scholarly journals Optimization of antifibrinolytic protection during neurosurgical operations

2012 ◽  
Vol 93 (3) ◽  
pp. 438-442
Author(s):  
L R Sultanov
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Retrospective Analysis ◽  
Blood Volume ◽  
Postoperative Blood Loss ◽  
Intraoperative Blood Loss ◽  
Circulating Blood Volume ◽  
The Third ◽  
Brain And Spinal Cord ◽  
The Brain

Aim. To conduct a retrospective analysis of intraoperative and postoperative blood loss during removal of brain tumors with the usage of tranexamic acid and infusion correction of hemodynamically significant blood losses. Methods. The study included 139 patients operated on for tumors of the brain and spinal cord, and treated with tranexamic acid. Distribution of patients according to the volume of blood loss was as follows: the first group - up to 500 ml of blood loss, 48 patients (34.5%); the second group - 500-1200 ml of blood loss, 72 patients (51.7%); the third group - more than 1200 ml of blood loss, 19 patients (13.9%). Results. The retrospective analysis has shown that 34.5% of patients (first group) were operated with the lowest blood loss - up to 10% of the circulating blood volume; 51.7% of patients (second group) - with a blood loss of 20 to 30% of the circulating blood volume. In the third group, which included 13.9% of patients, there was a blood loss of more than 30% of the circulating blood volume, which is defined as hemodynamically significant. It is in the third group, as shown by the analysis, that in addition a therapeutic dose of tranexamic acid 15-20 mg/kg was administered. The extent and intensity of intraoperative blood loss were dependent on many factors, mainly on the nature of the tumor process. Conclusion. It was established that the changes of the hemostatic system were depended on the degree of hemodilution; the use of tranexamic acid made it possible to reduce the amount of postoperative blood loss, despite the degree of intraoperative blood loss.

scholarly journals The role of Tranexamic acid in reducing the need for intraoperative and postoperative blood transfusion in patients undergoing arthroplasty for osteoarthritis

2021 ◽  
Vol 12 (1) ◽  
pp. 384-387
Author(s):  
Thiyagarajan U ◽  
Senthil Loganathan ◽  
Raghavendar ◽  
Pradeep P
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Low Dose ◽  
Postoperative Blood Loss ◽  
Renal Diseases ◽  
Intraoperative Blood Loss ◽  
Allogenic Blood ◽  
Postoperative Blood Transfusion ◽  
Mechanical Methods

Intraoperative blood loss and postoperative anaemia in patients undergoing arthroplasty of the hip and knee increase patient's morbidity and mortality. This increases the need for postoperative transfusion of blood products. Though mechanical methods like using tourniquet reduce the intraoperative blood loss, postoperative loss and resulting anaemia cannot be prevented. Our aim was to establish that the use of low dose tranexamic acid Intravenously and Topically in these patients reduce the total blood loss in these patients and hence the need for postoperative blood transfusion and associated complications of anaemia. Our study conducted in SRIHER between 2018-2020 prospectively, included an analysis of 84 patient's undergoing arthroplasty of the hip and knee. All patients included were above 55 years undergoing arthroplasty for hip and knee for osteoarthritis. Patients with h/o stroke, cardiac stents and chronic liver and renal diseases were excluded. Intravenous Tranexamic acid 1gm was given to all patients an hour before surgery as an infusion in normal saline along with tranexamic acid 500mg injected through the drain after closure. The average blood loss was 480ml intraoperatively and the average drain volume was 140ml. Only 14 patients (16.6%) had postoperative anaemia and required transfusion of allogenic blood. The mean postoperative haemoglobin in these patients was 12.2gm/dl. Our study indicates that low dose intravenous and topical Tranexamic acid significantly reduces the intraoperative and postoperative blood loss and resulting anaemia. This effectively reduces the need for postoperative blood transfusion and associated complications.

scholarly journals Is There a Role for Preoperative Local Infiltration of Tranexamic Acid in Elective Spine Surgery? A Prospective Randomized Controlled Trial Analyzing the Efficacy of Intravenous, Local Infiltration, and Topical Administration of Tranexamic Acid

2019 ◽  
Vol 11 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Viswanadha Arun-Kumar ◽  
J. Naresh-Babu
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Spine Surgery ◽  
Postoperative Blood Loss ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Local Infiltration ◽  
Safety And Efficacy ◽  
Instrumented Spine Surgery

