порока митрального клапана (МК) и ишемической болезнью сердца (ИБС) в периоперационном периоде используется гепарин. Терапевтическая активность гепарина зависит от уровня активности антитромбина (АТ). Дефицит АТ увеличивает риск тромбоза. Цель исследования: оценить эффективность и безопасность препаратной коррекции дефицита АТ в интраоперационном периоде у пациентов с сочетанием по рока МК и ИБС. Материалы и методы: Обследовано 30 доноров и 46 пациентов с ИБС и патологией МК. Измерение аналитов проводили на 3 этапах: до кожного разреза, после ушивания операционной раны, через 24 ч после начала операции. В зависимости от уровня активности АТ (cut-off 60%) пациенты с этапа 2 были разделены на 2 группы. Пациенты обеих групп получали лечение в соответствии со стандартным анестезиологическим протоколом, пациентам группы 2 дополнительно для коррекции дефицита АТ вводили препарат Антитромбин- III (Бакстер АГ, Австрия). Результаты: Не обнаружено разницы между группами по объему послеоперационной кровопотери, продолжительности искусственной вентиляции легких и времени пребывания в отделении реанимации и интенсивной терапии. Более низкая активность АТ в группе 2 сохранялась на всех этапах исследования. При нормировании снижения уровня АТ в группе 2 обнаружена более выраженная динамика. Аналогичные результаты получены для этапов 2 и 3 при нормировании восстановления активности АТ. Обнаружена умеренная отрицательная корреляция снижения активности АТ и времени пережатия аорты, уровня Д-димера и активности АТ на этапе окончания операции. Заключение: Исходная активность АТ у всех обследованных пациентов была ниже, чем в группе доноров. У пациентов с исходно низким уровнем АТ документирована более выраженная динамика его снижения. Восстановление активности АТ после препаратной коррекции его дефицита происходило значимо эффективнее. Пациентам с сочетанием порока МК и ИБС рекомендуется интраоперационная коррекция Антитромбином при снижении активности < 60% к моменту окончания операции. Применение препарата безопасно и не ведет к увеличению кровопотери. Background: Heparin is used as an anticoagulant perioperatively in patients with combined cardiac pathology. The heparin therapeutic activity depends on the level of antithrombin (AT) activity. AT defi ciency increases the risk of thrombosis. Objectives: to access the effectiveness and safety of drug correction of AT defi ciency in the intraoperative period in patients with combined mitral valve defect (MVD) and ischemic heart disease (IHD). Patients/Methods: 30 healthy blood donors and 46 patients with IHD and MVD were examined. The analytes were measured at 3 stages: before the skin incision, after suturing the operating wound, and 24 hours after the start of the operation. Depending on the AT activity at the second stage (cut-off 60%) patients were divided into 2 groups. All patients received treatment according to the standard anesthetic protocol; group 2 patients were given Antithrombin III (Baxter AG, Austria) to correct AT defi ciency. Results: There was no difference between the groups in the postoperative blood loss, duration of ventilation and ICU stay. The lower activity of AT in group 2 patients remained at all study stages. When the decrease in AT level was rationed, more pronounced dynamics was found in group 2. Similar results were found at stages 2 and 3 after the AT activity restoration also was rationed. Moderate negative correlation at the stage 2 was found between the drop of AT activity and the time of aortic clamping, and between the D-dimer level and AT activity. Conclusions: The initial AT activity in all examined patients was lower than in the blood donor group. In patients with an initially low AT level a more pronounced dynamic of its decrease was documented. Recovery of AT activity was significantly more effective after drug correction of its defi ciency. For patients with MVD and IHD combination intraoperative correction with Antithrombin is recommended if the activity decreases by < 60% by the end of the operation. The use of the drug is safe and does not lead to increased blood loss.

Нemocoagulation parameters in extensive liver resections

2021 ◽  
Author(s):  
Г.Э. Черкасов ◽  
И.Н. Соловьева ◽  
Н.Н. Багмет
Keyword(s):  
Blood Loss ◽  
Liver Tissue ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Postoperative Blood Loss ◽  
Control Group ◽  
Reference Ranges ◽  
Affecting Factors ◽  
Group 2 ◽  
Group 1

