Intravenous Injection Of Tranexamic Acid Research Articles

Intravenous Injection of Tranexamic Acid in Patients with Pelvis or Acetabulum Fractures to Reduce Blood Loss: A Double-Blind, Randomized, Controlled Trial

Background: Despite their low incidence, pelvis and acetabular fractures have a high mortality rate due to extensive hemorrhage. Tranexamic acid (TXA) is an antifibrinolytic drug that inhibits the production of plasminogen. The aim of the current study is to evaluate the safety and efficacy of TXA use for blood loss reduction and the need for blood transfusion in patients with fractures of the pelvis or acetabulum.
 Methods: 108 patients were recruited from two tertiary care hospitals and assigned evenly either to the intervention (TXA) or the control group. TXA group received 15 mg/kg TXA 30 minutes before the fracture reduction and fixation surgery. The number of transfused blood units before, during, and after the surgery was recorded. Blood loss was assessed by calculation of estimated blood loss (EBL), collected blood with drain, collected blood with suction, and weight of the used gauzes during the surgery. The time between fracture occurrence and the surgery, the duration of the surgery, and the days of admission were assessed.
 Results: The mean age was 39.49 ± 15.81 years, and 69.4% were women. 6 patients had pelvic, and 102 patients had acetabulum fractures. The duration of the surgery was not significantly different. The time gap between the reconstructive surgery and fracture occurrence was significantly higher in the TXA group (P = 0.032). The mean postoperative hospitalization time was significantly lower among TXA group patients (P = 0.037). The mean hemoglobin (Hb) in the TXA group was significantly higher, postoperatively (P = 0.028). The mean EBL, the blood volume collected by suction or drain, the weight of the consumed gauze during the surgery, and the number oftransfused blood units were significantly lower in the TXA group. The transfusion rate was significantly lower in patients with a shorter time gap between fracture occurrence and reduction surgery (P = 0.021).
 Conclusion: TXA can decrease blood loss, the transfused blood units during and after the operation, and hospital admission days. Moreover, it did not increase the chance of pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT) in the patients receiving TXA; thus, it can be assumed as a safe and efficient drug in patients with acetabulum or pelvis fractures.

Effect of Intravenous Injection of Tranexamic Acid in Total Knee Replacement

Effect of Intravenous Injection of Tranexamic Acid in Total Knee Replacement

The effect of early tranexamic acid on bleeding, blood product consumption, mortality and length of hospital stay in trauma cases with hemorrhagic shock: a randomized clinical trial

SummaryIntroductionBecause no medication has been approved for coagulation support in trauma, the current study was aimed to evaluate the effectiveness of intravenous injection of Tranexamic acid (TXA) in patients with acute traumatic bleeding.MethodsIn the current randomized controlled clinical trial, 68 patients with acute bleeding and hemorrhagic shock presentation due to blunt trauma of the abdomen, pelvis, and thorax, randomly assigned into two groups of TXA and placebo.ResultsThere was no statistically significant difference between the two groups in terms of Systolic blood pressure, pulse rate, Base excess, serum hemoglobin changes, bleeding volume, the incidence of thrombotic events, and the number of deaths (p > 0.05). But Systolic blood pressure, pulse rate, base excess, and serum hemoglobin, changed significantly within each group over time(p < 0.05). The median time for the length of hospital stay among the TXA group was lower than the Placebo group (6 days vs 10 days, p = 0.004). Also, there was a significant difference between the two groups about the median of pack cell, Platelet consumption, and bleeding Volume (p < 0.05).ConclusionThe use of TXA is associated with lower use of blood production and reduced length of hospital stay, however, thrombotic events incidence and mortality rates between the TXA and placebo groups were not different.

