Use Of Intravenous Tranexamic Acid Research Articles

The Role of Tranexamic Acid in Preventing Primary Post-Partum Haemorrhage During Caesarean Section: A Randomized Control Trial

Background: Primary postpartum haemorrhage (PPH) is a leading cause of maternal mortality in Ni-geria. Caesarean section (CS), though a life-saving alternative to vaginal delivery in several maternity units globally, is a risk factor for PPH. Its rate has increased globally with wide variability amongst various countries. Although tranexamic acid (TXA) is an affordable medication that has been widely investigated for the treatment of PPH, its role as prophylaxis against PPH during Caesarean section has not been well characterized in our environment. Methods: A randomized, double-blind, two-center study of 130 consenting pregnant women who were scheduled for either elective or emergency LSCS at the Institute of Maternal and Child Health, Lagos State University Teaching Hospital (LASUTH) and Federal Medical Center, Ebute-Metta (FMCEB) Lagos. Data was imported into Stata version 17 (StataCorp, USA) software for analysis. Results: The mean age of the participants was 30.8 ± 4.76 years. The prevalence of PPH among the placebo group was four times that of the Tranexamic acid group. (P-value < 0.0001). There was a sta-tistically significant lower estimated blood loss in the intervention compared to the placebo arm of the study (P-value < 0.0001) Conclusion: Prophylactic use of intravenous Tranexamic acid as an adjunct to uterotonic at caesarean section is efficacious in reducing blood loss and preventing post-partum haemorrhage.

Letter to editor regarding "The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with PELD".

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.

Effectiveness of prophylactic pharmacological hemostatic agents for reduction of blood loss at vaginal surgery: a systematic review and meta-analysis.

The objective was to evaluate the effectiveness of pharmacological hemostatic agents in the reduction of blood loss at vaginal surgery. A systematic review of randomized control trials (RCTs) was completed. We searched PubMed (1946-2022), Embase, and CINAHL, using search terms related to vaginal hysterectomies and reconstructive surgeries combined with peri-operative use of hemostatic agents. RCTs comparing hemostatic interventions with placebo or with standard care were analyzed with the primary outcome of estimated blood loss. Secondary outcomes included peri-operative complications, length of stay, blood transfusion, and readmission. Risk of bias was assessed using the Risk of Bias 2 tool. Nine RCTs were included with a total of 903 participants. All trials were considered to have an overall low risk of bias. Meta-analysis of six RCTs (491 participants) favored the use of vasoconstrictive agent (vasopressin/ornipressin) at the surgical site for an overall effect estimate of decreased blood loss by 70ml (95% CI -125, -14ml). There was significant heterogeneity of studies with both dose and technique of vasoconstrictive agents used. Only one RCT evaluated tranexamic acid and found a benefit in the prophylactic use of intravenous tranexamic acid. Peri-operative use of vasoconstrictive agents slightly reduces bleeding in women undergoing elective vaginal surgery. Additional studies evaluating alternative pharmacological agents such as tranexamic acid may be of benefit.

Intravenous Use of Tranexamic Acid in Total Knee Arthroplasty with no Tourniquet.

Objective: To identify blood transfusion requirements and postoperative complications in patients undergoing total knee arthroplasty (TKA) with no tourniquet and intraoperative intravenous administration of tranexamic acid. Methods: This retrospective observational study analyzed 49 preopeative and postoperative medical records of patients undergoing TKA. A paired t-test compared changes in hemoglobin (HB) and packed cell volume (PCV), and an independent t-test with Welch correction compared HB and PCV changes between genders. A Spearman correlation test determined associations between age and days of postoperative hospitalization with HB and PCV changes. The significance level adopted was p < 0.05. Results: The patients' mean age was 71.9 ± 6.7 years; most subjects were women (73.5%). The right side (59.2%) was the most affected. Only one participant required a blood transfusion, while three subjects had complications during the postoperative follow-up. No patient had a thromboembolic event. The median length of postoperative hospital stay was 2 days (interquartile range [IQR] = 1.0). There were reductions in HB and PCV levels between the pre-operative and postoperative period, and female patients had a higher HB reduction. Conclusion: TKA with tranexamic acid and no tourniquet did not cause significant postoperative complications or require blood transfusions.

Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery.

Topical and intravenous uses of tranexamic acid (TXA) have been shown to reduce bleeding and ecchymosis in various surgical fields. However, there is a lack of data evaluating the efficacy of TXA in breast surgery. This systematic review evaluates the impact of TXA on hematoma and seroma incidence in breast plastic surgery. A systematic review of the literature was performed for all studies that evaluated the use of TXA in breast surgery including reduction mammoplasty, gynecomastia surgery, masculinizing chest surgery, or mastectomy. Outcomes of interest included rate of hematoma, seroma, and drain output. Thirteen studies met the inclusion criteria with a total of 3297 breasts, of which 1656 were treated with any TXA, 745 with topical TXA, and 1641 were controls. There was a statistically significant decrease in hematoma formation seen in patients who received any form of TXA compared with control (odds ratio [OR], 0.37; P < 0.001), and a similar tendency toward decreased hematoma with topically treated TXA (OR, 0.42; P = 0.06). There was no significant difference in seroma formation with any TXA (OR, 0.84; P = 0.33) or topical TXA (OR, 0.91; P = 0.70). When stratified by surgery, there was a 75% decrease in the odds of hematoma formation with any TXA compared with the control for oncologic mastectomy (OR, 0.25; P = 0.003) and a 56% decrease in nononcologic breast surgery (OR, 0.44; P = 0.003). This review suggests that TXA may significantly reduce hematoma formation in breast surgery and may also decrease seroma and drain output. Future high-quality prospective studies are required to evaluate the utility of topical and intravenous TXA in decreasing hematoma, seroma, and drain output in breast surgery patients.

The Use Of Intravenous Tranexamic Acid Does Not Improve Arthroscopic Visualization In Shoulder Surgery: A Randomized Controlled Trial

The Use Of Intravenous Tranexamic Acid Does Not Improve Arthroscopic Visualization In Shoulder Surgery: A Randomized Controlled Trial

Predictive and protective factors for allogenic blood transfusion in total knee arthroplasty. A retrospective cohort study

BackgroundThis study aimed to identify the predictive and protective factors of blood transfusion in patients undergoing total knee arthroplasty (TKA) and therefore determine the profile of patients with low and high risk of blood transfusion after arthroplasty. MethodsWe conducted a retrospective study with all patients who underwent primary TKA between January 2017 and December 2019 (n = 1.028 patients) in our institution. Information about allogenic transfusion was collected from medical records to determine the incidence, the predictive and protective factors of blood transfusion. All cases of blood transfusions were documented as well the number of units and the moment of each transfusion. We performed univariate and multivariate logistic regression analyses to identify the independent risk and protective factors. ResultsThe total transfusion rate was 11%, 1.1% at intraoperative and 9,9% at postoperative period. The independent risk factors for transfusion were female gender (OR 1.64), older age (>55yo, OR > 2) higher surgical risk (ASA III, OR 3.07), lower preoperative hemoglobin levels (p = 0.024), post-traumatic arthritis (OR 4.11) and use of postoperative drains (OR 1.81) The protective factors for transfusion were male gender (OR 0.60), obesity (IMC >30, OR 0.60) and use of intravenous tranexamic acid intraoperatively (OR 0.40). ConclusionsWe conclude that in addition to the well-established risk factors for blood transfusion such as advanced age, low hemoglobin levels and high surgical risk, we can add post-fracture arthroplasty, non-use of tranexamic acid and the use of postoperative joint drain.

