Effects of tranexamic acid and exogenous fibrin monomer on the liver injury area and systemic circulation in pharmacological suppression of platelet function in an experiment

Aim. To identify and compare the morphological, hemostatic and hemostasiological consequences of intravenous administration of tranexamic acid and fibrin monomer in controlled liver injury against drug-induced thrombocytopathy. Methods. The morphological features of fibrin formation in the area of liver injury after spontaneous bleeding arrest combined with the indicators of blood loss in the animals treated with intravenous placebo, tranexamic acid or fibrin monomer was studied in 69 male rabbits. The effects of these drugs were assessed against thrombocytopathy associated with the combined use of acetylsalicylic acid and clopidogrel. Platelet number and function (adnosine diphosphate-induced aggregation), the data of thromboelastometry and calibrated automated thrombogram, fibrinogen concentration and D-dimer level were considered in the blood test. The feature distribution in the samples was assessed using the ShapiroWilk test. Depending on the distribution, Student's t-test, MannWhitney U test or Wilcoxon signed-rank test were used to test for a significant difference between the features. Differences in mortality rate were established by using Fisher's exact test. The differences were considered statistically significant at p 0.05. Results. A model of thrombocytopathy which showed decreased platelet aggregation function (by 4.5 times), increased blood loss (by 40%), and high mortality (53.9%) was reproduced. Only a small accumulation of thrombotic material was noted on the injured surface of such animals. The use of tranexamic acid led to decreased post-traumatic bleeding (2.5 times) and animal mortality (20%). The latter was provided on the wound surface by increasing the thickness of both thrombotic deposits and fibrin strands. When fibrin monomer was used, the phenomenon of an overcompensated decrease in blood loss (by 6.7 times) accompanied by zero mortality was noted despite a pronounced decrease in platelet aggregation. The maximum increase in the thickness of thrombotic material and fibrin strands was morphologically determined in the injury area compared with other animal groups. Conclusion. Morphological features of traumatic hemostatic effect at the injured area when using tranexamic acid and fibrin monomer have a number of differences despite the similarity of the achieved results in minimizing blood loss.

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Comparative study of the effect of tranexamic acid and exogenous fibrin monomer on fibrin formation in the injury area during stimulation of fibrinolysis by streptokinase

Hematology and Transfusiology ◽

10.35754/0234-5730-2021-66-4-556-566 ◽

2021 ◽

Vol 66 (4) ◽

pp. 556-566

Author(s):

A. P. Momot ◽

V. M. Vdovin ◽

D. A. Orekhov ◽

I. P. Bobrov ◽

I. I. Shakhmatov ◽

...

Keyword(s):

Liver Injury ◽

Blood Loss ◽

Tranexamic Acid ◽

Blood Cells ◽

Low Dose ◽

Venous Blood ◽

Fibrinogen Concentration ◽

Morphological Pattern ◽

Injury Area ◽

Stimulation Of

Introduction. Earlier studies of low-dose fibrin monomer (FM) demonstrated that low-dose FM has unique hemostatic properties in vivo.Aim — to compare the morphological consequences of intravenous administration of tranexamic acid (TXA) and FM with the hemostatic and hemostasiological effects in hypofibrinogenemia caused by the use of streptokinase after controlled liver injury.Materials and methods. The morphological pattern of fibrin formation in the liver injury area after spontaneous arrest of bleeding in the animals treated with streptokinase or placebo was studied in 73 male rabbits of the Chinchilla breed, split into four groups. In three groups, the study was performed under the conditions of intravenous administration of placebo, TXA, or FM against the background of fibrinolysis activation by streptokinase. Platelet count in the blood, the concentration of fibrinogen, as well as the results of calibrated thrombography, were taken into account.Results. Sequential administration of streptokinase and TXA was accompanied by decreased fibrinogen concentration (by 29.6 %) and, at the same time, a reduction in blood loss (by 15.4 times) in comparison with animals where placebo was used instead of TXA. A decrease in blood loss was associated with increased thickness of thrombotic deposits at the edge of the wound, mainly consisting of red blood cells. These observations were combined with data on the acceleration of thrombin formation in venous blood plasma in a calibrated thrombography test (Peak thrombin 65.4 nmol/L to 109.6 nmol/L in the placebo group). Compared to the observations where placebo was administered instead of FM, however, the sequential use of streptokinase and FM also led to a decrease in blood loss (by 11.0 times) despite decreased fibrinogen concentration (by 23.3 %). A decrease in blood loss was also associated with platelet consumption in venous blood and with increased thickness of thrombotic deposits on the injury surface, where, in addition to red blood cells, the accumulation of fibrin masses was determined by the morphological pattern.Conclusion. The mechanisms of the systemic hemostatic effect of TXA and FM are different, despite the similarity of the achieved hemostatic effects in the conditions of stimulation of blood fibrinolytic activity. These findings expand the understanding of new therapeutic possibilities for reducing post-traumatic blood loss.

