Efficacy Of Intravenous Tranexamic Acid Research Articles

Blood-conserving and therapeutic efficacy of intravenous tranexamic acid at different time points after primary total knee arthroplasty with tourniquet application: a randomised controlled trial

BackgroundThe use of a tourniquet in combination with tranexamic acid (TXA) not only ensures clear vision, reduces intraoperative blood loss and shortens operative time but also improves cement-bone inter-digitation in total knee arthroplasty (TKA). However, there is no proof whether the blood flow blocking effect of tourniquet affects the antifibrinolytic effect of TXA, and the optimal timing of TXA administration is still unclear. Therefore, this study aims to investigate the effect of the first dose of TXA administered intravenously before tourniquet compression and release in TKA on perioperative blood loss and therapeutic efficacy in patients.MethodsIn this double-blind trial, 90 patients undergoing primary TKA were randomised into 2 groups: Group A, patients received intravenous TXA 10 min before tourniquet compression (20 mg/kg) and 3, 6 and 24 h later (10 mg/kg), and Group B, patients were treated the same as those in Group A but received intravenous TXA before tourniquet release. The primary outcomes were changes in blood loss, haemoglobin and haematocrit. Secondary outcomes included operation and tourniquet times, blood transfusion rate, subcutaneous petechiae and circumferential changes in the operated limb, visual analogue scale (VAS) score, hospital for special surgery (HSS) score, length of stay (LOS) postoperatively, complications and patient satisfaction.ResultsNo statistically significant difference was found between the 2 groups with regard to age, sex, weight, body mass index (BMI), Kellgren-Lawrence class, preoperative blood volume, preoperative laboratory values, operation and tourniquet times, transfusion rate, knee circumference, preoperative HSS, or VAS score (P:n.s.). There was no significant difference in intraoperative blood loss (IBL) (52.7 ml vs. 63.4 ml, P = 0.07), hidden blood loss (HBL) (91.4 ml vs. 119.9, P = 0.4) or total blood loss (TBL) (144.1 ml vs. 183.3 ml, P = 0.72) between Groups A and B. Haemoglobin, haematocrit and red blood cell count (RBC) dropped to a low point on postoperative day 3 and then rebounded, returning to normal levels on day 21, and the trend of change between the 2 groups was not statistically significant (P:n.s.). There was no significant difference in subcutaneous ecchymosis incidence, knee swelling rate, HSS score, VAS score, LOS postoperatively, complication rate or patient satisfaction (P:n.s.).ConclusionTXA was administered intravenously prior to tourniquet compression could effectively reduce blood loss in patients who had undergone total knee arthroplasty. However, there was no significant difference in knee swelling rate, subcutaneous bruising and petechiae incidence, knee function, complication rate or satisfaction between patients who TXA was given intravenously before tourniquet compression and release in primary TKA.

Intravenous Tranexamic Acid Reduces Post-Operative Bleeding and Blood Transfusion in Patients Undergoing Aortic Surgery: A PRISMA-Compliant Systematic Review and Meta-Analysis

