Local Application Of Tranexamic Acid Research Articles

Tranexamic Acid and Rhinoplasty: How Do Different Administration Routes Affect Effectiveness?

The aim of this study was to evaluate the effectiveness of the intravenous, oral and local application of tranexamic acid in operation time, intraoperative bleeding, postoperative edema and ecchymosis in rhinoplasty. This was a randomized, double-blinded, prospective study. We included 146 patients who underwent rhinoplasty at the Bezmialem Vakif University Medical Faculty Otorhinolaryngology Clinic between April 2021 and April 2022. The patients were divided into four groups: Group 1 (intravenous TXA), Group 2 (oral TXA), Group 3 (topical TXA), and Group 4 (control). Operation time was recorded. Bleeding volume was measured in the suction chamber and nasopharyngeal pack. Postoperative edema and ecchymosis were evaluated using a scale at the end of the operation, on the 1st, 3rd, and 7th days. There was no statistically significant difference between groups in terms of mean operation time (p = 0.894). There was a statistically significant lower mean intraoperative bleeding level in Group 2 from the other groups (p = 0.020). Group 3 had significantly lower scores for postoperative edema than the other groups at the end of the operation, on the 1st, 3rd, and 7th days (p < 0.05), and significantly lower scores for postoperative ecchymosis at the end of the operation (p = 0.013) and on the 3rd day (p = 0.024). Although group 3 had a lower score than the other groups in the ecchymosis measurements on the 1st, and 7th days, no statistically significant results were obtained. Local application of tranexamic acid is founded more beneficial for reducing postoperative edema and ecchymosis in rhinoplasty than intravenous and/or oral applications in this study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A comparative study on hemostasis effect of different application methods and time of tranexamic acid in total hip arthroplasty.

To analyze the hemostatic effect of different application methods and time of tranexamic acid (TXA) on primary unilateral total hip arthroplasty. A total of 126 patients with primary unilateral total hip replacement admitted between January 2019 and January 2021 were recruited. The patients were divided into three groups (42 people in each group) by random number table method. In group I, 2.0g TXA was perfused locally into the hip joint cavity through the drainage tube for 2h. Group II was perfused locally with the same method for 4h. Group III was given TXA 15mg/kg intravenously 5-10min before surgical incision. The hemoglobin concentration, red blood cell (RBC) count, international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-Dimer (D-D), intraoperative blood loss, postoperative blood loss, implicit blood loss, total blood loss, postoperative blood transfusion and complications were compared. The postoperative drainage volume of group I (195.07 ± 34.65) mL and group II (199.62 ± 38.07) mL was significantly lower than that of group III (213.12 ± 25.05) mL (P = 0.037). There was no significant difference in postoperative drainage between group I and group II (P > 0.05). There was no significant difference in intraoperative blood loss, hidden blood loss and total blood loss between the three groups (P > 0.05). There was no difference in the incidence of deep vein thrombosis among the three groups (P > 0.05). TXA is a safe and effective way of hemostasis in total hip arthroplasty. Local intraarticular application of TXA can reduce the postoperative drainage, but the difference is not clinically significant, probably due to the number of samples. There is no difference in the postoperative drainage after local application of 2 or 4h, and there is no difference in the overall hemostasis effect between intravenous or local application of TXA.

Clinical efficacy of local infiltration of lidocaine and tranexamic acid application in tonsillar region on postoperative pain and bleeding during tonsillectomy: prospective, randomized, double-blind controlled study

BackgroundAnesthetic techniques are designed to minimize intraoperative surgical bed bleeding which is a major problem that may interfere with precision, surgery duration, or postoperative wound healing. The main reason for reoperation and/or mortality in children who have had tonsillectomies is post-tonsillectomy hemorrhage. We evaluate the local application effect of tranexamic acid and lidocaine local infiltration in the tonsillar bed during tonsillectomy surgery on postoperative analgesia and bleeding.ResultsFLACC scores showed a statistically significant reduction in the first 24 h in group T (P < 0.05). Post-tonsillectomy hemorrhage was significantly minimized in group T. No complications were recorded following the local application of tranexamic acid and local lidocaine infiltration inside the tonsil bed.ConclusionsLocal infiltration of lidocaine provides adequate postoperative analgesia, and tranexamic acid application during tonsillectomy surgery minimizes postoperative bleeding and shortens surgery duration.Trial registrationThis study was preregistered with the Clinical Trials Registry (NCT05817474).