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Effect of an exogenous fibrin monomer on hemostatic potential and fibrin formation in the area of controlled liver injury on the background of heparin administration in experiment

Nauchno-prakticheskii zhurnal «Patogenez» ◽

10.25557/2310-0435.2020.04.32-42 ◽

2020 ◽

pp. 32-42

Author(s):

А.П. Момот ◽

В.М. Вдовин ◽

Д.А. Орехов ◽

И.П. Бобров ◽

И.И. Шахматов ◽

...

Keyword(s):

Liver Injury ◽

Blood Loss ◽

Morphological Study ◽

Fibrillar Structure ◽

Fibrinogen Concentration ◽

Wound Surface ◽

Circulating Blood Volume ◽

Hemostatic Effect ◽

Fibrin Formation ◽

Fibrin Monomer

Актуальность. В проведенных ранее исследованиях на «гепариновой» модели посттравматической кровопотери был продемонстрирован гемостатический эффект экзогенно вводимого фибрин-мономера (ФМ) (доза 0,25 мг/кг), сопоставимый по выраженности с применением протамина сульфата (ПС), что не получило своего объяснения из-за отсутствия данных морфологического исследования в зоне травмы печени. Цель. Сопоставить гемостатические, гемостазиологические и морфологические последствия использования ФМ, при его внутривенном введении в дозе 0,25 мг/кг, у гепаринизированных животных, после дозированной травмы печени. Материалы и методы. На 77 здоровых кроликах породы «Шиншилла» моделировали гипокоагуляцию нефракционированным гепарином (НГ) в/в в дозе 150 ед/кг. Профилактику интраоперационных кровотечений осуществляли введением ФМ в/в в дозе 0,25 мг/кг, за один час до травмы, и ПС в/в в дозе 1,5 мг/кг за 10 мин до травмы. После нанесения дозированной травмы печени кровопотерю оценивали в % от объема циркулирующей крови. Исследовали также содержание тромбоцитов в крови, активированное парциальное тромбопластиновое время (АПТВ), уровень фибриногена и количество D-димера, параметры калиброванной тромбографии. Ткани печени в области раневой поверхности для гистологических исследований получали после спонтанной остановки кровотечения. Результаты. Гепаринизированным животным была свойственна повышенная кровопотеря на фоне выраженной гипокоагуляции и снижении генерации тромбина. Применение антидота НГ - ПС, минимизировало потерю крови (снижение кровопотери в 4,0 раза по сравнению с плацебо) и приводило к восстановлению гемостатического потенциала. Согласно морфологическим исследованиям, это достигалось увеличением толщины тромботических масс (в 15,1 раза по сравнению с плацебо). В не меньшей степени гемостатический эффект был достигнут при замене ПС на ФМ (уменьшение кровопотери в 5,1 раза по сравнению с плацебо). Данные эффекты не сопровождались коррекцией гипокоагуляционного сдвига и восстановлением генерации тромбина. В последнем случае определено меньшее по выраженности фибринообразование в зоне травмы (толщина фибрина 55,2 мкм против 201,8 мкм при применении ПС; р < 0,001). Еще одной отличительной особенностью явилось отсутствие фибриллярной структуры фибрина и наличие в тромботических массах многочисленных тромбоцитов, тогда как их число в просветах сосудов рядом с раневой поверхностью было минимальным. Заключение. Приведенные данные позволяют обозначить возможные механизмы и пути остановки постравматического кровотечения при использовании гепарина. Background. In previous studies using the heparin model of post-traumatic blood loss, a hemostatic effect of exogenous fibrin monomer (FM) (0.25 mg/kg) was observed, which was comparable in intensity to the effect of protamine sulfate (PS) and remained unexplained due to the lack of morphological study data for the area of liver injury. Aim. To compare hemostatic, hemostasiological, and morphological consequences of intravenous administration of FM 0.25 mg/kg following controlled liver injury in heparinized animals. Methods. Hypocoagulation was simulated by i.v. administration of unfractionated heparin (UFH) 150 U/kg to 77 healthy Chinchilla rabbits. Intraoperative bleeding was prevented by i.v. administration of FM 0.25 mg/kg one hour prior to the injury or PS 1.5 mg/kg 10 minutes prior to the injury. After the controlled liver injury, blood loss was measured and expressed in % of the circulating blood volume. Blood platelet count, activated partial thromboplastin time (APTT), fibrinogen concentration, D-dimer concentration, and data of calibrated thrombography were also studied. Samples of liver tissue from the wound surface area were collected for histology after spontaneous arrest of bleeding. Results. Heparinized animals were characterized by increased blood loss due to pronounced hypocoagulation and decreased thrombin production. The use of the UFH antidote, PS, minimized the blood loss (by 75% compared to placebo) and resulted in restoration of the hemostatic potential. According to results of the morphological study, this effect was due to increased thickness of thrombotic masses (15.1 times compared to placebo). At least equal hemostatic effect was obtained when PS was replaced with FM (80% decrease in blood loss compared to placebo). These effects were not associated with correction of the hypocoagulation shift or recovery of the thrombin generation. In this process, fibrin formation in the injury area was less pronounced (fibrin thickness 55.2 µm vs 201.8 µm with PS; p < 0.001). Another distinctive feature was the absence of the fibrillar structure of fibrin and the presence of numerous platelets in thrombotic masses while the platelet number in the lumen of blood vessels near the wound surface was minimal.