Background: Tranexamic acid (TXA), an antifibrinolytic agent, has been demonstrated to reduce blood loss and transfusion requirements in both cardiac and non-cardiac surgery. However, the evidence regarding the efficacy of intravenous TXA in aortic surgery has been seldomly analyzed. Therefore, the current study was performed to address this question. Methods: Searches of PubMed, EMBASE, OVID, Cochrane Library and CNKI were conducted comprehensively for randomized controlled trials (RCTs) comparing intravenous TXA versus no-TXA. Independently and in duplicate, we reviewed titles, abstracts and full-text articles, extracted data and evaluated bias risks. A random effect or fixed effect model was utilized to pool data. Results: The database search yielded 4 RCTs involving 273 patients. Meta-analysis revealed that, there was a significant reduction in bleeding volume within the first 4 hours post-operatively [(weighted mean difference (WMD) = –74.33; 95% confidence interval (CI): –133.55 to –15.11; p = 0.01)], and the first 24 hours post-operatively [(WMD = –228.91; 95% CI: –352.60 to –105.23; p = 0.0003)], post-operative red blood cell (RBC) transfusion volume [(WMD = –420.00; 95% CI: –523.86 to –316.14; p < 0.00001)], fresh frozen plasma (FFP) transfusion volume [(WMD = –360.35; 95% CI: –394.80 to –325.89; p < 0.00001)] and platelet concentrate (PC) transfusion volume [(WMD = –1.27; 95% CI: –1.47 to –1.07; p < 0.0001)] following intravenous TXA administration. In addition, intravenous TXA administration significantly decreased the incidence of postoperative complications (53/451 (8.2%) vs. 75/421 (13.9%); odds ratio (OR) = 0.47; 95% CI: 0.30 to 0.75; p = 0.001), according to this present meta-analysis. Conclusions: The current study preliminarily demonstrated that, TXA significantly reduced postoperative bleeding, blood transfusion requirements and postoperative complications among patients undergoing aortic surgery. More well-designed studies are warrant to confirm the efficacy and safety of intravenous TXA in patients undergoing aortic surgery.

Efficacy of Intravenous Tranexamic Acid on Perioperative Blood Loss and Transfusion Requirement in Spine Fusion Surgery

Introduction: Blood loss associated with spine fusion surgery is a common potential cause of morbidity and often requires a blood transfusion, which subjects patients to risks of blood transfusion. Tranexamic acid is used intra-operatively to reduce bleeding in major surgeries. This study aims to evaluate its efficacy on perioperative blood loss and transfusion requirement in patients undergoing spine fusion surgery
 Methods: This prospective randomised controlled study was conducted at Department of Orthopedics of Tribhuvan University Teaching Hospital between August 2015 and July 2016. Patients undergoing spine fusion surgery were randomly assigned to group A (TXA) and group B (control) equally, thirty patients in each group. TXA was given to group A in a loading dose of 10 mg/kg, followed by continuous infusion of 1 mg/kg/hr during surgery. Outcome measures included perioperative blood loss, amount of blood transfusion, and safety and adverse effects. The data were analyzed by means of SPSS version 21.0. The results were presented as mean ± SD. Differences were considered significant if the P-value was <0.05.
 Results: Sixty patients (31 males, 29 females) with mean age of 39.95 years were enrolled in study, thirty patients in each group. Statistical analysis showed no significant differences between the 2 study groups with regard to age, sex, weight, preoperative hemoglobin, level of fusion as well as operative time. The amount of perioperative blood loss was significantly less in the group A versus group B, 241.274±162.819 ml vs 661.053±189.469 ml, p=0.000. There was no difference in the incidence of allogenic blood transfusion. There were no complications related to use of TXA in this study.
 Conclusion: TXA provided an effective and safe method for reduction of blood loss during and after spine fusion surgery. However, there was no difference in the incidence of perioperative allogeneic blood transfusion.

Efficacy of intravenous tranexamic acid administration in medial opening-wedge distal tibial tuberosity osteotomy (MOWDTO) for varus knee osteoarthritis: a randomized control trial

BackgroundThis randomized controlled study was undertaken to investigate the efficacy of intravenous tranexamic acid (TXA) administration in reducing perioperative blood loss in patients undergoing medial opening-wedge distal tibial tuberosity osteotomy (MOWDTO). It was hypothesized that TXA would reduce perioperative blood loss in MOWDTO.MethodsA total of 61 knees in 59 patients who underwent MOWDTO during the study period were randomly assigned to either of the groups with intravenous TXA administration (TXA group) or without TXA administration (control group). In the TXA group, patients received 1000 mg of TXA intravenously before skin incision and 6 h after the first dose. The primary outcomes was the volume of perioperative total blood loss which calculated using the blood volume and hemoglobin (Hb) drop. The Hb drop was calculated as the difference between preoperative Hb and postoperative Hb at days 1, 3, and 7.ResultsThe perioperative total blood loss was significantly lower in the TXA group (543 ± 219 ml vs. 880 ± 268 ml, P < 0.001). The Hb drop was significantly lower at postoperative days 1, 3 and 7 in the TXA group than in the control group (day 1: 1.28 ± 0.68 g/dl vs. 1.91 ± 0.69 g/dl, P = 0.001; day 3: 1.54 ± 0.66 g/dl vs. 2.69 ± 1.00 g/dl, P < 0.001; day 7: 1.74 ± 0.66 g/dl vs. 2.83 ± 0.91 g/dl, P < 0.001).ConclusionIntravenous TXA administration in MOWDTO could reduce the perioperative blood loss.Trial registration The study was approved by the institutional review board. (Registered on 26/02/2019 Registration Number 3136).Level of Evidence Level I, randomized controlled trial.