Tranexamic Acid Treatment Reduces Blood Loss After Elective and Semi-Urgent Reverse Total Shoulder Arthroplasty.

Post operative blood loss after reverse shoulder arthroplasty (RSA) is associated with the need for blood transfusion and prolonged hospital stay, among other complications. Tranexamic acid (TXA) reduces perioperative blood loss and is effective when delivered systemically or locally. We compared the effects of TXA on perioperative blood loss between elective and semi-urgent RSA. We retrospectively reviewed patients who underwent either elective or semi-urgent RSA for fracture repair, with and without TXA treatment. Demographics, clinical records, and laboratory results were collected and analyzed to compare peripheral blood hemoglobin concentrations before and after surgery, the need for blood transfusion, and length of hospital stay between the 2 groups. In a cohort of 158 patients, 91 (58%) underwent elective RSA. TXA was administered in 91 (58%) patients from the entire group. TXA administration was associated with a significant decrease in post operative hemoglobin concentration reduction in both the elective and fracture groups (P = .026 and P = .018, respectively), a significant decrease in post operative blood transfusion rates (P = .004 and P = .003, respectively), and a decrease in the need for prolonged hospitalization (P = .038 and P = .009, respectively). The local application of TXA during RSA yielded a significant reduction in perioperative blood loss. We showed a significant positive effect of local TXA administration during RSA that is comparable for both elective and semi-urgent patients. Due to the baseline characteristics of fracture patients, their clinical benefits may be more notable. The positive outcomes for surgical patients with the use of TXA during RSA can possibly cause future consideration in clinical practice.

Local Application of Tranexamic Acid in Plastic Surgery Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

According to recent evidence, the use of local tranexamic acid (TXA) during plastic surgery may lessen blood loss. To comprehensively assess the use of local TXA during plastic surgery through a systematic review and meta-analysis of randomized controlled trials addressing these issues. Four electronic databases, including PubMed, Web of Science, Embase and the Cochrane Library, were searched until December 12, 2022. Following meta-analyses, the mean difference (MD) or standardized mean difference (SMD) for blood loss volume (BLV), ΔHct, ΔHb and operation time were calculated when appropriate. Eleven randomized controlled trials were included in the qualitative synthesis, while 8 studies were included in the meta-analysis. Compared with the control group, the local TXA group showed a reduction in blood loss volume of -1.05 (p < 0.00001; 95% CI, -1.72 to -0.38). However, local TXA had a limited effect on reducing ΔHct, ΔHb and operation time. A meta-analysis was not performed because of heterogeneity in other outcomes; however, except for 1 study in which no significant difference was observed on POD 1, all studies showed significantly lower rates of postoperative ecchymosis after surgery, 2 studies showed statistically significant reductions in transfusion risk or volume, and 3 studies reported significantly better surgical field quality in operations with local TXA. In the 2 included studies, the researchers concluded that local treatment does not play a role in relieving postoperative pain. Local TXA is associated with less blood loss, less ecchymosis and better surgical field in plastic surgery patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topical tranexamic acid in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly: A protocol for systematic review and meta-analysis.