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Prevention of massive intraoperative bleedings associated with heparin with the systemic use of fibrin monomer in the experiment

ZHurnal «Patologicheskaia fiziologiia i eksperimental`naia terapiia» ◽

10.25557/0031-2991.2019.04.48-55 ◽

2019 ◽

pp. 48-55

Author(s):

А.П. Момот ◽

В.М. Вдовин ◽

Д.А. Орехов ◽

Н.А. Лычёва ◽

И.Г. Толстокоров ◽

...

Keyword(s):

Liver Injury ◽

Blood Loss ◽

Unfractionated Heparin ◽

Loss Rate ◽

Antithrombin Iii ◽

Fibrinogen Level ◽

Circulating Blood Volume ◽

Intraoperative Bleeding ◽

Fibrin Monomer ◽

Antithrombin Iii Activity

Цель исследования - изучение способности фибрин-мономера предупреждать тяжелую интраоперационную кровопотерю, ассоциированную с введением нефракционированного гепарина, при дозированной травме печени. Методика. На кроликах «Шиншилла» индуцировали гипокоагуляцию нефракционированным гепарином (150 ед/кг). Профилактику интраоперационных кровотечений осуществляли внутривенным введением фибрин-мономера (0,25 мг/кг) за 1 ч до травмы или протамина сульфата (1,5 мг/кг) за 10 мин до травмы. После нанесения стандартной травмы печени оценивали объем (в % ОЦК) и темп (мг/с) кровопотери. Анализировали число тромбоцитов, активированное парциальное тромбопластиновое время, протромбиновое и тромбиновое время свертывания, уровень фибриногена и активность антитромбина III, параметры ротационной тромбоэластометрии крови. Результаты. Объем кровопотери в группах животных после в/в введения фибрин-мономера и протамина сульфата на фоне гепаринизации был, соответственно, в 5,1 и 4,0 раза меньше по сравнению с группой плацебо, получавшей тот же антикоагулянт. Вместе с тем, фибрин-мономер не влиял на параметры коагулограммы (отсутствие видимого гемостазиологического эффекта) и тромбоэластограммы, тогда как применение протамина сульфата в качестве антидота гепарина сопровождалось нормализацией данных тромбоэластометрии и коррекцией гипокоагуляционного сдвига по активированному парциальному тромбопластиновому времени, протромбиновому и тромбиновому времени. Заключение. Установлено, что фибрин-мономер (0,25 мг/кг) снижает посттравматическое кровотечение в условиях блокады свертывания крови гепарином без видимых признаков восстановления гемостатического равновесия. The research objective was to study the ability of fibrin monomer to prevent severe intraoperative blood loss associated with administration of unfractionated heparin in controlled liver injury. Methods. Hypocoagulation was induced in chinchilla rabbits with unfractionated heparin (150 U/kg). Intraoperative bleeding was prevented by administration of fibrin monomer (FM, 0.25 mg/kg, i.v.) one hour prior to the injury and of protamine sulfate (PS, 1.5 mg/kg, i.v.) 10 min prior to the injury. Following the liver injury, blood loss was assessed as percentage of circulating blood volume and the blood loss rate (mg/s). Platelet counts, aPTT, PT, TT, fibrinogen level, antithrombin III activity, and parameters of blood rotation thromboelastometry were analyzed. Results. The volume of blood loss was 5.1 times and 4.0 times less, respectively, after the FM and PS administration during heparinization compared to the placebo group treated with the same anticoagulant. However, FM affected neither coagulogram indexes (no visible hemostasiological effect) nor thromboelastogram while the use of PS as an antidote for heparin was associated with normalization of thromboelastometric data and correction of hypercoagulative changes in aPTT, PT, TT. Conclusion. FM at a dose of 0.25 mg/kg reduced severity of posttraumatic bleeding induced by heparin inhibition of coagulation with no visible signs of hemostatic balance recovery.

