Two Different Doses of Tranexamic Acid for Reduction of Perioperative Blood Loss in Cesarean Section: A Randomized Controlled Study

Blood Conservation

Objective To explore the validity and safety of application of tranexamic acid(TAX) on amount of blood loss during operative period in patients with ankylosing spondylitis who were underwent primary unilateral total hip arthroplasty. Methods The prospective study was conducted. The clinical data of 50 cases of ankylosing spondylitis who underwent unilateral primary total hip replacement at the Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University from May 2015 to August 2017 were selected. A total of 50 patients were enrolled and randomized into the study group (n=25) and control group (n=25) random number table . The patients in the study group were given 15 mg/kg TXA dissolved in 250 ml normal saline by intravenous administration at 10 minutes before incision, and intra-articular injection after close the joint capsule. The patients in the control group were given with 250 ml 0.9% saline by intravenous and 10 ml 0.9% saline by hip joint capsule injection at the the same dose instead. The amount of overt blood loss, hidden blood loss, haemoglobim level, hematocrit, the volume of blood transfusion, and number of blood transfusion were compared between two groups. The Color Doppler flow imaging of the lower limbs was performed to detect deep venous thrombosis and pulmonary embolism. Measurement data were expressed as mean±standard deviation (±s). It was expressed by t test. Count data were expressed as percentage (%). The data were statistically analysized by χ2 test between two groups. Results The amount of overt blood loss, hidden blood loss, haemoglobin level, hematocrit, blood transfusion volume and blood transfusion in the study group were (538.9±103.6) ml, (93.2±30.6) ml, (103.4±10.2) g/L, (0.31±0.04)/L, (210.4±45.7) ml, 4 cases. The indexes in the control group were (831.5±120.8) ml, (175.8±42.3) ml, (95.7±10.1) g/L, (0.26±0.03)/L, (439.8±78.1) ml, and 12 cases, respectively. In patients of study group, the amount of intraoperative blood loss, volume of postoperative drainage, amount of visible blood loss, hidden blood loss and the volume of blood transfusion were less than those of patients in control group, and the difference was statistically significant (P<0.05). Calf muscular venous thrombosis was found in one case of observation group. No pulmonary embolism occurred in both groups. Conclusion The application of TAX can significantly decrease the amount of blood loss during operative period in patients with ankylosing spondylitis who were underwent primary unilateral total hip arthroplasty without increasing risk for deep venous thrombosis. Key words: Tranexamic acid; Arthroplasty, replacement, hip; Spondylitis, ankylosing; Postoperative hemorrhage; Venous thrombosis

Low-Dose Epinephrine Infusions and Tranexamic Acid During Lower-Extremity Total Joint Arthroplasty: Commentary on an article by Wei-Nan Zeng, MD, et al.: "Low-Dose Epinephrine Plus Tranexamic Acid Reduces Early Postoperative Blood Loss and Inflammatory Response. A Randomized Controlled Trial".

Objective The aim of the study was to know which type of anesthesia, general or spinal, causes less amount of blood loss in elective cesarean section. Study design This was a randomized controlled trial conducted in Ain Shams University Maternity Hospital on 155 women. Seventy-seven women were allocated (after computer-generated randomization) to group G (general anesthesia), and 78 women to group S (spinal anesthesia). All patients underwent elective lower segment cesarean section following the same operative steps and by the same surgeon and their anesthesia, whether general or spinal, was standardized. Amount of intraoperative blood loss was estimated by the acute normovolemic hemodilution technique. Results On using hemoglobin level changes to estimate blood loss, it was seen that group S had significantly less blood loss than group G with a difference of 152.760 ml (P=0.003). On using hematocrit values, it was seen that group S had statistically significant less blood loss than group G, with a difference of 174.2 ml (P=0.001). Headache attacks were higher in group S (29.49%) than in group G (12.99%) (P=0.010). Group S started breast feeding 54.3 min earlier than group G (P=0.013). Group S started postoperative ambulation 69.36 min earlier than group G (P=0.014). Group G requested analgesia 17.6 min earlier than group S (P=0.035). No statistically significant differences were observed between the two groups with respect to postoperative pulse, blood pressure, urinary output, and fainting attacks. Conclusion Spinal anesthesia shows definite advantages over general anesthesia in terms of higher postoperative hemoglobin and hematocrit values, less intraoperative blood loss, less postoperative pain, less need for analgesia, earlier ambulation, and faster initiation of breast feeding.

