scholarly journals Impact of the Tranexamic Acid on Bleeding Amount of Surgical Patient With Degenerative Spinal Disease: A Randomized Blinded Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Lei Yan ◽  
Huihong Yang ◽  
Haibin Jiang ◽  
Mingshan Yu ◽  
Jie Tan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tranexamic Acid ◽  
Perioperative Period ◽  
Surgical Patients ◽  
Occurrence Rate ◽  
Spinal Disease ◽  
Intraoperative Bleeding ◽  
Drainage Volume ◽  
Degenerative Spinal Disease ◽  
D Dimer

Objective: This study aims to explore the effectiveness and safety of tranexamic acid (TXA) in reducing the bleeding amount of surgical patients with degenerative spinal disease in the perioperative period.Methods: A total of 80 cases of patients, who underwent elective posterior lumbar interbody fusion surgeries under general anesthesia, were enrolled in this study. The age of these patients ranged within 41–69 years old, and the surgical vertebral body segments were ≥2. The ASA classification was Level I or Level II. These patients were divided into two groups using the random number table (n = 40): TXA group and control group (S group). In the TXA group, the skin was incised after the anesthesia induction, and 20 mg/kg of TXA was immediately injected into the vein. The injection continued at a rate of 10 mg·kg−1·h−1 during the surgery, until the surgery was finished. In the S group, IV and pump injection with an equal amount of normal saline (NS) were performed. Then, the RBC, Hb, HCT, AST, ALT, BUN, Cr, PT, TT, APTT, FIB, and D-dimer were measured before the surgery and at 1 day after the surgery, and the SSFQ, intraoperative bleeding amount, homologous transfusion volume, urine volume, infusion quantity, surgical duration, drainage volume at 24 h after the surgery, total bleeding amount and adverse event occurrence at 1 week after the surgery were recorded.Results: The RBC, Hb and HCT at 1 day after the surgery were higher in TXA group than in the S group (average P < 0.05). Intraoperative bleeding, drainage volume at 24 h after surgery, and total blood loss were lower in the TXA group than in the S group (average P < 0.05). The SSFQ score and length of stay were lesser in the TXA group than in the S group (average P < 0.05). The differences in AST, ALT, BUN, Cr, PT, TT, APTT, FIB, and D-dimer at 1 day after the surgery for these two groups of patients had no statistical significance (average P > 0.05).Conclusion: TXA can reduce the bleeding amount of surgical patients with degenerative spinal disease in the perioperative period and decrease the length of stay, but does not increase the occurrence rate of adverse events, thereby promoting postoperative rehabilitation.Clinical Trial Registration:www.chictr.org.cn/index.aspx, identifier: ChiCTR2000033597.

scholarly journals Multiple intravenous tranexamic acid doses in total knee arthroplasty in patients with rheumatoid arthritis: a randomized controlled study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bing-xin Kang ◽  
Hui Xu ◽  
Chen-xin Gao ◽  
Sheng Zhong ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Randomized Controlled ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
D Dimer

Abstract Background We aimed to determine the efficacy and safety of multiple doses of intravenous tranexamic acid (IV-TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA) who had undergone primary unilateral total knee arthroplasty (TKA). Methods For this single-center, single-blind randomized controlled clinical trial, 10 male and 87 female participants with RA, aged 50–75 years, who underwent unilateral primary TKA were recruited. The patients received one dose of 1 g IV-TXA 10 min before skin incision, followed by articular injection of 1.5 g tranexamic acid after cavity suture during the surgery. The patients were randomly assigned (1:1) into two groups and received an additional single dose of IV-TXA (1 g) for 3 h (group A) or three doses of IV-TXA (1 g) for 3, 6, and 12 h (group B) postoperatively. Primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum hemoglobin (Hb) level decrease. Secondary outcomes were transfusion rate and D-dimer levels. All parameters were measured postoperatively during inpatient hospital stay. Results The mean TBL, HBL, and maximum Hb level decrease in group B (506.1 ± 227.0 mL, 471.6 ± 224.0 mL, and 17.5 ± 7.7 g/L, respectively) were significantly lower than those in group A (608.8 ± 244.8 mL, P = 0.035; 574.0 ± 242.3 mL, P = 0.033; and 23.42 ± 9.2 g/L, P = 0.001, respectively). No episode of transfusion occurred. The D-dimer level was lower in group B than in group A on postoperative day 1 (P <  0.001), and the incidence of thromboembolic events was similar between the groups (P > 0.05). Conclusion In patients with RA, three doses of postoperative IV-TXA further facilitated HBL and Hb level decrease without increasing the incidence of adverse events in a short period after TKA. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR1900025013).

scholarly journals Acute bilateral foot drop with or without cauda equina syndrome—a case series

