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 Effect of prophylactic tranexamic acid on blood conservation in Indian women undergoing abdominal hysterectomy

2018 ◽  
Vol 7 (9) ◽  
pp. 3538 ◽  
Author(s):  
Nivedhana Arthi P. ◽  
Jalakandan B. ◽  
Gunaseelan S.
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Normal Saline ◽  
Abdominal Hysterectomy ◽  
Controlled Study ◽  
Risk Of Death ◽  
Transfusion Requirements ◽  
Significant Difference ◽  
Duration Of Surgery

Background: The prevalence of anemia in India is so high that majority of women presenting for hysterectomy are already with borderline hemoglobin status and the perioperative blood loss puts them at risk of death and prolongs recovery. Antifibrinolytic agents, mainly Tranexamic acid (TXA) have been demonstrated to reduce blood loss and transfusion requirements in various surgeries. The present study was done to assess the efficacy of TXA in effectively reducing intraoperative blood loss and the need for transfusion in Indian population undergoing abdominal hysterectomy for benign indications.Methods: This randomized, double-blind, placebo-controlled study was conducted on hundred patients undergoing abdominal hysterectomy. Group T (n = 50)- received TXA 15 mg/kg in 100 ml Normal saline and Group N (n = 50)-received the same volume of Normal saline infused over 15 minutes. Estimated blood loss need for blood transfusion, duration of surgery, postoperative hemoglobin and incidence of adverse events were noted.Results: There was statistically significant reduction in mean blood loss in group T when compared to group N (360 ml versus 540 ml). Accordingly, there was significant difference in the number of patients requiring blood transfusion (12% versus 42%) and also the postoperative hemoglobin levels. The group T patients had a significantly shorter operating time (127.86 versus 148.64 minutes). None of the patients developed any major adverse events.Conclusions: The prophylactic TXA safely and effectively reduces the blood loss and transfusion requirements in Indian patients undergoing abdominal hysterectomy for benign indications.

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.

scholarly journals ε-Aminocaproic acid (EACA) vs. tranexamic acid (TXA) in children undergoing complex cranial vault reconstruction for repair of craniosynostosis

2021 ◽  
Author(s):  
Alexandra Borst ◽  
Christopher Bonfield ◽  
Poornachanda Deenadayalan ◽  
Chi Le ◽  
Meng Xu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Outcome Measures ◽  
Aminocaproic Acid ◽  
Cranial Vault ◽  
Secondary Outcome ◽  
Vascular Access Devices ◽  
Estimated Blood Loss ◽  
Transfusion Requirements ◽  
Significant Difference

INTRODUCTION: Children undergoing complex cranial vault reconstruction (CCVR) for craniosynostosis experience high rates of bleeding and transfusion, increasing risk for perioperative complications. ε-Aminocaproic acid (EACA) and tranexamic acid (TXA) are antifibrinolytic agents that have been shown to reduce intraoperative hemorrhage and transfusion requirements during CCVR. However, the relative efficacy of these two agents has not yet been evaluated. The aim of this study was to compare perioperative blood loss and transfusion rates in children receiving EACA vs. TXA. METHODS: All patients who underwent CCVR from September 2015 to December 2019 at a single center were retrospectively evaluated. Primary outcome measures included intraoperative estimated blood loss, postoperative drain output, transfusion volumes, and calculated blood loss. Secondary outcome measures included hematologic and coagulation parameters. RESULTS: 95 patients were included, with 47 patients in the EACA cohort and 48 patients in the TXA cohort. There were no significant differences in demographics, surgical outcomes, blood loss, transfusion requirement, or perioperative hematologic and coagulation laboratory values between the two cohorts. Adverse events were similar between the groups, but did include two seizure events and two thromboembolic events related to vascular access devices. DISCUSSION: We found no significant difference in blood loss, transfusion requirements, hematologic parameters, or outcomes between pediatric CCVR patients who received EACA vs. TXA. Further research is needed to define optimal antifibrinolytic dosing and duration of therapy. While standard laboratory parameters were similar between groups, future studies investigating coagulation-based and inflammatory assays may be useful in defining surgical-induced coagulopathy.