Background: WHO reported more than 100,000 maternal death due to obstetric hemorrhage annually, in other hand Cesarean Section (CS) is a common surgery done to save mother and child with one of the complications is hemorrhage. tranexamic acid (TXA) as antifibrinolytic might improve maternal outcome by decreasing blood loss in CS. Objectives:Determine effectiveness and safety of tranexamic acid in decreasing blood loss in cesarean section. Method:A prospective, double blinded, randomized controled study in Obstetrics and Gynecology Department of Southern Philippines Medical Center. The participants are 124 women underwent CS, 62 women given tranexamic acid after cord cut compared to 62 given placebo. Estimated blood loss, cardiac rate, systolic blood pressure before and after CS, events during CS and additional medicines. Hemoglobin and hematocrit was taken before and after CS, course in the ward, blood transfusion, adverse events, mortality and length of hospital stay were compared. Results: Socio demographic, clinical profile, events after interventions, need of additional medicines and complications are similar for both group (p-value>0.05). The cardiac rate after CS is significantly higher in TXA group (tranexamic:85.1±11.5 placebo:80.1±15. 6, p-value=0.0441), but still in normal range. Conclusion: Tranexamic acid is not recommended to be given routinely to reduce blood loss in CS, instead its more beneficence to abort severe bleeding hence its should be available during CS. There was no adverse events recorded in both treatment and placebo group showed safety of tranexamic acid.

Background and Aims:Antifibrinolytics may help bleeding in orthopaedic surgeries. The present study was undertaken to compare two dose regimens of tranexamic acid (TA) on perioperative blood loss in patients undergoing hip surgeries.Methods:In a prospective, randomised, controlled study, 59 patients scheduled for hip surgery were divided into Group C: receiving normal saline (n – 20), Group B: receiving single dose of TA (10 mg/kg) (n – 21), and Group I: receiving a bolus (10 mg/kg) plus infusion (1 mg/kg/h) of TA up to 4 h postoperatively (n – 18). Blood loss, haemoglobin and allogeneic blood transfusions were compared between the groups. For parametric data, P was calculated by ANOVA. Intergroup comparison was done by post hoc analysis with Bonferroni test. P < 0.05 was considered significant.Results:The intra-operative blood loss was lower in the patients who received TA (525 ± 150, 456 ± 156 and 400 ± 133 ml in Group C, B and I respectively; P = 0.05). The 6th hourly drain collection in Group I was lower than Group B and C (41 ± 18, 46 ± 14 and 31 ± 14 ml in Group C, B, and I respectively; P = 0.018). The blood loss at 24 h was less in groups receiving TA (146 ± 32, 120 ± 76, 107 ± 37 ml for Group C, B and I, respectively; P = 0.02). The requirement of blood transfusions was lower in Group I.Conclusions:A bolus of tranexamic acid followed by infusion is more useful than a single dose in decreasing perioperative blood loss in patients undergoing hip surgeries. It reduces allogenic blood transfusion without increasing risk of thromboembolic events.