Safety and Efficacy of Tranexamic Acid in Hip Hemiarthroplasty for Fracture Neck Femur: a Systematic Review and Meta-analysis.

Although numerous systematic reviews and meta-analyses have established the efficacy of tranexamic acid (TXA) in hip fracture surgeries, the included studies in those reviews have included all types of surgical interventions ranging from fixation to arthroplasty. Hip hemiarthroplasty is usually indicated in the elderly patients with femoral neck fracture and these patients have associated severe comorbidities and cognitive impairment. These subsets of patients with femoral neck fracture needs appropriate perioperative care and judicious use of antifibrinolytics. There is no meta-analysis evaluating the safety and efficacy of intravenous TXA in these patients. Searches of PubMed, Embase and Cochrane Central Register of Controlled Trials databases revealed 102 studies on TXA in hip fracture surgeries. After screening, eight studies were found to be suitable for review. The primary objective of this meta-analysis was to compare blood transfusion rate between TXA vs. control in hip hemiarthroplasty. The secondary objectives were total blood loss, postoperative haemoglobin, surgical duration, length of hospital stay and side effects (VTE, readmission and 30 days mortality). There were one RCT, one prospective cohort study and six retrospective studies. All studies recruited the elderly patients. Intravenous (IV) TXA administration resulted in significant reduction in requirement of blood transfusion (12.7% vs. 31.9%; OR 0.28; 95% CI 0.17-0.46; p < 00,001; I 2 = 73%). The TXA group had significantly decreased total blood loss (MD -100.31; 95% CI -153.79, -46.83; p < 0.0002). The postoperative Hb in the TXA group was significantly higher than the control group (MD 0.53; 95% CI 0.35, 0.71; p < 0.00001). There was no significant difference in the incidences of VTE (0.97% vs. 0.73%, OR 1.27; p = 0.81; I 2 = 64%) and readmission rate (9.2% vs. 9.64%; OR 0.79; p = 0.54), but 30-d mortality rate was significantly lower in the TXA group (3.41% vs. 6.04%; OR 0.66; p = 0.03). Intravenous TXA is efficacious in the reduction of blood loss and transfusion need in hip hemiarthroplasty surgery for hip fracture, without increased risk of VTE. The blood conservation protocol led to decreased 30 days mortality in these fragile elderly patients. III.

Intravenous tranexamic acid reduce postoperative drainage and pain after open elbow arthrolysis: a randomized controlled trial.

Open elbow arthrolysis (OEA), which has become an established treatment for post-traumatic elbow stiffness (PTES), requires complete release of contracture tissue and wide excision of ectopic bone, which results in extensive bleeding. The aim of the present study is to evaluate the efficacy of intravenous tranexamic acid (TXA) on postoperative drainage, calculated blood loss, and early clinical outcomes in patients undergoing OEA. A double-blind, randomized, placebo-controlled trial including 96 patients undergoing OEA was undertaken. Patients received intravenously either 100 mL saline (placebo group, n = 48), or 100 mL saline plus 1 g TXA (TXA group, n = 48) before skin incision. The primary outcome was the drainage volume on postoperative days (PODs) 1-3. Secondary outcomes included the calculated blood loss, elbow pain score measured by visual analog scale (VAS), elbow function valued by Mayo Elbow Performance Score (MEPS), and rate of complications after OEA. Mean total postoperative drainage volume (TXA group: 182 mL vs. placebo group: 214 mL, P = .003) and mean calculated total blood loss (TXA group: 582 mL vs. placebo group: 657 mL, P = .004) were significantly lower in the TXA group. No transfusions were necessary in either group. Mean VAS pain scores in elbow motion showed marked differences between both groups on POD 1 (TXA: 5 vs. placebo: 6, P = .003) and POD 2 (TXA: 4 vs. placebo: 5, P = .023) but not in other postoperative time points. No differences were detected in complications, such as pin-related infection, hematoma, new or exacerbation of ulnar nerve symptoms, and recurrent heterotopic ossification. At the 6-month follow-up, no statistical differences were found between the 2 groups with respect to the elbow functions including range of motion, VAS score, and MEPS. Intravenous administration of TXA significantly decreased the postoperative drainage volume and the total estimated blood loss and alleviated the elbow pain with motion during early postoperative days in patients undergoing OEA.