2021 ◽  
Vol 163 (4) ◽  
pp. 1191-1198
Author(s):  
Andreas K. Demetriades ◽  
Marco Mancuso-Marcello ◽  
Asfand Baig Mirza ◽  
Joseph Frantzias ◽  
David A. Bell ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Case Series ◽  
Foot Drop ◽  
Spinal Disease ◽  
Full Resolution ◽  
Degenerative Spinal Disease ◽  
The Mean ◽  
The One

Abstract Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h. Three had concomitant cauda equina syndrome; of these, the first two made a full motor recovery, one by 6 weeks follow-up and the second on the same-day post-op evaluation. Overall, five out of seven cases had full resolution of their ankle dorsiflexion pareses. One patient with 1/5 power has not improved. Another with 1/5 weakness improved to normal on the one side and to 3/5 on the other. Conclusion When bilateral foot drop occurs acutely, we encourage the consideration of degenerative spinal disease. Relevant discopathy was observed from L2/3 to L5/S1; aberrant innervation may be at play. Cauda equina syndrome is not necessarily associated with acute bilateral foot drop. The prognosis seems to be pretty good with respect to recovery of the foot drop, especially if partial at presentation and if treated within 48 h.

scholarly journals Preoperative Cognitive Impairment as a Predictor of Postoperative Outcomes in Elderly Patients Undergoing Spinal Surgery for Degenerative Spinal Disease

2021 ◽  
Vol 10 (7) ◽  
pp. 1385
Author(s):  
Hyung Cheol Kim ◽  
Seong Bae An ◽  
Hyeongseok Jeon ◽  
Tae Woo Kim ◽  
Jae Keun Oh ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
Mental State ◽  
Mini Mental State Examination ◽  
Operation Time ◽  
Cognitive Status ◽  
Blood Analysis ◽  
Spinal Disease ◽  
Degenerative Spinal Disease ◽  
State Examination

Cognitive status has been reported to affect the peri-operative and post-operative outcomes of certain surgical procedures. This prospective study investigated the effect of preoperative cognitive impairment on the postoperative course of elderly patients (n = 122, >65 years), following spine surgery for degenerative spinal disease. Data on demographic characteristics, medical history, and blood analysis results were collected. Preoperative cognition was assessed using the mini-mental state examination, and patients were divided into three groups: normal cognition, mild cognitive impairment, and moderate-to-severe cognitive impairment. Discharge destinations (p = 0.014) and postoperative cardiopulmonary complications (p = 0.037) significantly differed based on the cognitive status. Operation time (p = 0.049), white blood cell count (p = 0.022), platelet count (p = 0.013), the mini-mental state examination score (p = 0.033), and the Beck Depression Inventory score (p = 0.041) were significantly associated with the length of hospital stay. Our investigation demonstrated that improved understanding of preoperative cognitive status may be helpful in surgical decision-making and postoperative care of elderly patients with degenerative spinal disease.

Hemostatic Parameters and Platelet Activation Marker Expression in Cyanotic and Acyanotic Pediatric Patients Undergoing Cardiac Surgery in the Presence of Tranexamic Acid

2000 ◽  
Vol 83 (01) ◽  
pp. 54-59 ◽  
Author(s):  
Elena Levin ◽  
John Wu ◽  
John Alexander ◽  
Clayton Reichart ◽  
Suvro Sett ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Platelet Activation ◽  
Pediatric Patients ◽  
Factor Xiiia ◽  
Congenital Defects ◽  
Plasma Factor ◽  
Pai 1 ◽  
D Dimer

SummaryWe have investigated hemostatic parameters including platelet activation in 56 pediatric patients with or without cyanosis undergoing cardiopulmonary bypass (CPB) and cardiac surgery to repair congenital defects. Patients were participants in a study assessing the effects of tranexamic acid on surgery-related blood loss. Parameters monitored included blood loss, prothrombin F1.2, thrombin-antithrombin complexes, t-PA, PAI-1, plasminogen, fibrin D-dimer, and plasma factor XIII. Additionally, flow cytometry monitored platelet degranulation (P-selectin or CD63), as well as surface-bound fibrinogen, von Willebrand factor and factor XIIIa. Cyanotic patients had evidence of supranormal coagulation activation as both fibrin D-dimer and PAI-1 levels were elevated prior to surgery. While the extent of expression of Pselectin or CD63 was not informative, platelet-associated factor XIIIa was elevated in cyanotic patients at baseline. In both patient groups, CPB altered platelet activation state and coagulation status irrespective of the use of tranexamic acid.