Letter: We have read the recent article published by Zhang et al titled "The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Percutaneous Endoscopic Interlaminar Diskectomy: A Retrospective Study". In this retrospective study, authors performed interlaminar endoscopic lumbar discectomy (IELD) for L5-S1 disc herniations, categorizing patients into two groups. One group underwent IELD with saline irrigation fluid containing 0.33 gm of tranexamic acid (TXA) per 1L of saline, while the other group received only saline irrigation fluid. We appreciate the authors' efforts in shedding light on the use of TXA in irrigation fluid, which currently has limited literature available. However, we wish to highlight several points of concern that, in our view, warrant further discussion. Upon reviewing the manuscript, our initial concern centers on the reported amount of blood loss, a crucial outcome in this study. The blood loss figures presented in this study appear significantly higher compared to the existing literature. In both study groups, the authors indicate total blood loss (TBL) exceeding 300 ml and intraoperative blood loss (IBL) surpassing 40 ml. In contrast, a systematic review and meta-analysis by Jitpakdee et al. (1) reported a range of blood loss from 10.9 ml to 23.35 ml for interlaminar endoscopic discectomy without any systemic or local use of tranexamic acid. Accurately assessing blood loss in endoscopic spine surgery poses a challenge, and the accuracy of indirect calculation methods is questionable, particularly when bleeding is minimal. Endoscopic discectomy has been proven benefits by minimal tissue damage and negligible blood loss. Another significant concern we would like to address is related to the safety and efficacy of topical tranexamic acid (TXA) use in endoscopic spine surgery. The existing literature generally accepts the safety profile and efficacy of use of intravenous TXA in open spine surgery where the blood loss incurred is substantial (2, 3). However, when it comes to the safety of topical TXA, it is important to note that TXA is known to have neurotoxic and epileptogenic properties when applied to central nervous system (CNS) tissue (5, 6). This is due to its interference with central GABAA receptors and glycine receptors (7). In endoscopic spine surgeries, small dural tears can sometimes go unnoticed due to continuous irrigation fluid pressure. In such cases, the potential CNS side effects associated with topical TXA could pose a real danger. Furthermore, even when dural tears are identified during surgery, it can be challenging to completely washout all the irrigation fluid containing TXA from the surgical field. The accumulation of excessive epidural or intrathecal TXA, especially after a dural tear, can lead to life-threatening conditions such as seizures or arrhythmias, significantly increasing morbidity and mortality in what is often intended as a day-care procedure. Moreover, the authors have not mentioned any exclusion criteria for patients with conditions that are suspected to elevate risk of developing TXA-related side effects, such as a history of thromboembolic events and/or coagulopathy, convulsive disorders and dural disruption. Lastly, in terms of the efficacy of TXA, there are limited studies demonstrating the use of local TXA in spine surgeries to reduce blood loss. For example, Krohn et al(4) used topical TXA irrigation in open instrumented spinal fusion surgery before wound closure. Their study showed a reduction in postoperative blood loss, with drain output decreasing from 525 ml in the non-TXA group to 252 ml in the TXA group. However, it had no significant effect on intraoperative blood loss. We would like to raise a pertinent question regarding endoscopic discectomy procedures, which are characterized by minimal blood loss and are often conducted as day-care surgeries. It becomes a matter of concern whether the potential advantages of using topical TXA in reducing blood loss outweigh the associated risks of neurological damage to the central nervous system (CNS) and other potentially life-threatening complications.

To explore the effects of different administration methods of tranexamic acid(TXA) on the perioperative blood loss, hidden blood loss, transfusion rate and adverse reactions in lumbar spinal decompression and fusion. Sixty patients who received lumbar spinal canal decompression and fusion from July 2019 to July 2020 were enrolled and divided into observation group and control group, with 30 cases in each group. The observation group was given 2 g TXA orally at 2 hours before operation, control group was given 1 g TXA for 5-10 min before skin incision and 6 hours after operation intravenously. The intraoperative blood loss, postoperative drainage, total blood loss, hidden blood loss, drainage tube removal time, blood transfusion rate, venous thrombosis rate, adverse event rate were recorded respectively. The changes of hemoglobin(Hb) and hematocrit (HCT) were observed before operation and 1, 3 days after operation. Hb and HCT at 1 and 3 days after operation were significantly improved compared with those before operation(P<0.01). However, there was no significant difference between the groups(P>0.05). There were no significant difference in amount of blood loss, postoperative drainage, total blood loss, intraoperative blood loss, hidden blood loss, postoperative drainage time, and blood transfusion rate between two groups (P>0.05). There were no venous thrombosis and adverse events occurred in both groups. During the perioperative period of lumbar spinal decompression and fusion, oral TXA and intravenous TXA have the same effect in reducing perioperative blood loss and are safe and reliable. It is recommended that oral TXA be used to save medical costs and convenience.