Paper 16: The Use of Intravenous Tranexamic Acid Does Not Improve Arthroscopic Visualization in Shoulder Surgery: A Randomized Controlled Trial

Objectives: Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon’s visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is an effective alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. Methods: The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. Unweighted means (SD) were calculated for visualization and mean arterial pressure (MAP) for each patient. Study group allocation was represented with epinephrine and tranexamic acid being coded in dichotomous variables (used or not used) for each patient. A step-wise linear regression was performed using visualization as the dependent variable and a series of independent variables considered for inclusion: epinephrine, tranexamic acid, surgery duration, complexity, mean arterial pressure, increase in pump pressure, and volume of irrigation fluid. All statistical tests were considered significant if p&lt;0.05. Results: One-hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Figure 1 presents the patient flow through the study. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p&lt;0.001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p&lt;0.001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Conclusions: Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone. [Figure: see text]

Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery.

Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery.

Intravenous Tranexamic Acid Given at Femoral Fragility Fracture Surgery Reduces Blood Transfusion Requirements Fourfold

AimsThis study aims to determine whether intraoperative intravenous (IV) tranexamic acid (TXA) affects blood loss following the surgical management of femoral fragility fractures (FFF).MethodsThis was a single centre (university teaching hospital) non-randomised case–control study. There were 361 consecutive patients with FFF admitted over a 4-month period were included (mean age 81.4yrs; mean BMI 23.5; 73.7% female). Patient demographics, comorbidities, preoperative anticoagulation use, surgical management, intravenous TXA use, perioperative haemoglobin (Hb) and haematocrit, and requirement for blood transfusion were recorded. The primary outcome was postoperative blood transfusion requirement. Secondary outcomes included postoperative day one calculated blood loss (CBL) (using the Nadler and Gross formulae) and fall in Hb (percentage) from preoperative levels; and the incidence of thrombotic events and mortality up to 30 days.ResultsGroups were well matched in terms of patient demographics, comorbidities, preoperative anticoagulation use, injury types and surgical management. Intravenous TXA 1 g given at the beginning of surgery at the discretion of the operating team: 178 (49%) received TXA and 183 (51%) did not. The requirement for postoperative blood transfusion was significantly less in the TXA group: 15/178 (8.4%) compared to 58/183 (31.7%) (p < 0.001; Chi square). TXA significantly reduced both the percentage fall in Hb (mean difference 4.3%, p < 0.001) and the CBL (mean difference −222 ml, p < 0.001). There was no difference in VTE (2 vs 1, p = 0.620) or other thrombotic events (2 vs 0, p = 0.244) between groups.Conclusion1 g of intraoperative intravenous TXA during the surgical management of FFF was associated with reduced rate of transfusion, CBL and the percentage drop in HB. The use of TXA in this study was not randomised, so there could be un-quantifiable bias in the patient selection.

The Use of Tranexamic Acid in Hip Fracture Surgery-A Systematic Review and Meta-analysis.

To analyze the effect of intravenous tranexamic acid (TXA) on blood transfusion requirements in adult patients undergoing hip fracture surgery. Secondary aim was to evaluate the safety by assessing thromboembolic events. Cochrane Central Register of Controlled Trials, Medline, PubMed, and Embase were searched for randomized controlled trials published in English from 2010. Studies eligible for inclusion were randomized controlled trials that analyzed the use of intravenous TXA on blood transfusion requirement in hip fracture surgery. Titles and abstracts were screened and assessed for eligibility by 2 independent reviewers. Quality and risk of bias was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach and the Cochrane risk-of-bias tool (RoB2). Meta-analysis with random and fixed effect models was performed. Risk ratio (RR) was calculated for dichotomous outcomes and estimated with a 95% confidence interval (CI). For continuous data, the risk difference (RD) was estimated with a 95% CI. A total of 13 trials involving 1194 patients were included. Pooled results showed that patients in the TXA group had significantly lower transfusion requirements (RR 0.50, 95%CI 0.30-0.84, P = 0.009). Similar findings were observed in the subcohort of patients with transfusion threshold of Hb < 8g/dL, (RR 0.42, 95%CI 0.31-0.56, P < 0.0001). This risk reduction was not observed in the subcohort of patients with transfusion threshold of Hb 8.1-10g/dL who received TXA (RR 0.77, 95%CI 0.51-1.18, P = 0.23) and no statistically significant differences were found for total thromboembolic events (RR 0.01, 95%CI -0.02-0.04, P = 0.47). This meta-analysis demonstrated that intravenous TXA reduced blood transfusion rates and did not increase the risk of thromboembolic events. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Safety and efficacy of perioperative tranexamic acid infusion in acetabular fracture fixation: A randomized placebo-controlled double-blind prospective study