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EFFECT OF Ca2+ and Mg2+ ON PLATELET ACTIVATING FACTOR (PAF) INDUCED AGGREGATION AND SPECIFIC BINDING TO HUMAN PLATELETS

10.1055/s-0038-1642879 ◽

1987 ◽

Author(s):

C M Chesney ◽

D D Pifer

Keyword(s):

Platelet Aggregation ◽

Calcium Channel ◽

Binding Sites ◽

Competitive Inhibition ◽

Specific Binding ◽

Human Platelets ◽

High Affinity ◽

Specific Binding Sites ◽

Significant Difference ◽

Induced Aggregation

Gel filtered human platelets (GFP) collected in Tyrode's buffer containing 0.5 mM Ca+2, ImM Mg+2, and 0.35% albumin exhibit high affinity binding of 3H-PAF with a Kd of 0.109 α 0.029 nM (mean α SD; n=13) and 267 α 70 sites per platelet. When fibrinogen (1.67 mg/ml final concentration) is added to these GFP preparations biphasic aggregation is observed with PAF (4 nM). Normal aggregation is also observed with other platelet agonists including ADP, epinephrine, collagen, arachidonic acid, A23187 and thrombin. If GFP is prepared without added Ca+2 or Mg+2 in the presence of 3mM EDTA, platelets do not aggregate in response to PAF. However the number of specific binding sites remains unchanged (387 per platelet) with some decrease in affinity of binding (Kd = 0.2l4nM). In the presence of ImM Mg+2 there is no significant difference in binding kinetics over a range of Ca+2 concentrations (0-2mM). On the other hand the calcium channel blocker verapamil (5-10uM) exhibits competitive inhibition of 3H-PAF as analyzed by Lineweaver-Burk plots. Specific binding of 3H-PAF to GFP in the presence of ImM Mg+2 and ImM EGTA shows Kd of 0.l66nM but with increase in specific binding sites to 665. Despite increase in number of sites and no change in binding affinity, GFP under these conditions does not exhibit platelet aggregation with PAF in doses up to 80 nM.From these data it appears that external Ca+2 is not necessary for specific binding of 3H-PAF to its high affinity receptor. However, calcium does appear to be necessary for second wave aggregation with PAF. While Mg+2 appears to enhance 3H-PAF binding to platelets Mg+2 cannot substitute for Ca+2 in PAF induced platelet aggregation. Although verapamil appears to competitively inhibit binding of PAF to GFP it is not clear whether the inhibition is due to competition at or near the actual PAF receptor or at a site involving the calcium channel.

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Effect of Multiple Doses of Oral Tranexamic Acid on Haemostasis and Inflammatory Reaction in Total Hip Arthroplasty: A Randomized Controlled Trial

Thrombosis and Haemostasis ◽

10.1055/s-0038-1676625 ◽

2018 ◽

Vol 119 (01) ◽

pp. 092-103 ◽

Cited By ~ 7

Author(s):

Duan Wang ◽

Yang Yang ◽

Chuan He ◽

Ze-Yu Luo ◽

Fu-Xing Pei ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Inflammatory Response ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Multiple Dose ◽