Background and objective: Intraoperative a single bolus of tranexamic acid may be inadequate to prevent bleeding in the early postoperative period. We compared 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 (TURP). Methods: A total of 50 patients electively posted for TURP, were randomly assigned to receive either a single bolus dose of tranexamic acid 10 mg/kg (Group A), or a bolus of tranexamic acid 10 mg/kg followed by an infusion of tranexamic acid @1 mg/kg/h till 4 h postoperatively (Group B). Perioperative blood loss and the amount of blood transfused were the primary outcome. Postoperative hemoglobin and hematocrit levels, incidence of deep vein thrombosis and any convulsions were the secondary outcomes. Results: There was no significant difference among patients in both groups regarding intraoperative and postoperative blood loss at 6 h and 48 h postoperatively. However, the postoperative blood loss at 24 h was significantly higher among patients in Group A (P = 0.014). Conclusion: Tranexamic acid used as intravenous bolus followed by infusion continued in the postoperative period is more effective in reduction of perioperative blood loss in comparison to single bolus in transurethral resection of prostate. Abbreviations: TURP: transurethral resection of prostate, TXA: tranexamic acid, Hct: hematocrit, DVT Key words: Antifibrinolytics, blood loss, transurethral resection of prostate, tranexamic acid. Citation: Ghaly Tawadros SI, Kamal MM, Mohammed EA, Khairy MA. Single intravenous bolus vs. continuous infusion of tranexamic acid to reduce blood loss in transurethral resection of prostate: a prospective randomized double-blind study. Anaesth. pain intensive care 2025;29(2):210-216. DOI: 0.35975/apic.v29i2.2705 Received: November 10, 2024; Reviewed: February 03, 2025; Accepted: February 05, 2025

Background: Primary postpartum hemorrhage (PPH) plays a major role in maternal mortality and morbidity like severe anemia, blood transfusion requirement, hospital stay and infection. Tranexamic acid is now recommended in treatment of PPH, yet its prophylactic use before delivery is still not recommended. Objective: To assess the efficacy of preoperative administration of Tranexamic acid in decreasing blood loss during elective cesarean section. Patients and Methods: The study was conducted at Department of Obstetrics and Gynecology of Menoufia University Hospitals. It included 100 pregnant females who went through elective cesarean section with age >18 and < 35 years and singleton alive fetus. They were randomly allocated to two groups: the study group of which women received 1 gm of tranexamic acid 20 minutes before skin incision and the control group who did not receive tranexamic acid. The assessment included the following: measurement of blood loss amount and estimation of postoperative 1st day hemoglobin and hematocrit value. Results: There was highly statistically significant difference between both groups regarding the amount of blood loss during cesarean delivery and blood loss 2 hours from end of CS (p ≤ 0.001). This was reflected in the percentage of difference of preoperative and postoperative hemoglobin and hematocrit values, which showed highly significant statistical difference (p ≤ 0.001). Conclusion: Tranexamic acid administration before elective cesarean section was effective in decreasing intraoperative and postoperative bleeding. And in turn reduces the incidence of PPH with no immediate maternal or neonatal side effects.

Low vacuum re-infusion drains after total knee arthroplasty: is there a real benefit?

Introduction: Obstetric hemorrhage is one of the major causes of maternal morbidity and mortality. Blood loss during cesarean section is almost twice than that in vaginal delivery. The aim of this study was to evaluate the efficacy of tranexamic acid to reduce blood loss in cesarean section and its side effects. Methods: A comparative study was done in 100 women undergoing cesarean section between December 2015 to January 2017. The study group of 50 women received one gram intravenous tranexamic acid and the control group of 50 women did not receive tranexamic acid. Primary outcome measure was blood loss during cesarean section. Secondary outcome measures were drop in post-operative hemoglobin and hematocrit, change in pulse rate and blood pressure, need of additional uterotonics, auxiliary procedures to stop bleeding, blood transfusion rate and maternal and neonatal side effects of the drug. Results: Mean intraoperative blood loss in the study group was 443.62± 86.73ml; and in control group, 667.40±131.01ml (p&lt;0.001). Mean postoperative drop in hemoglobin (g/dl) in the two groups were 0.82±0.27 and 1.86±0.64 respectively (p&lt;0.001). Mean postoperative drop in hematocrit in the two groups were 2.60±0.91 and 5.49±1.97 respectively (p&lt;0.001). Fourteen patients in the control group required additional uterotonics while none in the study group (p&lt;0.001). There was no significant difference in the transfusion requirement (p=0.079). None of the mothers and the newborns had major side effects of drug. Conclusion: Tranexamic acid is a safe and effective drug to reduce blood loss in cesarean section.