Study Design: Randomized control trial. Objective: The purpose of the study is to evaluate the safety and efficacy of tranexamic acid in reducing blood loss when administered through various routes in instrumented spine surgeries. Methods: A total of 104 patients undergoing instrumented spine surgery were randomly assigned to 4 groups (n = 26 in each group). Groups included (1) ivTXA—intravenous administration of tranexamic acid (TXA) 1 hour prior to surgery, (2) loTXA—local infiltration of TXA bilaterally into the paraspinal musculature prior to incision, (3) tTXA—topical application of TXA just before wound closure, and (4) control group. Outcome measures included intraoperative blood loss, postoperative blood loss, need for blood transfusion, length of hospital stay, and hematological parameters. Results: All the 3 different modes of TXA administration were found to be effective in reducing blood loss in the treated groups compared with the control group. Intraoperative blood loss was significantly reduced in ivTXA (223.6 ± 40.1 mL, P < .0001) and loTXA (256.07 ± 119 mL, P = .0039) groups when compared with controls (344 ± 88.5 mL).The postoperative blood loss was least in tTXA followed by ivTXA, loTXA, and controls. There was 67% reduction in need for blood transfusion in tTXA group, 55.5% reduction in ivTXA group, and 33% reduction in loTXA group when compared with the control group. Conclusion: In instrumented spine surgery, ivTXA and loTXA were found to be equally effective in reducing the intraoperative blood loss. The tTXA has better postoperative blood conserving effects. This is the first study to detail about safety and efficacy on local infiltration of TXA in spine surgery, which is an effective and safe method for reducing intraoperative blood loss.

Tranexaminezuur in de gynaecologische en senologische heelkunde: een literatuuroverzicht

2022 ◽  
Author(s):  
J. Wytsman ◽  
K. Traen ◽  
W. Froyman ◽  
E. Despierre
Keyword(s):  
Postoperative Complications ◽  
Blood Transfusion ◽  
Literature Review ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Breast Surgery ◽  
Additional Treatment ◽  
Postoperative Blood Loss ◽  
Intraoperative Blood Loss ◽  
Total Blood

Tranexamic acid in gynecological and breast surgery: a literature review In gynecological and breast surgery, intra- or postoperative blood loss can cause many complications. A large number of interventions have already been described in literature to limit intraoperative blood loss. Tranexamic acid significantly reduces the amount of vaginal blood loss in women with menorrhagia and is also recommended as a treatment for postpartum hemorrhage. Tranexamic acid has been shown to be safe and efficient in limiting blood loss in many other surgical disciplines. In this literature review, the different applications of the use of tranexamic acid in gynecological and breast surgery are explained. The conclusion is that tranexamic acid can be a safe additional treatment that can reduce the total blood loss and the risk of postoperative complications and blood transfusion in various types of gynecological and breast surgery.

scholarly journals SPECIFICITY OF USING TRANEXAMIC ACID IN PATIENTS WITH CARDIAC SURGERY

2021 ◽  
Vol 29 (5) ◽  
pp. 590-597
Author(s):  
K.V. Bodyakov ◽  
◽  
A.V. Marochkov ◽  
A.S. Kylik ◽  
V.A. Dudko ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Balance Method ◽  
Postoperative Blood Loss ◽  
Open Heart ◽  
Circulating Blood Volume ◽  
Perioperative Blood Loss

Objective. To evaluate the efficacy of tranexamic acid (TA) in cardiac surgery patients undergoing the open-heart surgery under conditions of artificial blood circulation (ABC) by determining the volume of perioperative blood loss using the hemoglobin balance method. Methods. A pilot non-randomized prospective clinical trial was conducted. To determine the effectiveness of TA use, 2 groups of patients were formed: the 1<sup>st</sup> group, without TA application (n=40), the 2<sup>nd</sup> group - with TA application intraoperatively (n=40). In group 2, prior to sternotomy, intravenous bolus injection of TA (1000 mg (20 ml of 5% solution)) was performed and further titration of TA through a syringe dispenser was continued at a rate of 4 ml/hour (200 mg/hour) until the end of the operation.The volume of intraoperative blood-loss was assessed by the hemoglobin balance method. A special protocol was developed to control the volume of postoperative blood loss. Results. The volume of circulating blood (VCB) calculated by Nadler’s formula for the first group was 5433.2 (5008.5; 5768.2) ml, for the second - 5214.0 (4944.1; 5546.8) ml. In the first group of patients who did not receive TA during open- heart surgery, the volume of blood loss was 1460.6 (1196.8; 1725.8) ml or 26.9 % of the average circulating blood volume (CBV), and in the second group of patients who received TA intraoperatively - 1090.7 (882.3; 1468.6) ml or 20.9% of the CBV (p<0,001). Conclusion. The application of TA in cardiac surgery patients during open-heart surgery with ABC according to the developed algorithm (1000 mg/bolus, titration during surgery-200 mg/h) for the purpose of blood saving the volume of blood-loss was reduced by 25.3% compared to the control group. What this paper adds Algorithm for the use of tranexamic acid to reduce perioperative blood loss in cardiac surgery using cardiopulmonary bypass (CPB) during open-heart surgery has been developed. This algorithm included intravenous tranexamic acid injection (1,000 mg.) followed by titration during the operation - 200 mg/h). The use of this algorithm in cardiac surgical procedures allows reducing the volume of blood loss by 25.3%.