Numerous studies have demonstrated that the use of tranexamic acid (TXA) intravenously minimizes bleeding, lowers transfusion rates, and does not raise the risk of complications during major orthopedic surgery. Concerning the effectiveness of the topical application, there are, nevertheless, inconsistent findings. We aimed to develop a protocol for systematic review and meta-analysis on the benefits and safety of topical TXA in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly. PubMed, Embase, and the Cochrane Library will all be searched for randomized controlled trials published from the database inception to October 15, 2022. The primary outcomes will be intraoperative blood loss, hidden blood loss, total blood loss, transfusion rate, transfusion units, operative time, thromboembolic events, and mortality. The risk of bias will be evaluated using the Cochrane risk of bias assessment tool. Review Manager 5.3 will be used for the analysis. The effects and safety of topical TXA in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly will be quantified in this study. The study's findings will assist doctors in determining if topical TXA use is secure and efficient.

Local Tranexamic Acid for Preventing Hemorrhage in Anticoagulated Patients Undergoing Dental and Minor Oral Procedures: A Systematic Review and Meta-Analysis.

Dental procedures have posed challenges in managing anticoagulated patients due to early reports of oral hemorrhage. This study aims to evaluate the risks of postoperative bleeding with the local application of tranexamic acid. A systematic search was conducted until 31 March 2022, with keywords including tranexamic acid, oral hemorrhage, dental, and/or coagulation. The following databases were searched: PubMed, Scopus, Web of Science, CINAHL Plus, and Cochrane Library. Statistical analysis was conducted using Review Manager 5.4. In total, 430 patients were pooled in with the local application of tranexamic acid using mouthwash, irrigation, and compression with a gauze/gauze pad. The mean age was 61.8 years in the intervention group and 58.7 in the control group. Only 4 patients in the intervened group out of the 210 discontinued the trial due to non-drug-related adverse events. The risk difference was computed as -0.07 (p = 0.05), meaning that patients administered with local antifibrinolytic therapy for postoperative bleeding reduction for dental procedures were at a 7% less risk of oral bleeding. Current evidence on managing anticoagulated patients undergoing dental or oral procedures remains unclear. The present study presents favorable outcomes of postoperative bleeding with local tranexamic acid used in the postoperative period.

Evaluation of efficacy and safety of intraoperative tranexamic acid: prospective placebo-controlled comparative study

ABSTRACT Objectives Evaluation of the effect and safety of intravenous and local application of tranexamic acid (TXA) on outcomes of transurethral resection of the prostate (TURP). Patients & Methods 138 patients were divided into three groups according to the mode of TXA delivery (Groups I and II) or placebo. Hemoglobin concentration (HBC) and hematocrit value (HTC) were determined before and immediately after surgery to calculate hemoglobin deficit and estimated intraoperative blood loss (IO-BL). All surgeries were performed under bupivacaine spinal anesthesia with the preoperative saline co-load infusion. Results: Patients who received combined IV and local delivery of TXA showed significantly shorter operative time and duration of PO catheterization and hospital stay than patients of other groups. The IO-BL was significantly lower in patients received TXA than placebo. Hemoglobin deficit after surgery was significantly lower in patients received both IV and local delivery of TXA than patients of other groups. No adverse effects of TXA s were reported. Conclusion The applied policy for antifibrinolysis during TURP was safe and effectively improved operative and immediate PO outcomes.

Cytotoxicity and Effect of Topical Application of Tranexamic Acid on Human Fibroblast in Spine Surgery

In spinal surgery, considerable blood loss is increasingly treated with the local application of tranexamic acid (TXA). However, little is known about its cytotoxicity and effect on human fibroblasts. This study was to identify the effect of TXA solution on human fibroblast at different concentrations and exposure times invitro. To mimic the actual clinical situation, human fibroblasts were subjected to both limited and chronic exposure to various clinically relevant concentrations of TXA to mimic different ways of topical administration. At time points after treatment, the viability, proliferation, apoptosis, collagen synthesis, adhesion, and migration of fibroblasts were analyzed invitro. Limited exposure (10 minutes) to a high concentration of TXA (100 mg/mL) did not affect the viability, proliferation, and apoptosis of fibroblasts, and chronic exposure to low concentration of TXA (≤12.5 mg/mL) exerted little effect on viability, proliferation, apoptosis, collagen synthesis, adhesion, and migration of human fibroblasts (P > 0.05). However, the chronic exposure to a high concentration of TXA (≥25 mg/mL) can inhibit the viability, proliferation, collagen synthesis, adhesion and migration, and induce apoptosis of fibroblasts. Although limited exposure to high concentration of TXA and chronic exposure to low concentration of TXA exerted little effect on fibroblasts, chronic exposure to high concentration of TXA can lead to fibroblast injury.