THE USE OF TRANEXAMIC ACID IN ARTHOPLASTY OF LARGE JOINTS (LITERATURE REVIEW)

Endoprosthesis of large joints is an efficient method to restore the functional capacity of a limb, to increase the patientʼs motor activity, to eliminate the pain syndrome and to recover self-service. However, there is a risk of certain complications, one of which is massive blood loss. There have been recent publications on the feasibility of the use of tranexamic acid in the arthroplasty of large joints to prevent and reduce blood loss. The objective is to identifythe trends in the use of tranexamic acid in orthopedics and traumatology to prevent blood loss in the arthroplasty of large joints without increasing the risk of other complications. Methods. The search for the scientific information was conducted in Google Scholar, PubMed, World Digital Library, ScienceDirect. Results. The literature review is devoted to the topical issue of the present dayʼs orthopedics, which is the use of tranexamic acid to prevent bloodloss in arthroplasty of large joints. According to the studies, the use of tranexamic acid significantly reduces the overall blood loss without increasing the risk of complications such as thromboembolism. The risk of complications of infectious genesis and of those due to the blood transfusion is also reduced using tranexamic acid. It is determined that the combined intra-articular and intravenous injection of tranexamic acid is more efficient than the applicationof either method separately. However, the comparative results of the ways of administration and the dosage regimen are quite ambiguous. The question of the optimum dose of the medication, which would provide maximum efficiency, without increasing the risk of complications is still to establish. It is advisable to conduct further research on the use of tranexamic acid to determine the efficiency of the ways of injection, dosing regimen taking into accountthe patients' demographic features, their age, concomitant pathology, time of surgery and other factors.

A singular case of massive urethrorrhagia solved by transarterial embolization

BackgroundUrethrorrhagia is frequent in pelvic trauma, rarely due to traumatic injuries of internal pudendal artery branches.Case presentationOur aim is to underline the role of transarterial embolization in selected patients, as in this case in which a young man manifested urethral hemorrhage after high-energy motorcycle crash not associated with injuries of the inferior urinary tract. Multi-detector computed tomography (MDCT) showed pubic symphysis diastasis and perineal hematoma with pseudoaneurysm into the penis bulb. The first approach was conservative with perineal external compression and intravenous injection of tranexamic acid. Afterward, due to the decline of clinical conditions, we decided to perform a selective angiography, confirming the vascular injury of distal branches of both internal pudendal arteries with contrast agent extravasation into urethral bulb; endovascular embolization was performed with detachable micro-coils. The principal results were seen quickly, indeed urethrorrhagia arrested and hemoglobin values normalized. Erectile function was preserved at 6-months follow-up.ConclusionsEndovascular embolization proved to be a minimally invasive therapeutic approach, clinically effective, with a low rate of complications and high probability to preserve erectile function.

The Efficacy of Intravenous Versus Topical Use of Tranexamic Acid in Reducing Blood Loss after Primary Total Knee Arthroplasty: A Randomized Clinical Trial.

Blood loss during and immediately after total knee arthroplasty (TKA) is among the most challenging concerns. It has been demonstrated that Tranexamic acid (TXA) can help to reduce perioperative blood loss. TXA can be used as an oral, topical or intravenous injection. Many studies evaluated the effectiveness of each route of administration but few works on a comparison between them. The current study aimed to compare the effectiveness of intravenous injection versus topical use of TXA in reducing perioperative blood loss after primary total knee arthroplasty. Eighty-five patients who were a candidate for total knee arthroplasty were randomized into two groups: one group received Intravenous injection of 15 mg/kg TXA, 10 min before tourniquet inflation while the other group received 1 g diluted TXA during wound closure. The postoperative blood loss was estimated by measuring the whole drain output and also hemoglobin (HB) drops. Both groups compared based on the need for allogenic blood transfusion and also thromboembolic events. Patients who received topical TXA had a higher total drain output (p <0.0001) compared to intravenous injection. The hemoglobin drop also was more in the topical group although it was marginally significant (p =0.05). Intravenous injection of TXA is more effective in reducing postoperative blood loss after primary TKA compared to topical administration.