IntroductionOpen reduction and internal fixation of acetabular fracture is associated with significant blood loss. Although Tranexamic acid (TXA) infusion effectively reduces perioperative blood loss and transfusion requirements in elective orthopedic surgery, its efficacy in major orthopedic trauma surgery is controversial. Material and methodsSixty-three patients undergoing open reduction and internal fixation of acetabular fracture were randomized into either TXA (n = 36) or placebo (n = 27) group. TXA group received a bolus dose of TXA (10 mg/kg) 15 min prior to incision, followed by another similar dose after 3 h of surgery. The placebo group received the same volume of normal saline similarly. All patients were operated on by a single pelviacetabular surgeon with a uniform perioperative protocol. The intraoperative blood loss, drain output, the number of blood transfusions, postoperative hemoglobin (Hb) drop, and hematocrit (Hct) drop were calculated. ResultsBoth groups were similar in relation to age, sex, BMI, preoperative Hb, the timing of surgery, fracture pattern, operative time, and surgical approaches. The mean postoperative Hb was 10.35 ± 1.36 gm% in TXA group and 9.74 ± 1.98 gm% in placebo group (p-value 0.158). There were no differences in intraoperative blood loss (438.11 ml vs. 442.81, p=.947), drain output (131.94 ml vs. 129.63, p=.870), and blood transfusion (8 patients vs. five patients, p=.719) between the groups. The drop in Hb and Hct in the postoperative period was also statistically not significant between the groups. ConclusionThere is no significant reduction in blood loss and blood transfusion with the use of intravenous Tranexamic acid in open reduction and internal fixation of acetabular fractures.

The effect of intravenous tranexamic acid use on blood loss after revision shoulder arthroplasty

BackgroundRevision total- and reverse shoulder arthroplasties have become more common as the incidence of primary shoulder arthroplasties rise and the older population grows. The use of tranexamic acid (TXA) to decrease perioperative blood loss has been well established in literatures; however, its use in revision shoulder arthroplasty has yet to be explored. We retrospectively examined the effect of TXA use on perioperative blood loss during revision shoulder arthroplasties. MethodsThis was a retrospective review of patients ≥18 years of age, who underwent revision total- or reverse shoulder arthroplasties at the investigating institution between June 2013 and December 2020. Patients were stratified into 2 groups based on perioperative intravenous (IV) TXA vs. No TXA exposure. Contraindications to IV TXA included a history of blood clots and coagulopathies. Demographics, medical comorbidities, pre- and post-op hemoglobin, drain output, need for transfusion during hospitalization, duration of surgery, length of hospitalization, emergency department visits within 90 days of surgery, readmission to hospital within 90 days of surgery, and development of postoperative hematoma were analyzed. ResultsA total of 192 procedures (90 IV TXA vs. 102 No TXA) were analyzed. The cohorts did not significantly differ in age, gender, body mass index, breakdown of type of revision, or medical comorbidities. Analysis of the cohorts demonstrated that the IV TXA group had a significantly higher preoperative hemoglobin (12.9 vs. 13.5, P = .012) and postoperative hemoglobin (9.6 vs. 10.5, P < .001), as well as a significantly lower exposure to drain placement (75% vs. 43%, P < .001) and lower drain output per day (145 ml vs. 97.5 ml, P < .001) as compared to the No TXA group following revision shoulder arthroplasty. The results favored the IV TXA group with regard to blood loss, transfusions, duration of surgery, length of stay, and hospital readmissions within 90 days; however, these did not reach statistical significance. ConclusionsTXA use in revision shoulder arthroplasty significantly decreased the drain output; however had no significant effect on blood loss or transfusion rates.