Efficacy and safety of tranexamic acid in total hip arthroplasty via direct anterior approach

To evaluate the efficacy and safety of local application of tranexamic acid (TXA) in reducing perioperative blood loss in total hip arthroplasty via direct anterior approach (DAA). From July 2013 to September 2018, 46 patients with avascular necrosis of the femoral head were divided into tranexamic acid group (n=23) and saline group (n=23). In the tranexamic acid group, there were 14 males and 9 females, aged 52 to 72(63.70±5.34) years old. They were diluted with 3 g tranexamic acid in 50 ml normal saline and immersed in the joint cavity for 3 min after prosthesis replacement;in the normal saline group, there were 13 males and 10 females, aged 55 to 73 (61.26±5.78) years, who were treated with the sameamount of normal saline. The blood loss, hemoglobin value, number of blood transfusion cases, the time of first landing after operation, the incidence of thrombosis and incision adverse events were compared between the two groups. Harris score was used to evaluate hip joint function at 1 and 3 months after operation. The incision healed well and no obvious complications occurred in the two groups. All patients were followed up for 12 to 59 months(averaged 31.11 months). No hip pain was found in the follow-up patients. Hip joint function was improved effectively and no prosthesis loosening occurred. The total perioperative blood loss in tranexamic acid group and normal saline group was(740.09±77.14) ml and (1 069.07±113.53) ml respectively, 24 hours after operation, the drainage volume was (87.61±9.28) ml, (233.83±25.62) ml, the hidden blood loss was (409.65±38.01) ml and (588.33±57.16) ml. the difference of hemoglobin before and after operation was (24.78±2.19) g / L and (33.57±2.95) g / L, the difference was statistically significant (P<0.05). There was no significant difference in blood loss, incidence of deep vein thrombosis and pulmonary embolism, and Harris score of hip joint between the two groups (P>0.05). local application of tranexamic acid in total hip arthroplasty through direct anterior approach can safely and effectively reduce perioperative blood loss, and does not increase the risk of thrombosis, and does not affect the normal recovery of joint function.

Effect of tranexamic acid on the timing of drainage tube removal in total knee arthroplasty

Introduction:To investigate the effect of tranexamic acid on the removal time of drainage tube in the first unilateral total knee arthroplasty.Hypotheses:The timing of removing the drinage system can be changed when using TXA.Methods:From June 2017 to December 2018, 182 patients (42 males and 140 females) who planned to undergo primary unilateral total knee replacement were included.Age (68.1±7.1) years (60-76 years).According to the random number table method, it was divided into four groups: 45 cases of Tranexamic acid group 1 (TXA1), 46 cases of Tranexamic acid group 2 (TXA2), 46 cases of Tranexamic acid group 3 (TXA3) and None Tranexamic acid group (NTXA).TXA1-3 group intraoperative intravenous infusion combined with local application of tranexamic acid;NTXA group was locally perfused in the joint cavity with 100ml normal saline only after surgery.Differences in drainage volume, total blood loss, invisible blood loss, degree of postoperative joint swelling, Hospital for special surgery (HSS) and visual analogue scale (VAS) of pain were compared among the four groups.Results:The postoperative drainage volume of TXA1˜3 groups was 85.5±34.3ml, 189.4±72.3ml and 215.3±93.4ml, respectively, which was less than that of the non-tranexamic acid group (351.3±113.5ml). The overall difference was statistically significant (F=11.5,P=0.005). The postoperative drainage volume of tranexamic acid 1 group was less than that of tranexamic acid 2 and 3 groups.The total postoperative blood loss was 699.0±255.7ml, 710.4±296.1ml, and 715.8±248.2ml in the tranexamic acid 1-3 groups, respectively, which was less than 1130.5±354.2ml in the non-tranexamic acid group, and the overall difference was statistically significant (F=13.1,P=0.001).On the 4th day after the operation, the knee swelling degree of the tranexamic acid 1- 3 groups was 1.25±0.07, 1.13±0.12, and 1.12±0.13, respectively, which were smaller than that of the non-tranexamic acid group (1.43±0.22), and the overall difference was statistically significant (F=8.23, P=0.015).There were 2 cases of positive bacterial culture in non-tranexamic acid group and tranexamic acid group.There were 3 cases of hematoma in the non-tranexamic acid group,and 1 case of delayed wound healing.Conclusion:The application of tranexamic acid after TKA can reduce postoperative drainage volume, latent blood loss and total blood loss.The removal of the drainage tube 18h after the operation can not only fully drain,relieve pain, promote the recovery of knee joint function, but also effectively reduce the risk of infection caused by the drainage tube.