Efficacy of intravenous tranexamic acid and closed suction drainage in total hip arthroplasty

Efficacy of intravenous tranexamic acid and closed suction drainage in total hip arthroplasty

Efficacy of Intravenous Tranexamic Acid in Reducing Perioperative Blood Loss and Blood Product Transfusion Requirements in Patients Undergoing Multilevel Thoracic and Lumbar Spinal Surgeries: A Retrospective Study.

Introduction: Acute perioperative blood loss is a common and potentially major complication of multilevel spinal surgery, usually worsened by the number of levels fused and of osteotomies performed. Pharmacological approaches to blood conservation during spinal surgery include the use of intravenous tranexamic acid (TXA), an anti-fibrinolytic that has been widely used to reduce blood loss in cardiac and orthopedic surgery. The primary objective of this study was to assess the efficacy of intraoperative TXA in reducing estimated blood loss (EBL) and red blood cell (RBC) transfusion requirements in patients undergoing multilevel spinal fusion. Materials and Methods: This a single-center, retrospective study of subjects who underwent multilevel (≥7) spinal fusion surgery who received (TXA group) or did not receive (control group) IV TXA at The Ohio State University Wexner Medical Center between January 1st, 2016 and November 30th, 2018. Patient demographics, EBL, TXA doses, blood product requirements and postoperative complications were recorded. Results: A total of 76 adult subjects were included, of whom 34 received TXA during surgery (TXA group). The mean fusion length was 12 levels. The mean total loading, maintenance surgery and total dose of IV TXA was 1.5, 2.1 mg per kilo (mg/kg) per hour and 33.8 mg/kg, respectively. The mean EBL in the control was higher than the TXA group, 3,594.1 [2,689.7, 4,298.5] vs. 2,184.2 [1,290.2, 3,078.3] ml. Among all subjects, the mean number of intraoperative RBC and FFP units transfused was significantly higher in the control than in the TXA group. The total mean number of RBC and FFP units transfused in the control group was 8.1 [6.6, 9.7] and 7.7 [6.1, 9.4] compared with 5.1 [3.4, 6.8] and 4.6 [2.8, 6.4], respectively. There were no statistically significant differences in postoperative blood product transfusion rates between both groups. Additionally, there were no significant differences in the incidence of 30-days postoperative complications between both groups. Conclusion: Our results suggest that the prophylactic use of TXA may reduce intraoperative EBL and RBC unit transfusion requirements in patients undergoing multilevel spinal fusion procedures ≥7 levels.

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

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

Tranexamic Acid and Ethamsylate for Reducing Blood Loss in Patient Undergoing Lower Segment Cesarean Section at High Risk for Post-Partum Hemorrhage: A Pilot Study