Use of Tranexamic Acid in Liposculpture: A Double-Blind, Multicenter, Randomized Clinical Trial.

Intraoperative hemostasis should be performed with great caution because bleeding is a huge enemy of patient safety during surgery. Tranexamic acid is a lysine synthetic derivate that inhibits fibrinolysis and diminishes the bleeding by blocking the five lysine-binding sites for plasminogen. The authors compare the efficacy of tranexamic acid versus placebo as a hemostatic agent in liposculpture procedures. The authors conducted a multicenter, double-blind, randomized, controlled clinical trial in patients who were scheduled for liposculpture in three plastic surgery centers (Colombia and Mexico) between January of 2019 and February of 2020. One hundred forty-one patients were randomly assigned into three groups: intravenous (1 g of tranexamic acid), subcutaneous (1 g of tranexamic acid), and placebo (normal saline). Forty-seven patients were assigned to each group. There were 30 male patients and 111 female patients. The main outcome was to evaluate the amount of postoperative bleeding between groups. The primary outcome was measured by the hemoglobin point loss at day 1 (preoperative hemoglobin minus hemoglobin at day 1 postoperatively) and the hemoglobin (in milligrams per deciliter) point loss at day 5 (preoperative hemoglobin minus hemoglobin at day 5 postoperatively). The authors found the intravenous intervention group to have a greater hemoglobin level than the other two groups on both the first postoperative day ( p = 0.0001) and the fifth postoperative day ( p = 0.001). There were no statistical differences in hemoglobin values between the placebo and the subcutaneous intervention groups. Intravenous tranexamic acid is a good therapeutic choice to implement on liposculpture procedures to decrease postoperative bleeding. The preoperative use of intravenous tranexamic acid not only decreases the bleeding rate after liposuction procedures, but also allows greater lipoaspirate volumes when performing high-definition liposculpture. Further studies are required to support the effectiveness of tranexamic acid within the infiltration solution. Therapeutic, I.

Optimal Use of Intravenous Tranexamic Acid for Hemorrhage Prevention in Pregnant Women

(Am J Obstet Gynecol. 2021;225:85.e1–11) Postpartum hemorrhage (PPH) is a major cause of pregnancy-related death worldwide. Tranexamic acid (TXA) reduced death from bleeding by 31% when administered to women with PPH in the World Maternal Antifibrinolytic (WOMAN) trial. While some data suggests a low dose of TXA may achieve a therapeutic effect while minimizing exposure to the neonate, there is a lack of data on the use of TXA in pregnant women, including pharmacokinetic (PK) and pharmacodynamic (PD) data. This study aimed to evaluate the safety of using TXA in women undergoing cesarean delivery, including PK and PD outcomes, and to provide data on breast milk TXA concentration.

Role of tranexamic acid in the prevention of primary postpartum haemorrhage.