Application of intravenous injection of tranexamic acid combined with local use of tranexamic acid cocktail in intertrochanteric fracture fixation

To explore the efficacy and safety of intravenous injection of tranexamic acid (TXA) combined with local use of TXA cocktail in intertrochanteric fracture fixation with proximal femoral nail antirotation (PFNA). Patients with intertrochanteric fractures who underwent close reduction and internal fixation with PFNA between February 2018 and March 2019 were enrolled in the study. Among them, 45 patients who met the selection criteria were included in the study and randomly allocated into 3 groups ( n=15). The patients in group A were not received TXA during perioperative period. The patients were intravenously injected of 1.0 g TXA before operation in group B and combined with local use of TXA cocktail during operation in group C. There was no significant difference in the age, gender, body mass index, fracture classification, disease duration, and complications between groups ( P>0.05). The perioperative blood loss and blood transfusion rate, the visual analogue scale (VAS) score before operation and at 12, 24, and 48 hours after operation, the levels of prostaglandin E2 (PGE2) and bradykinin (BK) before operation and at 1 and 3 days after operation, postoperative complications, and the maximum amplitude (MA) of thromboelastogram were recorded and compared between groups. The total blood loss, hidden blood loss, and visible blood loss were significantly lower in groups B and C than those in group A ( P<0.05), and the total blood loss and hidden blood loss were significantly lower in group C than those in group B ( P<0.05). There was no significant difference in the blood transfusion rate, preoperative VAS scores and the levels of PGE2 and BK between groups ( P>0.05). The postoperative VAS scores and the levels of PGE2 and BK were significantly lower in group C than in groups A and B ( P<0.05). There was no significant difference in pre- and post-operative MA of thromboelastogram between groups ( P>0.05). The incidences of postoperative complications were 33.33% (5/15), 20.00% (3/15), and 13.33% (2/15) in groups A, B, and C, respectively, with no significant difference between groups ( χ 2=1.721, P=0.550). For intertrochanteric fractures, application of intravenous injection of TXA combined with local use of TXA cocktail in PFNA fixation can reduce perioperative blood loss, relieve pain after operation, and do not increase the risk of complications.

Assessing the effect of per operative intravenous injection of tranexamic acid in patients undergoing arthroscopic anterior cruciate ligament reconstruction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Anterior cruciate ligament (ACL) tear is a common injury sustained during contact games hampering performance of the sportsmen and thus requires promt management. Arthroscopic ACL reconstruction is commonly associated with postoperative knee effusion which affects the functional recovery. Various treatment modalities are available for managing effusion after ACL reconstruction, which are associated with various grades of success and side effects.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective interventional study was carried out at tertiary care Orthopaedic centre. It involved 48 Young male athletes with ACL tear managed subsequently by arthroscopic ACL reconstruction. Subjects were divided into Injection group and non injection group by randomization and blinding was ensured. Postoperative rehabilitation, prophylactic antibiotic and chemoprophylaxis for DVT was kept standardised for all patients. Patients were assessed for pain at operative site by visual analogue scale, effusion of knee by classification of Coupens and Yates and Lysholm knee scoring at 2nd, 6th and 12th week postoperatively.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; During follow ups it was found that Injection group was having significant less incidence of effusion as compared with Non injection group; which also has reflected in functional recovery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It can be concluded that use of inj tranexamic acid preoperative dose in case of patients undergoing ACL reconstruction is efficient to reduce the knee effusion.&lt;/p&gt;

Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty.

PurposeTotal knee arthroplasty (TKA) accompanies the risk of bleeding and need for transfusion. There are several methods to reduce postoperative blood loss and blood transfusion. One such method is using tranexamic acid during TKA. The purpose of this study was to confirm whether tranexamic acid reduces postoperative blood loss and blood transfusion after TKA.Materials and MethodsA total of 100 TKA patients were included in the study. The tranexamic acid group consisted of 50 patients who received an intravenous injection of tranexamic acid. The control included 50 patients who received a placebo injection. The amounts of drainage, postoperative hemoglobin, and transfusion were compared between the groups.ResultsThe mean amount of drainage was lower in the tranexamic acid group (580.6±355.0 mL) than the control group (886.0±375.5 mL). There was a reduction in the transfusion rate in the tranexamic acid group (48%) compared with the control group (64%). The hemoglobin level was higher in the tranexamic acid group than in the control group at 24 hours postoperatively. The mean units of transfusion were smaller in the tranexamic acid group (0.76 units) than in the control group (1.28 units).ConclusionsOur data suggest that intravenous injection of tranexamic acid decreases the total blood loss and transfusion after TKA.