Objective: To assess the efficacy of intravenous tranexamic acid and ethamsylate in reducing blood loss during and after elective lower segment cesarean delivery in patients at high risk for postpartum hemorrhage. Methods: A double-blind, randomized placebo-controlled study was undertaken of women undergoing elective lower-segment cesarean delivery of a full-term pregnancy at high risk for postpartum hemorrhage at Ain Sham University Maternity Hospital in Cairo, Egypt, between January 2019 and October 2019. Patients were randomly assigned (1:1) using computer-generated random numbers to receive either 1 g tranexamic acid and 1 gm ethamsylate or 5% glucose (placebo) just after delivery of the fetus. Prophylactic oxytocin was administered to all women. Preoperative and postoperative complete blood count, hematocrit values, and maternal weight were used to calculate the estimated blood loss (EBL) during the cesarean, which was the primary outcome. Results: Analyses included 32 women in each group. Our results showed that tranexamic acid and ethamsylate significantly reduced bleeding during and after cesarean delivery. The study group’s total blood loss (149.22 ± 54.74 ml) was significantly less than the control group (353.75 ± 115.56 ml) (p the control group (p the control group (p Conclusion: The use of tranexamic acid and ethamsylate during cesarean delivery can significantly reduce blood loss during and after cesarean delivery.

Efficacy of intravenous tranexamic acid in reducing blood loss during and after elective cesarean section

Background Tranexamic acid (TXA) is one of the prominent amino acid lysine synthetic derivatives having its antifibrinolytic effect through the reversible blockade of the lysine-binding sites on plasminogen molecules. It is regularly administered intravenously to treat and avoid bleeding, with good results. Objective This study was carried out to evaluate the effectiveness, safety, and complications of using TXA in elective cesarean section (CS). Patients and methods This was a prospective study that was conducted at Al-Zahraa University Hospital and El Sahel Teaching Hospital on 200 patients planned for elective CS: 100 patients were given 1 g/10 ml TXA (group A) diluted with 20 ml of 5% glucose, whereas another 100 patients received 30 ml of 5% glucose (group B) 10 min before CS. Following the delivery, patients in both groups received a 5 IU intravenous bolus of pre-prepared oxytocin followed by 30 IU oxytocin in 500-ml lactated Ringer's solution, infused at a rate of 125 ml/h. An antibiotic, 1 g cefazolin, was diluted in normal saline of 20 ml, and it was administered over a duration of 5 min. Estimated blood loss was measured by comparing the hematocrit values before and after the procedure. Results The study revealed a statistically significant decrease in hemoglobin level in group B (placebo group) compared with group A (TXA group), which indicates that there was a significant reduction in the amount of intraoperative and postoperative blood loss in CS in TXA group. Conclusion The use of TXA before CS shows positive effects and can be used as a prophylaxis against postpartum hemorrhage, as revealed by the findings of this study.

Efficacy of intravenous tranexamic acid in reducing perioperative blood loss in patients undergoing hemiarthroplasty

Introduction: Femoral neck fractures are frequent injuries in a trauma centre and have a high incidence in the general population. Hip fracture surgeries are associated with substantial blood loss, exposing patients to postoperative anaemia. The severity of anaemia is related directly to post-operative functional recovery of the patients, which is related to long-term mortality. Blood transfusion related adverse effects also can directly influence the recovery. Tranexamic acid is a simple and inexpensive synthetic antifibrinolytic agent, which prevents the degradation of fibrin and delays the breakdown of haemostasis clots. Aim of this study is to assess the efficacy of intra-venous administration of Tranexamic acid in patients undergoing hemiarthroplasty with regards to blood loss at perioperative period. Materials and Methods: A prospective randomised control study was done in a tertiary care hospital in southern part of India during the period of January 2016 to June 2017. 40 consecutive fracture neck of femur patients were randomised into two group, each group consist of 20 patient, Group 1 patients received placebo of 50 ml of normal saline administered intravenously 10 minutes before starting the surgery. Group 2 patients received Tranexamic acid -1500Mg diluted in 50ml Normal Saline administered intravenously 10 minutes before the surgery. Intraoperative blood loss was assessed by collecting the number of fully soaked mopping pads, fully soaked gauze pieces and quantity of irrigation fluid form suction bottle after subtracting the amount of normal saline used for wash. Post operatively all patients were assessed by evaluating the haemoglobin, Packed cell volume values from patients and blood collected in the negative suction drain of day 1 and day 2. The study group and control group parameters were analysed and compared. Results: 45 patients were enrolled in our study and 5 patients were excluded from the study due to not giving consent for study. Demographic date like age, gender, side of fracture, type of fracture type of prosthesis were not influenced our study. Requirement of intra operative blood transfusion were significantly reduced in study group in comparison with control group which was statistically significant (p=0.027). In study group only 3 patient received blood transfusion, whereas control group 11 patents were received. Conclusion: In our study, there was significant reduction in the amount of blood loss in tranexamic acid administered group when compared to the placebo group. Tranexamic acid was cost effective and safer when compared to blood components. Tranexamic acid should be considered for routine use in Hemiarthroplasty surgery to decrease blood loss.