Objectives: To determine the role of TRANEXAMIC ACID in prevention of primary postpartum haemorrhage in women. Study Design: Observational Retrospective Cohort Design. Settings: DHQ Hospital, Gujranwala. Period: April 2016 to July 2018. Material &amp; Methods: The data of 110 women who suffered postpartum haemorrhage was retrieved from the hospital records. Exclusion criteria included all the females who were below and equal to 18 years of age. Patients suffering from acute respiratory distress syndrome (ARDS), on long-term anti-inflammatory and steroid therapy were also excluded. Whereas all the women who had experienced postpartum haemorrhage after birth were included. Results: We retrieved data of 110 women who had experienced postpartum haemorrhage after birth. The age of participants was averaged 28.95 + 7.6 years. The group I was named as early treatment group and contained 35 women whereas the group II (late treatment or without TRANEXAMIC ACID) had 75 women. The mean age of women is higher in the group I i.e. 30.2 +6.8 than 27.7+8.4. The TRANEXAMIC ACID was given intravenously with an average dose of 1 gram (0.1-3.0 grams) 1.5 hours after the birth. This was an average time for all cases in group I. The average time was 4.6 hours in group II. Conclusion: We concluded that use of intravenous TRANEXAMIC ACID in postpartum haemorrhage is associated with reduced haemorrhage but a low dose at early treatment may not yield good results.

The Use of Tranexamic Acid in Anterior Cruciate Ligament Reconstruction: A Systematic Review

Background: There are several papers that investigate the use of tranexamic acid (TXA) in anterior cruciate ligament reconstructions (ACLR) or other arthroscopic procedures that show favorable results and little to no complications. We aimed to perform a systematic review of all published randomized controlled trials (RCTs) that wanted to determine the effectiveness of intravenous use of TXA in ACLR. Methods: Data collection was performed independently by two authors via a previously created spreadsheet. They extracted information such as: first author name, publication year, lot size, TXA protocol, surgical protocol, outcome measures and follow-up duration. Results: After applying the screening process and the inclusion criteria, we were left with a total six RCTs. The selected studies included a total of 699 randomized patients. Statistical significance regarding a lower pain score (VAS) in the intervention groups was mostly reported for the early postoperative period (2 weeks). A statistically significant decrease in hemarthrosis grade was reported for the first 2–3 weeks. Conclusions: in our study, we show that TXA use in arthroscopic ACLR decreases postoperative blood loss and pain. Some evidence of improvement in functional scores was observed, but we believe that this needs to be addressed in specific long-term result studies.

Comparison of efficacy of tranexamic acid irrigation versus intravenous injection for preventing blood loss in percutaneous nephrolithotomy

Purpose: Bleeding is the most dreadful and distressing complication of percutaneous nephrolithotomy, which can cause significant morbidity. Intravenous use of tranexamic acid to reduce bleeding complication is widely established. Our aim is to compare the result between the two groups using tranexamic acid intravenous and in irrigation solution. Materials and methods: A total of 160 patients were enrolled in this study. Patients were randomly allocated to two groups. Group 1 received 0.1% tranexamic acid solution (1000 mg in 1 L of irrigation solution (normal saline)). Group 2 received 1 g tranexamic acid intravenously in intraoperative period. Results: The mean estimated fall in haematocrit, mean estimated total blood loss and mean operative time in tranexamic acid irrigation group is significantly less compared to intravenous tranexamic acid group. No significant difference was found with regards to stone clearance. Conclusion: We found that tranexamic acid irrigation was safe and associated with reduced blood loss as compared to intravenous tranexamic acid.

Tranexamic Acid Use in Anterior Cruciate Ligament Reconstruction Decreases Bleeding Complications: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

