Effect of low dose tranexamic acid on intra-operative blood loss in neurosurgical patients

Abstract Background: The optimal dose of tranexamic acid (TA) is still an issue. The authors compared two doses of TA during cardiac surgery in a multicenter, double-blinded, randomized study. Methods: Patients were stratified according to transfusion risk, then randomized to two TA doses: 10 mg/kg bolus followed by 1 mg·kg−1·h−1 infusion (low dose) until the end of surgery or 30 mg/kg bolus followed by 16 mg·kg−1·h−1 infusion (high dose). The primary endpoint was the incidence of blood product transfusion up to day 7. Secondary ones were incidences of transfusion for each type of blood product and amounts transfused, blood loss, repeat surgery, TA-related adverse events, and mortality. Results: The low-dose group comprised 284 patients and the high-dose one 285. The primary endpoint was not significantly different between TA doses (63% for low dose vs. 60% for high dose; P = 0.3). With the high dose, a lower incidence of frozen plasma (18 vs. 26%; P = 0.03) and platelet concentrate (15 vs. 23%; P = 0.02) transfusions, lower amounts of blood products (2.5 ± 0.38 vs. 4.1 ± 0.39; P = 0.02), fresh frozen plasma (0.49 ± 0.14 vs.1.07 ± 0.14; P = 0.02), and platelet concentrates transfused (0.50 ± 0.15 vs. 1.13 ± 0.15; P = 0.02), lower blood loss (590 ± 50.4 vs. 820 ± 50.7; P = 0.01), and less repeat surgery (2.5 vs. 6%; P = 0.01) were observed. These results are more marked in patients with a high risk for transfusion. Conclusions: A high dose of TA does not reduce incidence of blood product transfusion up to day 7, but is more effective than a low dose to decrease transfusion needs, blood loss, and repeat surgery.

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The use of low-dose aprotinin to decrease post-operative blood loss following cardiopulmonary bypass in children

Heart Lung and Circulation ◽

10.1046/j.1443-9506.2000.09016.x ◽

2000 ◽

Vol 9 (3) ◽

pp. A165

Author(s):

D.N. Murphy ◽

O.D.H. Jones ◽

M.R. Crawford ◽

G.R. Nunn ◽

P.W. Grant

Keyword(s):

Cardiopulmonary Bypass ◽

Blood Loss ◽

Low Dose ◽

Operative Blood Loss

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Evaluations of topical application of tranexamic acid on post-operative blood loss in off-pump coronary artery bypass surgery

Saudi Journal of Anaesthesia ◽

10.4103/1658-354x.130724 ◽

2014 ◽

Vol 8 (2) ◽

pp. 224 ◽

Cited By ~ 7

Author(s):

AliAkbar Rahimianfar ◽

MohammadHassan Abdollahi ◽

MohammadHossein Moshtaghiyoon ◽

Mahdi Haddadzadeh ◽

Asefeh Fekri ◽

...

Keyword(s):

Coronary Artery ◽

Blood Loss ◽

Tranexamic Acid ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Operative Blood Loss ◽

Off Pump ◽

Pump Coronary Artery Bypass

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Effects of intravenous tranexamic acid on ovarian reserve and intra-operative blood loss during laparoscopic cystectomy of endometriotic cyst: a pilot randomized controlled trial

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00907-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Prangthip Akkaranurakkul ◽

Srithean Lertvikool ◽

Woradej Hongsakorn ◽

Orawin Vallibhakara ◽

Siriluk Tantanavipas ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Ovarian Reserve ◽