Objective: To evaluate the efficacy of tranexamic acid (TA) in decreasing blood loss during and after elective caesarean section (CS).Methods: This prospective randomized trial was conducted among 124 pregnant women subjected to term elective CS. Patients were equally divided into two groups. Study group received 10 mg/kg TA intravenously 5 min before skin incision while the control group did not. In addition, both groups received 10 units oxytocin and 1 ml ergometrine after delivery of the fetus. Blood loss in both groups was measured from placental delivery to end of the surgery and from end of the surgery to 2 h postpartum. Hemoglobin and hematocrit values were determined preoperatively and on the third day postpartum (before discharge) for all cases. Maternal and neonatal adverse effects in study groups were recorded.Results: TA group showed lower amount of blood loss (391 ml) when compared to control group (597 ml). Risk estimation has revealed that treatment with TA resulted in decrease in risk of postpartum blood loss by 30%. Hemoglobin and hematocrit levels were significantly lower in the control group on the third post-operative day.Conclusion: TA reduces blood loss during and immediately after CS. Its use in caesarean delivery may be considered especially in cases where blood loss is expected to be high or in anemic patients.

The amount of blood loss in a primary cemented total knee arthroplasty (TKA) seems to vary in different reported studies. We carried out a prospective study to determine the factors affecting the peri-operative blood loss, hidden blood loss and blood transfusion requirements in a primary cemented total knee arthroplasty. The factors analysed were gender, diagnosis, tourniquet time and body mass index (BMI). We included a total of 66 consecutive patients who underwent primary TKA by a single surgeon (A.M). There was significantly more peri-operative blood loss in male patients than in females (p=0.001, Student's t test). The patients with rheumatoid arthritis did not show any statistical difference in peri-operative blood loss compared with that in patients with osteoarthritis. The tourniquet time and the surgical time showed a positive correlation with peri-operative blood loss. The BMI did not show any correlation with peri-operative blood loss. The incidence of blood transfusion was significantly higher in patients with rheumatoid knees as their pre-operative haemoglobin value was low. The amount of hidden blood loss in our series was 38%. We concluded that gender and tourniquet time plays a role in blood loss in TKA, but diagnosis (advanced osteoarthritis [OA] or rheumatoid arthritis (RA) does not. The blood transfusion depends on both pre-operative haemoglobin value and intra-operative blood loss. The post-operative transfusion trigger can be brought to 8.0 g% in a haemodynamically stable patient.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tranexamic acid (TXA) is effective and safe in decreasing blood loss and transfusion rate in total knee arthroplasty (TKA). Few studies focused on the role of patients’ characteristics on the efficacy of TXA in TKA. The purpose of this study was to conduct a retrospective analysis to investigate if age, gender and BMI influence the efficacy of TXA in reducing perioperative blood loss in TKA.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We did an observational study including 366 consecutive patients undergoing TKA in Hospital Particular do Algarve between January 2011 and April 2019 which were divided in two groups: intraoperative administration of intravenous TXA (TXA Group) and no administration of TXA (Control Group). The perioperative blood loss between groups and their relation with age, gender and BMI was compared.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the 366 patients, 225 (61%) received TXA. In both groups, age did not correlate to the blood loss. Women in the TXA group had less perioperative blood loss than in the control group. No such difference was found for men. The normal weight group showed no difference in perioperative blood loss with or without TXA administration. However, there was a statistically significant difference in the overweight and obese groups. The mean perioperative blood loss was higher in the control group (854±342 ml) than in the TXA group (720±335 ml).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; TXA administration is efficient in controlling TKA associated hemorrhage in overweight and obese individuals and in women but it doesn’t have that effect in normal weight patients or in men.&lt;/p&gt;