Comparing Efficacy of Three Methods of Tranexamic Acid Administration in Reducing Hemoglobin Drop Following Total Knee Arthroplasty

The ideal method of providing tranexamic acid (TXA) for decreasing hemoglobin drop after TKA is still controversial. In this clinical trial, 200 patients were randomly allocated to four groups. In group 1, 500mg TXA was administered intravenously. In group 2, the joint irrigated with 3g of TXA in 100cc of saline. In group 3, 1.5g of TXA was injected through the drain. Group 4 did not take TXA. Albeit all methods had a statistical effect on hemoglobin drop, drainage and number of transfused units when compared to controls, but intravenous injection of TXA seems to be much more effective in terms of reducing hemoglobin drop and transfused units; and what's more TXA injection by drain is more effective regarding to reducing postoperative drainage.

Can Intravenous Injection of Tranexamic Acid Be Used in Routine Practice With Active Management of the Third Stage of Labor in Vaginal Delivery? A Randomized Controlled Study

Obstetric hemorrhage accounts for ∼25% of maternal morbidity. Many methodologies are used to promote active management of the third stage of labor. Tranexamic acid successfully reduces blood loss and transfusion requirements in nonobstetric conditions. This double-blind, randomized, controlled trial was undertaken to estimate the effects of adding tranexamic acid to an active management protocol. The parturients were at 34 to 42 weeks’ gestation, with a live fetus in cephalic presentation, and expecting vaginal birth. The experimental group (n = 228) received 1 g/10 mL tranexamic acid diluted with 20 mL 5% glucose; the placebo group (n = 226) received 30mL5%glucose. Tranexamic acid or placebo was administered intravenously over 5 minutes at delivery of the fetus’ anterior shoulder. Standard management of the third and fourth stages of labor was applied. The primary outcome was the volume of blood loss during the third and fourth stages of labor. Other outcomes were the incidence of postpartum hemorrhage (PPH; >500 mL), severe PPH (>1000 mL), need for blood transfusion, need for additional uterotonic drugs, and adverse effects of tranexamic acid. Participants were contacted 3 weeks after delivery to assess the incidence of thromboembolic events. Data were analyzed on an intent-to-treat basis. The final analysis included 220 and 219 in the tranexamic acid and control groups, respectively. The groups were similar in patient characteristics and risk factors for PPH. At the third and fourth stages of labor, mean estimated blood losses were 261.5 ± 146.8 and 349.98 ± 188.85 mL in the tranexamic acid and control groups, respectively (P < 0.001). Four patients (1.8%) in the tranexamic acid group and 15 (6.8%) in the control group had PPH of greater than 500 mL (RR, 3.76; 95% CI, 1.27–11.15; P = 0.01). Six (2.7%) and 19 (8.7%) women in the tranexamic acid and control groups, respectively, required additional uterotonic agents (RR 3.18; 95% CI, 1.29–7.81; P = 0.007). The groups did not differ in need for blood transfusion. Predelivery hemoglobin and hematocrit levels were the same in the 2 groups, but at 1 day postpartum, hemoglobin levels were 9.9 T 1.4 and 9.3 T 0.9 g/dL (P G 0.001), and hematocrit levels were 30.2% ± 1.2% and 29.0% ± 1.3% (P < 0.001) in the tranexamic acid and placebo groups, respectively. No major complications and no significant changes in prothrombin time, active prothrombin time, or liver or renal function tests were noted in either group. Rates for nausea, vomiting, and diarrhea were 15.0%, 13.6%, and 7.3% in the tranexamic acid group and 5.5%, 6.4%, and 1.8% in the control group. At the clinical checkup 3 weeks postpartum, no episode of thrombosis was reported in patients given tranexamic acid. Tranexamic acid can reduce the average amount of blood loss during the third and fourth stages of labor. Determining the clinical settings in which this medication may be beneficial is critical for future research.