Double-blind, randomized controlled trial of tranexamic acid in minor lumbar spine surgery: no effect on operative time, intraoperative blood loss, or complications

2019 ◽  
Vol 31 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Signe Elmose ◽  
Mikkel Ø. Andersen ◽  
Else Bay Andresen ◽  
Leah Yacat Carreon
Keyword(s):  
Placebo Group ◽  
Lumbar Spine ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Spine Surgery ◽  
Operative Time ◽  
Decompressive Surgery ◽  
Lumbar Spine Surgery ◽  
Intraoperative Blood Loss ◽  
Double Blind

OBJECTIVEThe purpose of this study was to investigate the effect of tranexamic acid (TXA) compared to placebo in low-risk adult patients undergoing elective minor lumbar spine surgery—specifically with respect to operative time, estimated blood loss, and complications. Studies have shown that TXA reduces blood loss during major spine surgery. There have been no previous studies on the effect of TXA in minor lumbar spine surgery in which these variables have been evaluated.METHODSThe authors enrolled patients with ASA grades 1 to 2 scheduled to undergo lumbar decompressive surgery at Middelfart Hospital into a double-blind, randomized, placebo-controlled, parallel-group study. Patients with thromboembolic disease, coagulopathy, hypersensitivity to TXA, or a history of convulsion were excluded. Patients were randomly assigned, in blocks of 10, to one of 2 groups, TXA or placebo. Anticoagulation therapy was discontinued 2–7 days preoperatively. Prior to the incision, patients received either a bolus of TXA (10 mg/kg) or an equivalent volume of saline solution (placebo). Independent t-tests were used to compare differences between the 2 groups, with statistical significance set at p < 0.05.RESULTSOf the 250 patients enrolled, 17 patients were excluded, leaving 233 cases for analysis (117 in the TXA group and 116 in the placebo group). The demographics of the 2 groups were similar, except for a higher proportion of women in the TXA group (TXA 50% vs placebo 32%, p = 0.017). There was no significant between-groups difference in operative time (49.53 ± 18.26 vs 54.74 ± 24.49 minutes for TXA and placebo, respectively; p = 0.108) or intraoperative blood loss (55.87 ± 48.48 vs 69.14 ± 83.47 ml for TXA and placebo, respectively; p = 0.702). Postoperative blood loss measured from drain output was 62% significantly lower in the TXA group (13.03 ± 21.82 ml) than in the placebo group (34.61 ± 44.38 ml) (p < 0.001). There was no significant difference in number of dural lesions or postoperative spinal epidural hematomas, and there were no thromboembolic events.CONCLUSIONSTranexamic acid did not have a statistically significant effect on operative time, intraoperative blood loss, or complications. This study gives no evidence to support the routine use of TXA during minor lumbar decompressive surgery.Clinical trial registration no.: NCT03714360 (clinicaltrials.gov)

scholarly journals Predictors of complications occurring after open and robot-assisted prostate cancer surgery: a retrospective evaluation of 1062 consecutive patients treated in a tertiary referral high volume center

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Alessandro Tafuri ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Marco Sebben ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Postoperative Complications ◽  
Radical Prostatectomy ◽  
Blood Loss ◽  
Open Approach ◽  
Intraoperative Blood Loss ◽  
Tertiary Referral ◽  
Robot Assisted ◽  
The Third ◽  
Major Complications

AbstractTo investigate factors associated with the risk of major complications after radical prostatectomy (RP) by the open (ORP) or robot-assisted (RARP) approach for prostate cancer (PCa) in a tertiary referral center. 1062 consecutive patients submitted to RP were prospectively collected. The following outcomes were addressed: (1) overall postoperative complications: subjects with Clavien-Dindo System (CD) one through five versus cases without any complication; (2) moderate to major postoperative complications: cases with CD < 2 vs.  ≥ 2, and 3) major post-operative complications: subjects with CDS CD ≥  3 vs.  < 3. The association of pre-operative and intra-operative factors with the risk of postoperative complications was assessed by the logistic regression model. Overall, complications occurred in 310 out of 1062 subjects (29.2%). Major complications occurred in 58 cases (5.5%). On multivariate analysis, major complications were predicted by PCa surgery and intraoperative estimated blood loss (EBL). ORP compared to RARP increased the risk of major CD complications from 2.8 to 19.3% (OR = 8283; p < 0.0001). Performing ePLND increased the risk of major complications from 2.4 to 7.4% (OR = 3090; p < 0.0001). Assessing intraoperative blood loss, the risk of major postoperative complications was increased by BL above the third quartile when compared to subjects with intraoperative blood loss up to the third quartile (10.2% vs. 4.6%; OR = 2239; 95%CI: 1233–4064). In the present cohort, radical prostatectomy showed major postoperative complications that were independently predicted by the open approach, extended lymph-node dissection, and excessive intraoperative blood loss.

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

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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