Better Treatment Values in Local Application of Tranexamic Acid (TXA) than Intravenous Application with the Same Dose in Total Hip Arthroplasty

The aim of our study was to investigate the hemostatic effect of local and intravenously administered tranexamic acid (TXA) at the same dose in total hip arthroplasty. The prospective study included 72 patients who underwent total hip arthroplasty in our hospital between March 2018 and March 2019. The patients enrolled in the study were randomly divided into two groups: the observation group (36 patients were injected with 2.0g TXA in 10mL 0.9% NaCl using the joint cavity drainage tube after suturing the joint capsule) and the control group (36 patients were given an intravenous infusion of 2g TXA in 200mL 0.9% NaCl 30min before the operation). In each patient, apparent blood loss, hidden blood loss, average blood transfusion, and the number of cases receiving blood transfusion were compared between the two groups after treatment. Hematocrit (Hct) and hemoglobin (Hb) levels were recorded at postoperative day (POD) 1, 2, 3, 7, and 10. We also recorded the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) before the operation and 12h postoperative and POD1, 3, 7, and 10. The incidence of deep venous thrombosis and pulmonary embolism was also taken into account. In the observation group, apparent blood loss, hidden blood loss, average blood transfusion volume, and the number of patients receiving blood transfusion were lower compared than the control group (P < 0.001). The levels of Hct and Hb were compared between the two groups at POD1, 2, 3, 7, and 10, and the observation group reported higher levels of Hct and Hb (P < 0.001). The levels of CRP and IL-6 were compared between the two groups at POD1, 3, 7, and 10, and the observation group reported lower levels of CRP and IL-6 than the control group (P < 0.001). On POD7, there was no pulmonary embolism in both groups, and no significant difference was observed in the incidence of deep venous thrombosis between the two groups (P > 0.05). Local and intravenous applications of TXA at the same dose are effective approaches in terms of reducing bleeding and inflammatory reaction with a good safety profile; however, the effect of local application had superior therapeutic values.

Clinical Study of Tranexamic Acid in Treatment of Cervical Ectopy-AnInstitutional Experience