Controlled Trial ◽

Mean Difference ◽

Control Groups ◽

Operative Blood Loss ◽

Post Surgery ◽

Laparoscopic Cystectomy ◽

And Control

Abstract Background Strategies to preserve ovarian function after ovarian endometriotic cyst removal have been reported in many studies; however, no study has evaluated tranexamic acid administration during surgery. Objective To evaluate feasibility of conducting a definitive trial and assessing the potential efficacy of tranexamic acid on ovarian reserve and intra-operative blood loss by comparing mean differences in anti-Müllerian hormone (AMH) levels following laparoscopic ovarian cystectomy between tranexamic acid and control groups. Materials and methods A parallel two-arm pilot trial was conducted with 40 participants with endometriotic cysts who underwent laparoscopic ovarian cystectomy. They were randomized 1:1 to either 1 g tranexamic acid (TXA) or no TXA (n = 20 per group). TXA was administered to the participants immediately after induction of general anesthesia and intubation. The primary outcome was the feasibility of conducting a definitive trial in terms of design and procedures (such as recruitment rate, retention, safety of intravenous 1 gm of TXA, sample size verification) and assess the efficacy of TXA on the ovarian reserve and intra-operative blood loss by comparing mean difference of AMH levels between TXA and control groups at pre- and 3 months post-surgery. Results The recruitment and successful completion rates were 95% and 100%. Baseline characteristics were similar in the two groups. The mean difference of serum AMH levels (pre- and 3 months post-surgery) between the TXA and control groups was not significantly different. When performing a subgroup analysis, the mean difference of AMH levels (pre- and 3 months post-surgery) seemed to be higher in the bilateral than in the unilateral ovarian cyst group but not significantly different. Operating time was significantly longer in bilateral than in unilateral cysts. No post-operative complications or adverse effects were found. Conclusion The full randomized controlled trial for evaluating effects of TXA administration during laparoscopic cystectomy for endometrioma on ovarian reserve was shown to be feasible. Several modifications should be added for improving feasibility, for example, increasing the TXA dose, modifying TXA administration, focusing on either patients with unilateral or bilateral ovarian cysts, and exploring other outcome measures, e.g., surgeons’ satisfaction. Trial registration Thai Clinical Trials Registry, TCTR20190424002, Registered 24 April 2019.

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Single Intravenous Bolus versus Continuous Infusion of Tranexamic Acid to Reduce Blood Loss in Transurethral Resection of Prostate: a Prospective Randomized Double-Blind Study

QJM ◽

10.1093/qjmed/hcab086.026 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Safaa I Ghaly ◽

Marwa A Khairy ◽

Mohamed M Kamal ◽

Eman A Mohammed

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Transurethral Resection ◽

Bolus Dose ◽

Transurethral Resection Of Prostate ◽

Intraoperative Blood Loss ◽

Operative Blood Loss ◽

Single Bolus Dose ◽

Group A ◽

Group B

Abstract Background and aim Intraoperative use of a single bolus dose of tranexamic acid may not be sufficient to prevent bleeding in the early postoperative period. The present study was carried out to compare the effect of two dose regimens of tranexamic acid in reducing perioperative blood loss and the amount of allogeneic blood transfusion in transurethral resection of prostate. Design prospective, double-blinded and controlled study. Setting Ain Shams University Hospital, Patients and Methods 50 patients electively posted for transurethral resection of prostate were randomly assigned to receive a single bolus dose of tranexamic acid (10 mg/kg) (Group A), a bolus dose of tranexamic acid (10 mg/kg) followed by infusion (1 mg/kg/h) till 4 h postoperatively (Group B). Measurements Total intraoperative blood loss, amount of allogeneic blood transfusion, postoperative drain collections, and hemoglobin and hematocrit levels were recorded at different time intervals. Data obtained after comparing two groups were analyzed using the statistical package for social sciences. Results There was no statistically significant difference among patients in both groups regarding intraoperative blood loss and postoperative blood loss at 6 hrs and 48 hrs postoperatively. However the post-operative blood loss at 24 hrs was significantly higher among patients in group A than patients in group B (P-value= 0.014) . Conclusion Tranexamic acid causes more effective reduction in post-operative blood loss when used as a bolus followed by an infusion continued in the postoperative period in comparison to its use as a single intravenous bolus in transurethral resection of prostate.

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