Введение. Нормализация параметров гемостаза после обширной резекции печени является профилактикой послеоперационной кровопотери, печеночной недостаточности и других осложнений. Цель исследования: проанализировать стандартные показатели гемостаза при обширной резекции печени (ОРП) и оценить влияющие на них факторы: характер заболевания, объем интраоперационной кровопотери, объем использованных гемокомпонентов. Материалы и методы. Обследовано 374 пациента, оперированных по поводу доброкачественных и злокачественных образований печени с 2000 по 2019 гг. Сформировано 2 группы: 93 пациента, оперированные в 2000–2006 гг. (группа 1), и 281 пациент, оперированные в 2007–2019 гг. (группа 2), когда использовали новые кровесберегающие технологии выделения и резекции печеночной ткани; в группу контроля вошли 89 соматически здоровых родственных доноров печени. До операции и в 1-е, 3-и и 7-е сутки послеоперационного периода изучены стандартные показатели плазменного гемостаза: фибриноген, активированное частичное тромбопластиновое время, международное нормализованное отношение и содержание тромбоцитов. Контролировали объем кровопотери и расход донорских гемокомпонентов. Результаты. Средний объем кровопотери в 2000–2006 гг. был в 1,8 раза больше, чем в последующие годы. Соответственно, объем перелитой эритромассы в группе 1 был выше в 2,8 раза, свежезамороженной плазмы — в 1,8 раза по сравнению с группой 2. Показатели гемостазиограммы до операции у всех больных были в референсных пределах. Критических нарушений гемокоагуляции после операций ОРП не наблюдалось. Отмечена некоторая тенденция к гипокоагуляции, максимально прослеживаемая у больных группы 1. Сохранение эффективной гемокоагуляции и значений гемоглобина было достигнуто адекватной гемотрансфузионной заместительной терапией. Заключение. На объем кровопотери при ОРП с высокой степенью значимости влияют метод диссекции ткани печени, маневр Прингла и характер новообразования. В свою очередь, параметры гемостаза зависят от величины кровопотери и адекватности ее замещения донорскими гемокомпонентами. Background. Normalization of hemostasis parameters after extensive liver resection (ELR) is a prevention of postoperative blood loss, liver failure and other complications. Objectives: to analyze the standard hemostasis parameters in ELR and to assess the affecting factors: the nature of the disease, the volume of intraoperative blood loss, the volume of used hemocomponents. Patients/Methods. We observed 374 patients operated on for benign and malignant liver formations for 20 years. Since 2006, blood-saving technologies have been used for isolation and resection of liver tissue. We compared 93 patients ope rated on in 2000–2006 (group 1), 281 patients operated on in 2007–2019 (group 2), and 89 healthy liver donors (control group). Standard parameters of plasma hemostasis — fibrinogen level, activated partial thromboplastin time, international normalized ratio and platelet count before surgery and on the 1st, 3rd and 7th days after surgery were studied. We controlled the volume of blood loss and the consumption of donor hemocomponents. Results. The average volume of blood loss in 2000–2006 was 1.8 times higher than in subsequent years. Accordingly, the volume of transfused erythromass in group 1 was 2.8 times higher, and the volume of transfused fresh frozen plasma was 1.8 times higher, than in group 2. Almost all hemostasiogram parameters before surgery in all patients were within the reference ranges. Critical coagulation disorders after ELR were not observed. A certain tendency towards hypocoagulation was noted that was maximally traced in patients of group 1. Maintaining effective hemocoagulation and hemoglobin values was achieved by adequate hemotransfusion replacement therapy. Conclusions. The method of liver tissue dissection, Pringle’s maneuver, and the nature of the neoplasm significantly affect the volume of blood loss in ELR. In turn, hemostasis parameters depend on the amount of blood loss and the adequacy of its replacement with donor hemocomponents.

Comparison of Incidence of Neonatal Anemia in Different Timing of Delayed Cord Clamping; at 30 Seconds, 1 Minute and 2 Minutes in Term Vaginal Delivery: A Randomized Controlled Trial

2020 ◽  
Vol 103 (12) ◽  
pp. 1255-1261
Keyword(s):  
Blood Loss ◽  
Controlled Trial ◽  
Controlled Study ◽  
Delayed Cord Clamping ◽  
Randomized Controlled ◽  
Cord Clamping ◽  
Estimated Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: To compare the effect of cord clamping time on the incidence of neonatal anemia, clinical outcomes, and maternal and neonatal complications in term vaginal delivered newborns. Materials and Methods: A randomized controlled study was undertaken. Two hundred forty healthy full term vaginal delivered newborns were randomly allocated to either 30-seconds, 1-minute, or 2-minutes groups (group 1, 2, and 3) of umbilical cord clamping. During the interval between delivery and cord clamping, the attendant held the neonate supine at the level of the introitus. Neonatal venous hematocrit (Hct) was measured at 48 to 72 hours after birth. Results: Two hundred thirty newborns completed the present study. Neonatal anemia (Hct less than 45%) was detected in six of 77 cases (7.8%) in group 1, five of 76 cases (6.6%) in group 2, and three of 77 case (3.9%) in group 3, and there were no significant differences among the groups. Mean venous hematocrit values at 48 to 72 hours of life ± standard deviations were 53.1±6.4% in group 1, 53.0±5.5% in group 2, and 53.0±5.7% in group 3. The incidence of polycythemia (hematocrit more than 65%) and neonatal jaundice were similar among all the groups. There were no significant differences in the estimated postpartum blood loss and other neonatal outcomes. Conclusion: Neonatal hematocrit was not significantly different following delayed cord clamping (DCC) at 30-seconds, 1-minute, and 2-minutes, but the incidence of neonatal anemia decreased with the longer timing of DCC. The estimated blood loss and other complications were not different between the groups. Therefore, a minimum of a one minute DCC should be considered for neonatal anemic prevention when compared with the 30-seconds DCC. Keywords: Delayed cord clamping, Timing, Hematocrit, Neonatal anemia

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