Background: Cervical ectopy is a common entity among women attending gynaecological OPD for various complaints which itself could be the cause or present otherwise. The treatment modalities currently available are electrocoagulation, cry cauterization, laser cauterization, and drug treatment. Most of these procedures require a high learning curve, associated with side-effects, and are costly. Furthermore, routine treatment for ectopy has long been debated and there are no current guidelines for the same. Tranexamic acid, with its easy applicability, availability, and minimal costs could be an effective alternative. Objective: To evaluate the therapeutic effectiveness and safety of topical tranexamic acid for the treatment of cervix erosion. Methodology: A total of 75 cases of cervical erosion were taken who satisfied the inclusion and exclusion criteria of the study. Patients were randomized into two groups. Local application of tranexamic acid (Group A, n=38) or povidone-iodine solution (Group B, n=37) for 5 minutes were applied with the patient position kept constant for 15 minutes and daily dosage were given for 10 days. All the patients were followed up at the end of 2nd and 4th week and after 3 months for complete healing, relief of symptoms like chronic pelvic pain, recurrent vaginitis, contact bleeding, and vaginal discharge, and possible side effects. Results: In group A, all 7 and 20 patients complaining of chronic pelvic pain and contact bleeding respectively were cured of it (100% cure). For the other symptoms such as recurrent vaginitis and vaginal discharge, cure rates were 81.25% and 87.5% respectively. In group B, the cure was seen only in vaginal discharge with 12 patients getting cured out of 33 (36.36%) and no response in other symptoms. Side effect in the form of vaginal irritation was found only in group B in 17 patients (45.94%) whereas none were observed in group A who received the tranexamic acid application. We observed a positive correlation between cervical erosion and tranexamic acid application in terms of healing and side effects. Conclusion: Tranexamic acid application is a promising new treatment modality of cervical erosion in symptomatic women.

Clinical Study of Tranexamic Acid in Treatment of Cervical Ectopy-AnInstitutional Experience

Background: Cervical ectopy is a common entity among women attending gynaecological OPD for various complaints which itself could be the cause or present otherwise. The treatment modalities currently available are electrocoagulation, cry cauterization, laser cauterization, and drug treatment. Most of these procedures require a high learning curve, associated with side-effects, and are costly. Furthermore, routine treatment for ectopy has long been debated and there are no current guidelines for the same. Tranexamic acid, with its easy applicability, availability, and minimal costs could be an effective alternative. Objective: To evaluate the therapeutic effectiveness and safety of topical tranexamic acid for the treatment of cervix erosion. Methodology: A total of 75 cases of cervical erosion were taken who satisfied the inclusion and exclusion criteria of the study. Patients were randomized into two groups. Local application of tranexamic acid (Group A, n=38) or povidone-iodine solution (Group B, n=37) for 5 minutes were applied with the patient position kept constant for 15 minutes and daily dosage were given for 10 days. All the patients were followed up at the end of 2nd and 4th week and after 3 months for complete healing, relief of symptoms like chronic pelvic pain, recurrent vaginitis, contact bleeding, and vaginal discharge, and possible side effects. Results: In group A, all 7 and 20 patients complaining of chronic pelvic pain and contact bleeding respectively were cured of it (100% cure). For the other symptoms such as recurrent vaginitis and vaginal discharge, cure rates were 81.25% and 87.5% respectively. In group B, the cure was seen only in vaginal discharge with 12 patients getting cured out of 33 (36.36%) and no response in other symptoms. Side effect in the form of vaginal irritation was found only in group B in 17 patients (45.94%) whereas none were observed in group A who received the tranexamic acid application. We observed a positive correlation between cervical erosion and tranexamic acid application in terms of healing and side effects. Conclusion: Tranexamic acid application is a promising new treatment modality of cervical erosion in symptomatic women.

Prevention of Anastomotic Leak Via Local Application of Tranexamic Acid to Target Bacterial-mediated Plasminogen Activation: A Practical Solution to a Complex Problem.

To investigate the role of bacterial- mediated plasminogen (PLG) activation in the pathogenesis of anastomotic leak (AL) and its mitigation by tranexamic acid (TXA). AL is the most feared complication of colorectal resections. The pathobiology of AL in the setting of a technically optimal procedure involves excessive submucosal collagen degradation by resident microbes. We hypothesized that activation of the host PLG system by pathogens is a central and targetable pathway in AL. We employed kinetic analysis of binding and activation of human PLG by microbes known to cause AL, and collagen degradation assays to test the impact of PLG on bacterial collagenolysis. Further, we measured the ability of the antifibrinolytic drug TXA to inhibit this process. Finally, using mouse models of pathogen-induced AL, we locally applied TXA via enema and measured its ability to prevent a clinically relevant AL. PLG is deposited rapidly and specifically at the site of colorectal anastomoses. TXA inhibited PLG activation and downstream collagenolysis by pathogens known to have a causal role in AL. TXA enema reduced collagenolytic bacteria counts and PLG deposition at anastomotic sites. Postoperative PLG inhibition with TXA enema prevented clinically and pathologically apparent pathogen-mediated AL in mice. Bacterial activation of host PLG is central to collagenolysis and pathogen-mediated AL. TXA inhibits this process both in vitro and in vivo. TXA enema represents a promising method to prevent AL in high-risk sites such as the colorectal anastomoses.

Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial

The primary objective of this study is to compare the effectiveness of 3 treatment protocols to stop anterior epistaxis: classic compression, nasal packing, and local application of tranexamic acid. It also aims to determine the frequency of rebleeding after each of these protocols. This single-center, prospective, randomized controlled study was conducted with patients who had spontaneous anterior epistaxis. The study compared the effect of 3 treatment options, tranexamic acid with compression but without nasal packing, nasal packing (Merocel), and simple nasal external compression, on the primary outcome of stopping anterior epistaxis bleeding within 15 minutes. Among the 135 patients enrolled, the median age was 60 years (interquartile range 25% to 75%: 48 to 72 years) and 70 patients (51.9%) were women. The success rate in the compression with tranexamic acid group was 91.1% (41 of 45 patients); in the nasal packing group, 93.3% (42 of 45 patients); and in the compression with saline solution group, 71.1% (32 of 45 patients). There was an overall statistically significant difference among the 3 treatment groups but no significant difference in pairwise comparison between the compression with tranexamic acid and nasal packing groups. In regard to no rebleeding within 24 hours, the study found rates of 86.7% in the tranexamic acid group, 74% in the nasal packing group, and 60% in the compression with saline solution group. Applying external compression after administering tranexamic acid through the nostrils by atomizer stops bleeding as effectively as anterior nasal packing using Merocel. In addition, the tranexamic acid approach is superior to Merocel in terms of decreasing rebleeding rates.

Efficiency of local application of tranexamic acid during augmentative mammoplasty

Surgical patients are often at risk of bleeding, which in some cases may even require blood components transfusion. In addition, bleeding provokes the hematoma development, which remains a rather common complication in surgery. Despite the fact that specialists apply post­operative blood pressure monitoring, compression therapy and drainage to prevent the development of such complications, hematomas are marked in plastic surgery at 1 — 15 %.The aim — to increase the augmentation mammoplasty surgery effectiveness by reducing perioperative and postoperative blood loss with tranexamic acid topical use.Materials and methods. 29 women to whom the augmentation mammoplasty was performed for the breast shape restoration, were supervised in the period from 2015 to 2018. Patients were divided into 2 groups. In the first group (n = 10) 10 ml of tranexamic acid were additionally introduced into the implant pocket for haemostasis, in the second group (n = 19) tranexamic acid was not used.Results and discussion. All patients completed the in­patient treatment according to the plan and were discharged on the second and third day after surgery. At control of the drainage fluid, the haemorrhagic and serous­haemorrhagic exudate was obtained from 25 to 90 ml per day after the intervention. The volume of the exudate decreased in the first group more rapidly.Conclusions. The tranexamic acid local application allows to reduce the amount of blood loss in the postoperative period, the duration of the drainage systems functioning and, accordingly, reduce the complications risk associated with the presence of drainage and contrapertures.