Efficacy of intravenous tranexamic acid at reducing blood loss during elective caesarean section in Abakaliki: A double blind randomized placebo controlled trial

Increasing caesarean section rate is a source of concern to obstetricians due to the attendant increased health risk, its commonest complication is bleeding, which occasionally may be life threatening. Tranexamic acid has recently been investigated as a potentially useful adjunct for the prevention of maternal morbidity. The research aim to evaluate the efficacy of tranexamic acid at reducing blood loss during elective caesarean section. The method used was a double blind randomized placebo controlled trial among women who had elective caesarean section at the Federal Teaching Hospital Abakaliki (FETHA) and Mile 4 Hospital Abakaliki. Data analysis was done using statistical Package for Social Science (IBM SPSS) software (version 20, Chicago II, USA). The results from the finding show that mean estimated blood loss was significantly lower in the tranexamic acid group (566.78±267.42 ml versus 819.09±348.36 ml, p 1000 ml was also significantly lower in the study group compared with the control group 5(8.8%) versus 16(27.6%); alternatively, 0.25; 95% CI 0.09 to 0.74; p=0.012. Tranexamic acid significantly reduced the need for additional uterotonics. However, the number of patients that had blood transfusion between had no difference and the maternal side effect profile was similar. Intravenous tranexamic acid significantly reduced blood loss at elective caesarean sections. It also reduced the risk of blood loss greater than 1000 ml and the need for additional uterotonics without increasing maternal risks. Key words: Tranexamic acid, blood loss, elective caesarean section.

Efficacy of Intravenous Tranexamic Acid in Reducing Blood Loss after Elective Cesarean Section

Background: Primary post-partum hemorrhage (PPH) is defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. Objective: was to determine the efficacy and safety of tranexamic acid in reduction of blood loss after the elective cesarean sections. Patients and Methods: We performed a randomized, controlled study of 200 pregnant females who underwent elective CS. The patients had attended the Labor Ward in Al-Azhar University Maternity Hospital. 100 of them received tranexamic acid 20 minutes before beginning of anesthesia in addition to oxytocin after delivery of the baby; the other 100 patients received oxytocin only. Results: In the 1st two hours post-partum vaginal bleeding was significantly less severe in study group than control group (p<0.019). There was nonsignificant difference between study and control groups as regards preoperative hemoglobin concentration (p=0.195), Postoperative hemoglobin concentration was significantly greater in study group than control group (p<0.001), Reduction in hemoglobin levels ware significantly less in study group than control group (p<0.001). There was nonsignificant difference between study and control groups as regards to preoperative hematocrite (p=0.967), Postoperative hematocrite levels were significantly higher in study group than control group (p0.015), Reduction in hematocrite levels ware significantly less in study group than control group (p<0.001).

Efficacy of Intravenous Tranexamic Acid in Reducing Blood Loss after Elective Cesarean Section