To systematically review all available randomized controlled trials (RCTs) in the literature that examine outcomes following tranexamic acid (TXA) use in anterior cruciate ligament reconstruction (ACLR) to determine its effectiveness. PubMed/MEDLINE, Embase, Science Direct, Web of Science, CINAHL, and The Cochrane Library databases were systematically searched for RCTs comparing TXA versus no TXA in ACLR with a 4-week minimum follow-up. Quality was assessed using Risk of Bias 2. Pooled analyses were conducted using inverse variance for continuous variables and Mantel-Haenszel for dichotomous variables. The Grading of Recommendations, Assessment, Development and Evaluation guidelines were used to evaluate primary outcomes. A total of 807 patients (632 male, 175 female) from 7 RCTs were included. Mean age was 28.4 years. Bias was graded "low" in 4 RCTs, "some concerns" in 2 RCTs, and "high" in 1 RCT. Visual analog scale was found to be not significantly different with TXA use at day 1-3 (mean difference [MD] -0.92, I2= 96%, P= .14) and 12 weeks (MD -0.03, I2= 0%, P= .73). Visual analog scale was significantly decreased at week 2 (MD -1.18, I2= 56%, P < .00001) and weeks 3-6 (MD -0.38, I2= 73%, P < .010). Lysholm scores were greater with TXA use at week 2 (MD 9.04, I2= 74%, P= .002) and weeks 4-6 (MD 6.17, I2= 73%, P= .0004) but not significantly different at 12 weeks (MD 6.13, I2= 98%, P= .28). Need for aspiration was less with TXA use (odds ratio 0.40, I2= 49%, P= 0.0009). Considerable heterogeneity was seen in many results. Certainty was low for 2 primary outcomes, moderate for 2, and high for5. Pooled data suggest that the use of TXA in ACLR reduces the need for aspiration, hemarthrosis, drain output, and knee swelling in the postoperative period. While early improvements in pain and function were observed, the clinical relevance is questionable. The risk of complications does not increase with TXA use, and the use of intravenous TXA over intra-articular TXA may improve and prolong hemarthrosis reduction, although the evidence is weak. Level II, systematic review of therapeutic Level I-II studies.

Efficacy and Safety of Tranexamic Acid in Resection and Endoprosthetic Reconstruction of Distal Femoral Osteosarcomas in Children: A Retrospective Cohort Study.

This study aimed to investigate the effect of intravenous tranexamic acid (TXA) on blood loss and transfusion rates in children who underwent resection and endoprosthetic reconstruction of distal femoral osteosarcomas. The medical records of 56 patients who underwent resection and endoprosthetic reconstruction for distal femoral osteosarcomas between 2017 and 2019 were retrospectively reviewed. Patients were divided into 2 groups: group 1 consisted of 25 patients (11 male and 14 female, mean age 15.2±3 y) who received preoperative 15 mg/kg intravenous TXA, and group 2 consisted of 31 control patients (18 male and 13 female, mean age 14.3±2.6 y) who did not receive TXA. The groups were compared based on their total blood loss, intraoperative blood loss, hidden blood loss, postoperative drain output, transfusion requirements, preoperative and postoperative hemoglobin (Hb) and hematocrit (Htc) difference, length of hospital stays, operative time, and complications. The mean total blood loss was lower in intravenous TXA group (1247.5±300.9 mL) when compared with control group (1715.7±857.0 mL) (P=0.018). The mean intraoperative blood loss in intravenous TXA group (386±109 mL) was lower than that in control group (977.4±610.7 mL) (P<0.001). Postoperative drain output at 24 and 48 hours was 198.0±61.8 and 72.4±27.4 mL in intravenous TXA group, respectively, and was low compared with 268.4±118.2 and 117.1±67.8 mL in control group (P=0.028 and 0.006). The rate of patients requiring transfusion was significantly lower in intravenous TXA group (56%) than in control group (83.9%). Preoperative and postoperative 6, 24, and 72 hours Hb and Htc differences were significantly lower in intravenous TXA group [(-1.7±1.8 g/dL P<0.001; -2.0±1.5 g/dL P<0.001; -2.3±1.7 g/dL P<0.001, for Hb) (-5.7±4.6, P<0.001; -6.9±4.0, P<0.001; -9.6±9.1, P<0.001, for Htc)]. Intravenous TXA group had shorter hospital stay time in comparison to control group (P<0.001). The operative time was significantly longer in the control group (P<0.05). No increase in pulmonary embolism or venous thromboembolism rate was observed with intravenous TXA use. We conclude that administration of intravenous TXA reduces intraoperative and postoperative blood loss, transfusion rates, and hospital stay in resection and endoprosthetic reconstruction of the distal femoral osteosarcomas in children. This was a retrospective comparative study. Level III.