Local application of tranexamic acid affects tendon healing negatively in the late period

This study aims to evaluate the potential adverse effects of tranexamic acid (TA) on tendon healing. Twelve male Wistar-Albino rats (weighing 300 g to 350 g) were used in the study. Rats were divided into two groups. Right legs of the rats were determined as the TA group and left legs as the serum physiologic (SP) group. Bilateral Achilles tenotomy was performed and surgically repaired. For the right side, 1 mL of TA and for the left side, 1 mL of SP were applied. Half of the rats were sacrificed at the third week and the other half at the sixth week and tendon samples were collected from the extremities. Histological analyses were performed according to the tendon scoring system (Bonar classification). Tenocyte cell morphology was better in the third week in TA group than in SP group. In terms of colloidal organization, SP groups gave superior results in all weeks. An analysis of total tendon healing scores revealed that the results of the third week TA groups were superior to the results of the sixth week TA groups. Tenocyte morphology and total tendon healing scores of rats in the sixth week TA group were statistically significantly lower compared to the third week TA group (tenocyte morphology p=0.009, total score p=0.041). In this study, we detected that locally administered TA has an adverse effect on tendon healing in late period. However, further immunohistochemical and biomechanical studies are needed to support these results.

Local application of tranexamic acid to reduce upper gastrointestinal bleeding in patients with liver cirrhosis

Background There has been a growing interest in the topical use of tranexamic acid (TXA) for the prevention of bleeding during different surgeries. Patients with liver cirrhosis may develop upper gastrointestinal (UGI) bleeding, which arises because of portal hypertension, which includes gastroesophageal varices and portal hypertensive gastropathy. The aim of this study was to evaluate the efficacy of the local application of TXA in reducing blood loss, transfusion requirements, and shortening the time for emergency endoscopy in cirrhotic patients presenting with UGI bleeding. Patients and methods A total of 100 patients with end-stage chronic liver disease presenting with UGI bleeding were randomly assigned to two groups to receive a standard protocol for UGI bleeding management, in addition to nasogastric lavage with either normal saline only (group S) or normal saline with TXA (group S+TXA). The lavage was repeated till its measured hematocrit (Hct) was less than 1%. The duration to reach this Hct was recorded. The volume of washes and transfusion requirements for each group were also recorded. Results Hemodynamic stability was observed in group S+TXA with less bleeding. The volumes of washes were significantly lower in group S+TXA. Time to reach Hct less than 1% in washed fluid was significantly shorter in group S+TXA (81.5±20.7 min) compared with group S (230.1±29.9 min). Transfusion requirements were significantly low in group S+TXA (765±184 ml) compared with group S (1345±278 ml). Duration to perform emergency upper endoscopy was shorter in group S+TXA (667±198 min) compared with group S (1094±163 min). Conclusion Local application of TXA during nasogastric lavage was efficient in reducing blood loss and transfusion requirements and in shortening the time for emergency endoscopy in cirrhotic patients presenting with UGI bleeding.

LOCAL APPLICATION OF TRANEXAMIC ACID IN KNEE REPLACEMENT

The purpose of the study – assessment of the efficacy of local application of tranexamic acid in TKA and the choice of the optimal dosage. Materials and methods. 48 patients were included in open-prospective study and were randomized to one of four groups. In the first group tranexamic acid was used as intravenous bolus at the beginning of the operation at a dose of 15 mg/kg. Additionally, after the installation of the prosthetic components, the surgeon performed periarticular infiltration of soft tissue by tranexamic acid solution at a dose of 15 mg/kg. In the second group of patients tranexamic acid was used as 500 mg intravenous bolus before surgery, and 500 mg locally after installation of the prosthesis components. In the third group of patients received tranexamic acid once at the beginning of the operation at a dose of 15 mg/kg iv bolus. In the fourth group tranexam was used after surgery once at a dose of 10 mg/kg. Results. In the first group of patients were achieved statistically significant, 5-6 times, reduction of blood loss on drainage in comparison with other groups, where the volume of postoperative blood loss was not significantly different between groups. Also in the first group recorded the smallest decrease in hemoglobin at the 5th postoperative day compared to the third and fourth groups. Complications associated with the use of tranexamic acid were not revealed. Conclusion. The method of periarticular infiltration by tranexamic acid in combination with its intravenous use in knee joint replacement is an effective and safe method for reduction of post-operative blood loss.