Abstract 13317: Acute Pulmonary Embolism in Covid-19 Patients: Presenting Characteristics, Outcomes and Risk Stratification Strategies

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hai Xu ◽  
Angel Martin ◽  
Avneet SINGH ◽  
Mangala Narasimhan ◽  
Joe Lau ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Risk Stratification ◽  
Clinical Outcomes ◽  
Acute Pulmonary Embolism ◽  
Severe Bleeding ◽  
Study Cohort ◽  
D Dimer

Introduction: Pulmonary Embolism in coronavirus disease 2019 (COVID-19) patients have been increasingly reported in observational studies. However, limited knowledge describing their diagnostic features and clinical outcomes exist to date. Our study aims to systemically analyze their clinical characteristics and to investigate strategies for risk stratification. Methods: We retrospectively studied 101 patients with concurrent diagnoses of acute pulmonary embolism and COVID-19 infection, admitted at two tertiary hospitals within the Northwell Health System in New York City area. Clinical features including laboratory and imaging findings, therapeutic interventions, intensive care unit (ICU) admission, mortality and length of stay were recorded. D-dimer values were respectively documented at COVID-19 and PE diagnoses for comparison. Pulmonary Severity Index (PESI) scores were used for risk stratification of clinical outcomes. Results: The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among our study cohort. Baseline D-dimer abnormalities (4647.0 ± 8281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13288.4 ± 14917.9; p<0.05). 5 (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. 31 (31%) patients developed acute kidney injury (AKI) and 1 (1%) patient required renal replacement therapy. Throughout hospitalization, 23 (23%) patients were admitted to intensive care units, of which 20 (20%) patients received invasive mechanical ventilation. The overall mortality rate was 20%. Majority of patients (65%) had Intermediate to high risk PESI scores (>85), which portended a worse prognosis with higher mortality rate and length of stay. Conclusions: This study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. D-dimer levels and PESI scores may be utilized to risk stratify and guide management in this patient population. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection, despite the preliminary and retrospective nature inherent to this study.

scholarly journals EP.WE.782Retrospective analysis of acute surgical admissions during COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shenbaga Rajamanikam ◽  
Suzzana Argyropoulos ◽  
Reza Arsalani Zadeh
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Surgical Procedures ◽  
Length Of Hospital Stay ◽  
Period Length ◽  
Surgical Patients ◽  
Surgical Team ◽  
Surgical Operations

Abstract Background COVID-19 pandemic has affected the number of surgical admissions and the number of emergency general surgical operations performed. COVID-19 pandemic has also led to changes in how some of the acute surgical patients were managed. Aim of the study was to compare acute surgical admissions and number of emergency general surgical procedures in this period. Material and Method We retrospectively analyzed acute surgical admissions during the pandemic from 20/3/20 to 19/4/20 and compared it with acute surgical admissions during pre-COVID-19 period from 1/11/2019 to 30/11/2019. Results During the COVID-19 pandemic 97 patients were assessed and admitted by the General surgical team, during the pre COVID-19 period 205 patients were assessed and admitted by the General surgical team. The number of acute surgical admissions during COVID-19 pandemic dropped by 53%. There were 46% less emergency surgeries performed during COVID 19 pandemic period. Length of stay during and before the COVID-19pandemic were 4.1 vs 4.4 days. Conclusion During the COVID-19 pandemic number of acute surgical admissions and the number of emergency surgeries were fewer than during pre COVID-19 pandemic. Length of hospital stay was less during COVID-19 pandemic.

scholarly journals Analysis of 30-day unplanned readmissions after degenerative spinal disease surgery

2017 ◽  
Vol 31 (1) ◽  
pp. 59-65 ◽  
Author(s):  
D. Adam ◽  
D. Iftimie ◽  
Gina Burduşa ◽  
Cristiana Moisescu
Keyword(s):  
Spinal Stenosis ◽  
Disc Herniation ◽  
Unplanned Readmission ◽  
Spinal Disease ◽  
Readmission Rates ◽  
Quality Of Patient Care ◽  
Degenerative Spinal Disease ◽  
Surgical Group ◽  
Csf Leaks

Abstract Background: Degenerative spinal disease surgery is frequently performed in most neurosurgical departments. Unplanned 30-day readmissions represent a significant economic burden and have been used in several studies as a tool to evaluate quality of patient care. Objective: To review 30-day unplanned readmission rates after degenerative spinal disease surgery in our department, in order to identify their causes and determine strategies aimed at decreasing their frequency. Methods: A retrospective analysis was performed on all patients operated in our department for spinal stenosis or disc herniation over a 3 year period (January 2014 – December 2016), evaluating the rate and causes of unplanned readmission in the first month after discharge. Complications were divided in medical and surgical. Results: Out of the 1106 patients included, 33 (2,98%) presented a 30-day unplanned readmission. The percentage was higher after disc herniation surgery (3,40%), compared to spinal stenosis (1,92%). Pain management was the most common medical cause for readmission (45,45%), while in the surgical group, CSF leaks were the most frequent complication (18,18%). Conclusions: The rate of 30-day readmissions was low in our series but, even so, they associate significant costs. They could be avoided by applying correct and aseptic surgical technique, proper availability of dural sealing agents and superior patient medical education.

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