Does tranexamic acid, deliberate hypotension, and anti-Trendelenburg position improve the quality and outcome for functional endoscopic sinus surgery

EnAbstract Objectives To improve the control of bleeding during functional endoscopic sinus surgery (FESS) by means of positional changes, controlled hypotensive anesthesia, and an intraoperative (IO) intravenous injection of tranexamic acid. Patients and methods The study included 45 patients assigned to undergo FESS. Patients were divided randomly into three equal groups: group A received an IO injection of tranexamic acid 10 mg/kg as a bolus injection after induction of anesthesia. Group B included patients placed on a table inclined by ∼30π in the anti-Trendelenburg position and received an IO injection of tranexamic acid 10 mg/kg after induction of anesthesia. Group C included patients maintained supine who did not receive an IO injection of tranexamic acid. All patients received a maintenance anesthetic regimen that used combined intravenous/inhalational anesthesia. Operative field visibility was evaluated using the Fromme scale. The total amount of bleeding as judged by the amount evacuated was recorded. Results The anesthetic maneuver used reduced blood pressure and heart rate significantly at the end of surgery compared with the measures estimated at the time of induction of anesthesia. Groups A and C showed significantly higher blood pressure and heart rate estimated at the end of surgery compared with group B. All surgeries were conducted completely without IO complications. No extensive bleeding was recorded and no patient had a visibility score of 0 or 5. Four patients had a visibility score of 1, nine patients had a visibility score of 2, 15 patients had a visibility score of 3, and 17 patients had a visibility score of 4. The frequency of patients who had higher field visibility was significantly higher in group B compared with groups A and C, with a significantly higher frequency in group A compared with group C. Manipulations applied for group B significantly reduced the amount of IO bleeding, with a subsequent significant improvement in the mean field visibility score compared with groups A and C. Tranexamic acid significantly reduced the amount of bleeding and improved field visibility in group A compared with group C. Conclusion A combination of maintaining patients in the anti-Trendelenburg position, anesthetic manipulation using combined intravenous and inhalational anesthesia, and an IO intravenous injection of tranexamic acid could minimize bleeding and improve field visibility during FESS and this combination of manipulations could be recommended as strategy for this type of surgery.

Can Intravenous Injection of Tranexamic Acid Be Used in Routine Practice with Active Management of the Third Stage of Labor in Vaginal Delivery? A Randomized Controlled Study

To estimate the effects of adding intravenous tranexamic acid (TA) to the standard active management of third-stage labor to reduce vaginal blood loss during the third and fourth stages of labor. A prospective, double-blind, equivalence randomized, controlled study was performed. Women were randomly allocated to receive an intravenous infusion of TA (experimental group, n = 228) or 5% glucose (placebo group, n = 226) at delivery of the anterior shoulder. Active management of the third stage of labor, which includes prophylactic injection of 10 IU of oxytocin within 2 minutes of birth, early clamping of the umbilical cord, and controlled cord traction following delivery, was used in both groups. The primary outcome was mean blood loss during the third and fourth stages of labor. Mean estimated blood loss at the third and fourth stages of labor was significantly lower in the experimental group than that in the placebo group (261.5 ± 146.8 mL versus 349.98 ± 188.85 mL, respectively; p < 0.001). The frequency of postpartum hemorrhage > 500 mL was also lower in the experimental group (4, 1.8%) compared with that in the placebo controls (15, [6.8%]; relative risk, 3.76; 95% confidence interval, 1.27 to 11.15; p = 0.01). No episode of thrombosis occurred in the women who received TA. The use of TA with standard active management of the third stage of labor reduced postpartum blood loss, and no increase in the incidence of thromboembolic events was observed.

Does Tranexamic Acid Save Blood in Minimally Invasive Total Knee Arthroplasty?

Tranexamic acid (TEA) reportedly reduces perioperative blood loss in TKA. However, whether it does so in minimally invasive TKA is not clear. We asked whether TEA would reduce blood loss and blood transfusion requirements after minimally invasive TKA. We prospectively enrolled 100 patients who underwent minimally invasive TKAs: 50 received one intravenous injection of TEA before deflation of the tourniquet and a control group of 50 patients received an equivalent volume of placebo. We compared changes in hemoglobin, postoperative drainage, total blood loss, and transfusion rates between the two groups. The total blood loss was less for patients in the TEA group than for the control group: 833 mL (374-1014 mL) versus 1453 mL (733-2537 mL), respectively. The rate of blood transfusion also was less for patients in the TEA group than in the control group (4% versus 20%). The hemoglobin levels on the second and fourth postoperative days were greater for patients in the TEA group than in the control group. Our data suggest one intraoperative injection of TEA decreased the total blood loss and need for transfusion after minimally invasive TKA. Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.