Control Group ◽

Total Hip ◽

Estimated Blood Loss ◽

Significant Difference

AbstractTranexamic acid (TXA) reduces surgical blood loss and alleviates inflammatory response in total hip arthroplasty. However, studies have not identified an optimal regimen. The objective of this study was to identify the most effective regimen of multiple-dose oral TXA in achieving maximum reduction of blood loss and inflammatory response based on pharmacokinetic recommendations. We prospectively studied four multiple-dose regimens (60 patients each) with control group (group A: matching placebo). The four multiple-dose regimens included: 2-g oral TXA 2 hours pre-operatively followed by 1-g oral TXA 3 hours post-operatively (group B), 2-g oral TXA followed by 1-g oral TXA 3 and 7 hours post-operatively (group C), 2-g oral TXA followed by 1-g oral TXA 3, 7 and 11 hours post-operatively (group D) and 2-g oral TXA followed by 1-g oral TXA 3, 7, 11 and 15 hours post-operatively (group E). The primary endpoint was estimated blood loss on post-operative day (POD) 3. Secondary endpoints were thromboelastographic parameters, inflammatory components, function recovery and adverse events. Groups D and E had significantly less blood loss on POD 3, with no significant difference between the two groups. Group E had the most prolonged haemostatic effect, and all thromboelastographic parameters remained within normal ranges. Group E had the lowest levels of inflammatory cytokines and the greatest range of motion. No thromboembolic complications were observed. The post-operative four-dose regimen brings about maximum efficacy in reducing blood loss, alleviating inflammatory response and improving analgaesia and immediate recovery.

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Efficacy of tranexamic acid in reducing blood loss, blood and blood products requirements in Cesarian sections for patients with placenta accreta

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-019-0051-9 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Tamer Hamed Ibrahim

Keyword(s):

Platelet Count ◽

Placebo Group ◽

Blood Loss ◽

Tranexamic Acid ◽

Placenta Accreta ◽

Controlled Study ◽

Intraoperative Blood Loss ◽

Blood Products ◽

Coagulation Profile ◽

Significant Difference

Abstract Background Placenta accreta is an obstetric emergency and the main cause of maternal morbidity and mortality due to the associated bleeding and coagulopathy. Tranexamic acid has been widely used to decrease blood loss in trauma patients and patients with postpartum hemorrhage. We aimed at studying the effect of tranexamic acid in reducing blood loss and blood transfusion in patients with placenta accreta. Methods In a double-blinded randomized controlled study, 46 patients were recruited and divided into two groups, Group A is the tranexamic group where patients received 10 mg/kg tranexamic acid after cord clamping and continued on tranexamic infusion 10 mg/kg/h till the end of the surgery. Group B is the placebo where patients received normal saline instead. Primary outcome was the amount of intraoperative blood loss, and other outcomes included the number of blood and blood products transfused intraoperative and in the first 24 h postoperative, the immediate postoperative Hb level, platelet count, and coagulation profile. Data were collected, coded, tabulated, and then analyzed using Minitab® 16.1.0 statistics software package. Variables were presented as mean and standard deviation and analyzed using unpaired t test. Any difference with p value < 0.05 was considered statistically significant. Results Amount of intraoperative blood loss was significantly less in the tranexamic group 2232 ± 1204 ml compared to the placebo group 3405 ± 1193 ml (p value 0.002), and patients in the tranexamic group received less units of packed red blood cells, fresh frozen plasma, and platelets compared to those in the placebo group (4.2 ± 1.9 vs 6.1 ± 2.2 with p value 0.003, 3.4 ± 1.3 vs 4.2 ± 1.2 with P value 0.036 and 4.8 ± 2.1 vs 6.2 ± 2.4 with p value 0.041, respectively). There was no statistically significant difference in the first postoperative Hb level, platelet count, and coagulation profile between the two groups; however, the amount of blood and products transfused in the first 24 h postoperative were significantly less in the tranexamic group Conclusion Tranexamic acid infusion was effective in reducing intraoperative blood loss and intraoperative and postoperative blood and blood products’ transfusion.

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Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2885-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Hao-Yang Wang ◽

Liu Wang ◽

Ze-Yu Luo ◽

Duan Wang ◽

Xin Tang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Total Blood ◽

Significant Difference ◽

Group A ◽

Total Knee ◽

Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

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The Use of Tranexamic Acid in Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00283 ◽

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.