441 Intravenous Tranexamic Acid Given at Femoral Fragility Fracture Surgery Reduces Blood Transfusion Requirements Four-Fold

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Powell-Bowns ◽  
R Olley ◽  
C McCann ◽  
J Balfour ◽  
C Brennan ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Fragility Fracture ◽  
Mean Difference ◽  
Complication Rates ◽  
Postoperative Blood Transfusion ◽  
Transfusion Requirements ◽  
Significant Difference ◽  
Fracture Surgery

Abstract Introduction Tranexamic acid (TXA) is proven to reduce blood loss in several surgical fields, but its use in femoral fragility fracture (FFF) management is ill defined. This study examined the effect of intraoperative TXA on the rate of postoperative blood transfusion following FFF. Method A prospective non-randomized case-control study of 361 consecutive patients admitted to the study centre with FFFs over a 4-month period was performed. Intravenous TXA 1g was administered intraoperatively at the discretion of the operating team: 178 patients received TXA and 183 did not. Results Patients given TXA required fewer blood transfusions: 15/178 (8.4%) vs controls 58/183 (31.7%), (p &lt; 0.001). Calculated blood loss (mean difference -222ml (-337 to -106, 95%CI), p &lt; 0.001) and percentage drop in Hb (mean difference -4.3% (-6.3 to -2.3, 95%CI), p &lt; 0.001) were significantly lower in the TXA group. The difference in CBL was greatest following intramedullary nail (n = 49: mean difference -394ml, p = 0.030) and DHS (n = 101, mean difference -216ml, p = 0.032). There was no significant difference in complication rates: venous thromboembolism TXA 2/178 vs control 1/182 (p = 0.620); MI/stroke/TIA 2/178 vs 0/182 (p = 0.244) Conclusions Intraoperative intravenous TXA significantly reduced calculated blood loss and blood transfusion requirements following femoral fragility fracture surgery without increasing the rate of complications.

scholarly journals Tranexamic acid for reducing blood loss following vaginal delivery: a double-blind randomized controlled trial.

2021 ◽  
Author(s):  
Francis Igboke ◽  
Lucky Lawani ◽  
Vitus Obi ◽  
Ikechukwu Dimejesi
Keyword(s):  
Treatment Group ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Vaginal Delivery ◽  
Controlled Trial ◽  
Controlled Study ◽  
Control Group ◽  
P Value ◽  
Double Blind ◽  
Estimated Blood Loss

Abstract Background: Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality worldwide with the highest incidence in the developing countries. Tranexamic acid (TXA) is a useful drug for prevention of PPH and merits evaluation in our environment. This study evaluates the efficacy of TXA in reducing blood loss following vaginal delivery.Methods: This was a double-blind randomized placebo-controlled study on the efficacy and safety of intravenous TXA in reducing blood loss in women undergoing vaginal delivery in a tertiary hospital. Data analysis was conducted with IBM SPSS software (version 20, Chicago II, USA). P-value <0.05 was considered statistically significant.Results: The mean estimated blood loss was lower in TXA compared with the placebo group (174.87±119.84 ml versus 341.07±67.97 ml respectively; P<0.0001). PPH (blood loss >500ml) was 5.13% in the study arm compared to the control arm 7.14%- risk ratio (RR) 0.82; 95% [CI 0.38 – 1.79, p=0.5956]. Additional uterotonics was required more in the control group compared to the treatment group 14(16.67%) versus 3(3.85%) of the treatment group, p-value of 0.007. There were no major complications noticed in the treatment group.Conclusion: This study demonstrated that intravenous administration of TXA acid following vaginal delivery reduced blood loss following vaginal delivery. It also reduced the need for additional uterotonics. However, blood loss greater than 500 was not significantly reduced.Pan African Clinical Trial Registry: PACTR202010828881019

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

2018 ◽  
Vol 119 (01) ◽  
pp. 092-103 ◽  
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.

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

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.

scholarly journals Tranexamic acid in prevention of postpartum hemorrhage in elective cesarean section

2019 ◽  
Vol 8 (2) ◽  
pp. 372
Author(s):  
Pravin Shah ◽  
Ajay Agrawal ◽  
Shailaja Chhetri ◽  
Pappu Rijal ◽  
Nisha K. Bhatta
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Elective Cesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Estimated Blood Loss ◽  
Elective Cesarean ◽  
The Mean

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

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

QJM ◽  
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 &lt; 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 &lt; 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 &lt; 0.001), Reduction in Hemoglobin was significantly less in study group than control group (p &lt; 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 &lt; 0.001), Reduction in Hematocrite was significantly less in study group than control group (p &lt; 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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