Background: Primary post-partum hemorrhage (PPH) is defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. Objective: was to determine the efficacy and safety of tranexamic acid in reduction of blood loss after the elective cesarean sections. Patients and Methods: We performed a randomized, controlled study of 200 pregnant females who underwent elective CS. The patients had attended the Labor Ward in Al-Azhar University Maternity Hospital. 100 of them received tranexamic acid 20 minutes before beginning of anesthesia in addition to oxytocin after delivery of the baby; the other 100 patients received oxytocin only. Results: In the 1st two hours post-partum vaginal bleeding was significantly less severe in study group than control group (p<0.019). There was nonsignificant difference between study and control groups as regards preoperative hemoglobin concentration (p=0.195), Postoperative hemoglobin concentration was significantly greater in study group than control group (p<0.001), Reduction in hemoglobin levels ware significantly less in study group than control group (p<0.001). There was nonsignificant difference between study and control groups as regards to preoperative hematocrite (p=0.967), Postoperative hematocrite levels were significantly higher in study group than control group (p0.015), Reduction in hematocrite levels ware significantly less in study group than control group (p<0.001).

Comparison of the efficacy of intravenous tranexamic acid with and without topical administration versus placebo in urgent endoscopy rate for acute gastrointestinal bleeding: A double-blind randomized controlled trial.

Tranexamic acid (TXA), a synthetic antifibrinolytic drug, is effective as a treatment for serious hemorrhage, including bleeding arising from major trauma and post-operative interventions. Significant acute gastrointestinal bleeding may have a poor outcome despite routine medical and endoscopic treatments. The aim of this study was to assess whether early intravenous and/or intravenous plus topical administration of TXA reduces the need for urgent endoscopy for acute gastrointestinal bleeding. This double-blind randomized clinical trial included 410 patients with proven acute gastrointestinal bleeding. All patients received conventional therapy. The subjects were randomized to three groups: (A) 138 patients received intravenous TXA (1 g q6h); (B) 133 patients received topical TXA (1 g single dose by nasogastric tube) plus systemic TXA; and (C) 139 patients received a placebo (sodium chloride 0.9%) for 24 hours. Subgroup statistical analyses were conducted for urgent endoscopy, mortality, re-bleeding, blood transfusion, endoscopic and/or surgical intervention rates, and health status. The time to endoscopy was significantly shorter in group C (15.58 ± 7.994, p < 0.001). A need for urgent endoscopy was seen in 14.49%, 10.52%, and 30.21% of patients in groups A, B, and C, respectively (p < 0.001). No significant statistical differences were seen between treatment groups regarding mortality, re-bleeding, blood transfusion, and endoscopic and/or surgical intervention rates. No thromboembolic event was documented during the 1-week follow up. Our results showed that the antifibrinolytic properties of TXA can aid in changing an urgent endoscopy to an elective procedure, with better outcomes for both physicians and patients.

Combination Intravenous and Intra-Articular Tranexamic Acid Compared with Intravenous Only Administration and No Therapy in Total Knee Arthroplasty: A Case Series Study

IntroductionExcessive perioperative bleeding requiring transfusion remains a potential complication of Total Knee Arthroplasty (TKA). There is overwhelming evidence supporting the efficacy of intravenous Tranexamic acid to reduce bleeding and the need for transfusion in TKA. There is still some question regarding the efficacy of other methods of Tranexamic acid administration. This case series study evaluated the effects of the use of intravenous Tranexamic acid administered alone, or in combination with intra-articular tranexamic acid on transfusion rate and other clinical outcomes; and compared this to a group of patients who received neither treatment.MethodWe conducted a case review of 150 patients who had undergone TKA from 2012-2015. 50 patients underwent TKA with IV Tranexamic acid (Group A). A further 50 patients underwent TKA with IV Tranexamic acid in combination with intra-articular administration of 2grams of Tranexamic acid in 20ml saline (Group B). A final 50 patients underwent TKA without the use of Tranexamic acid (non-treatment group). Outcome measures were transfusion rate, change in haemoglobin and haematocrit, medical review events, patient mortality and changes in knee flexion and extension measurements at six weeks after surgery.ResultsThere were no significant differences in red blood cell transfusion rates between the non-treatment group and the two treatment groups, however an absolute reduction in transfusion rate from 8% to 0% (p=0.134) was observed. The mean change of haemoglobin level in the non-treatment group was 29 while in treatment groups A and B, this was 23 and 19 respectively (p=0.0001). No significant difference was observed between treatment group A and B. There was a significant difference in post-operative haemoglobin level, where mean haemoglobin concentrations in non-treatment, Group A and B were 110 vs 115 vs 123 respectively (P= 0.0001). Pairwise comparison showed that Group B was significantly different when compared to both non treatment (p=0.0001) and treatment group A (p=0.020). There were no significant differences observed in other outcomes.ConclusionThis study supports the existing literature and suggests that the use of IV Tranexamic acid alone or in combination with intra-articular dose in TKA may reduce the requirement for transfusion (Level IV evidence). Furthermore, this study suggests that the use of tranexamic acid as a combination of Intravenous and intra-articular administration has no effect on range of motion, or medical complications during hospital stay. Although it was not a statistically significant finding, our study suggested a trend towards a greater reduction in haemoglobin and haematocrit fall in the combination therapy group when compared to IV Tranexamic acid alone