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The Efficacy of Intravenous Tranexamic Acid in Reduction of Blood Loss in Women at High Risk of Postpartum Hemorrhage

QJM ◽

10.1093/qjmed/hcaa056.014 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

K M Diab ◽

R M Mohamed ◽

A G Abdelhay

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Tranexamic Acid ◽

Maternal Mortality ◽

Vaginal Delivery ◽

Control Group ◽

Study Group ◽

Control Groups ◽

Significant Difference ◽

And Control

Abstract Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. All women who carry a pregnancy beyond 20 weeks’ gestation are at risk for PPH and its sequelae. Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Aim of the Work To assess the efficacy and safety intravenous tranexamic acid in reduction of amount of blood loss in high risk women who deliver by cesarean section or vaginal delivery in postpartum period. Patients and Methods This prospective double blind randomized controlled clinical trial study was conducted on 200 patients planned for LSCS or vaginal delivery at Gestational Age ≥ 34 Weeks at Ain Shams University Maternity Hospital. Recruitment of data begun once the protocol was approved by research and ethical committee of the department of obstetrics and gynecology. Results No significant difference between Study and Control groups as regards age (p = 0.508), no significant difference between Study and Control groups as regards Gestational age (p = 0.447),total blood loss (p < 0.001) was significantly lower in study group than control group, Vaginal pads in the 1st 24 hours post-partum was significantly less soaked in study group than control group (p < 0.001). no significant difference between Study and Control groups as regards Preoperative Hemoglobin, Postoperative Hemoglobin was significantly higher in study group than control group (p < 0.001), Reduction in Hemoglobin was significantly less in study group than control group (p < 0.001), no significant difference between Study and Control groups as regards Preoperative Hematocrite, Postoperative Hematocrit was significantly higher in study group than control group (p < 0.001), Reduction in Hematocrite was significantly less in study group than control group (p < 0.001).Need to iron replacement or blood transfusion was significantly less frequent in study group than control group (p = 0.24). Conclusion The use of tranexamic acid prior to cesarean section or vaginal delivery is effective as a prophylaxis against post-partum hemorrhage as shown by the results of this study. It can significantly reduce blood loss during and after cesarean section or vaginal delivery.

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Third generation P2Y12 antagonists inhibit platelet aggregation more effectively than clopidogrel in a myocardial infarction registry

Thrombosis and Haemostasis ◽

10.1160/th13-06-0508 ◽

2014 ◽

Vol 111 (02) ◽

pp. 266-272 ◽

Cited By ~ 18

Author(s):

Philipp Diehl ◽

Katharina Schnabel ◽

Patrick Weik ◽

Qian Zhou ◽

Christoph Bode ◽

...

Keyword(s):

Myocardial Infarction ◽

Platelet Aggregation ◽

Whole Blood ◽

Antiplatelet Agents ◽

Platelet Inhibition ◽

Current Standard ◽

Antiplatelet Effect ◽

P2y12 Antagonists ◽

Significant Difference ◽

Induced Aggregation

SummaryThe current standard of antiplatelet therapy of patients after myocardial infarction includes the P2Y12 receptor antagonists clopidogrel, prasugrel or ticagrelor. This study aimed to compare the antiplatelet effect of clopidogrel, prasugrel and ticagrelor in patients after myocardial infarction. In a single-centre registry the antiplatelet effect of clopidogrel, prasugrel and ticagrelor was investigated by aggregometry in patients after myocardial infarction. To assess the overall capacity of platelet aggregation whole blood was induced with thrombin receptor activating peptide (TRAP; 32 μM). To specifically quantify the effect of P2Y12 antagonists, whole blood was stimulated with 6.4 μM adenosine diphophosphate (ADP). Relative ADP induced aggregation (r-ADP-agg) was defined as the ADP-TRAP ratio to reflect an individual degree of P2Y12-dependent platelet inhibition. Platelet function of 238 patients was analysed [clopidogrel (n=58), prasugrel (n=65), ticagrelor (n=115)]. The r-ADP-agg was 35 ± 14% for patients receiving clopidogrel, 28 ± 10% for patients receiving prasugrel and 26 ± 11% for patients receiving ticagrelor. The r-ADP-agg was significantly lower in patients treated with prasugrel (p=0.0024) or ticagrelor (p<0.0001) compared to clopidogrel. There was no significant difference between patients receiving prasugrel or ticagrelor (p=0.2559). In conclusion, prasugrel and ticagrelor provide a stronger platelet inhibition compared to clopidogrel in patients after myocardial infarction. No significant difference in platelet inhibition was detected between prasugrel and ticagrelor. (registry for patients after Myocardial Infarction Treated with AntiPlatelet agents; DRKS00003146).

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