Tranexamic acid in adenotonsillectomy in children: A double-blind randomized clinical trial

ObjectivesAdenotonsillectomy is one of the most common surgical procedures in pediatric otolaryngology, in which bleeding is a potential complication. We evaluated the efficacy of intravenous tranexamic acid in reducing intraoperative bleeding volume, and bleeding in the following 10 postoperative days in children who underwent adenotonsillectomy. DesignDouble-blind, randomized placebo-controlled trial. SettingTertiary hospital. PatientsNinety-five children of both sexes between four and twelve years old who underwent adenotonsillectomy due to adenotonsillar hyperplasia. InterventionsIntravenous tranexamic acid in the preoperative and at the eighth and the sixteenth hours of the postoperative periods. Main outcome measureBleeding volume was measured in milliliters (mL) at the end of the procedure, and bleeding events were registered in the following 10 postoperative days. ResultsThere was no statistically significant reduction in bleeding volume with the use of tranexamic acid (mean±standard deviation, 135.13±71.44 [tranexamic acid] versus 158.21±88.09 [placebo]; P=0.195). No difference was observed in the incidence of postoperative bleeding in the 10 postoperative days, but the sample size is insufficient to exclude a type 2 error. ConclusionsThere is no benefit in the use of tranexamic acid for reducing bleeding during the transoperative period of adenotonsillectomy in children. More studies with a greater sample are required to evaluate the benefit of tranexamic acid in postoperative bleeding.

Efficacy of Intravenous Tranexamic Acid in Reducing Blood Loss after Elective Cesarean Section: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Efficacy of Intravenous Tranexamic Acid in Reducing Blood Loss after Elective Cesarean Section: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Efficacy of Intravenous Tranexamic Acid in Reducing Blood Loss after Elective Cesarean Section: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

We sought to determine the efficacy and safety of tranexamic acid (TA) in reducing blood loss during elective cesarean section (CS). We performed a randomized, double-blind, placebo-controlled study of 660 women who underwent elective CS. The patients were randomly selected to receive an intravenous infusion of either TA (1 g/10 mL in 20 mL of 5% glucose; N = 330) or 30 mL 5% glucose prior to surgery. The primary outcome was the estimated blood loss following CS. No demographic difference was observed between groups. The mean estimated blood loss was significantly lower in women treated with TA compared with women in the placebo group (499.9 ± 206.4 mL versus 600.7 ± 215.7 mL, respectively; P < 0.001), and the proportion of women in the TA group who had an estimated blood loss >1000 mL was significantly lower than in the placebo group (7 [2.1%] versus 19 [5.8%], respectively; relative risk [RR] 2.7; 95% confidence interval [CI] 1.1 to 6.3; P < 0.03). Furthermore, more women in the placebo group than in the TA group required additional uterotonic agents (48 [14.5%] versus 28 [8.5%], respectively; RR 1.7; 95% CI 1.1 to 2.6; P = 0.02). Maternal and neonatal outcomes did not differ significantly. TA significantly reduced bleeding during CS, the percentage of patients with blood loss >1000 mL, and the need for additional uterotonic agents. Furthermore, the incidence of thromboembolic events did not increase. Our results suggest that TA can be used safely and effectively to reduce CS bleeding.