Local Application Of Tranexamic Acid Research Articles

Effect of local application of tranexamic acid on the hidden blood loss after total hip arthroplasty

Objective To assess the impact of local application of tranexamic acid on the hidden blood loss after unilateral total hip arthroplasty (THA). Methods Between September 2014 and December 2015, 82 patients underwent primary unilateral THA because of avascular necrosis of the femoral head. They were divided into an experimental group and a control group. In the experimental group, there were 42 patients, 24 males and 18 females; according to the Association Research Circulation Osseous (ARCO) classification, necrosis of the femoral head was type Ⅲ in 8 cases of and type Ⅳ in 34. In the control group, there were 40 patients, 22 males and 18 females; according to ARCO classification, necrosis of the femoral head was type Ⅲ in 7 cases and type Ⅳ in 33. In the experimental group, tranexamic acid was injected around the hip joint and into the hip articular cavity. In the control group, a same amount of physiological saline was injected around the hip joint and into the hip articular cavity. The 2 groups were compared postoperatively in terms of total blood loss, hidden blood loss, difference in diameter of the affected thigh, prothrombin time, partial thromboplastin time, D-dimer concentration, and incidence of deep vein thrombosis (DVT). Results The postoperative total blood loss and hidden blood loss in the experimental group (875.2±79.6 mL and 476.3±54.8 mL) were significantly less than those in the control group (1,262.7±105.2 mL and 683.5±75.9 mL) (P 0.05). DVT happened 2 weeks after surgery in 3 cases in the experimental group and in 4 cases in the control group. Conclusion Intraoperative local use of tranexamic acid can significantly reduce postoperative total and hidden blood loss, and effectively decrease swelling of the thigh, but does not increase the risk of DVT. Key words: Arthroplasty, replacement, hip; Tranexamic acid; Postoperative hemorrhage; Embolism and thrombosis

The effect of local application of tranexamic acid to reduce blood loss after off pump coronary artery bypass grafting (CABG)

After off-pump CABG surgery, bleeding and requirement of blood transfusion are the most common problems. Systemic use of antifibrinolytic reduces the postoperative blood loss. We have evaluated the effect of the topical use of tranexamic acid in the pericardial cavity on postoperative bleeding following open heart surgery.

Topical tranexamic Acid does not affect electrophysiologic or neurovascular sciatic nerve markers in an animal model.

Tranexamic acid is a safe and effective antifibrinolytic agent used systemically and topically to reduce blood loss and transfusion rate in patients having TKA or THA. As the hip does not have a defined capsule, topical application of tranexamic acid may entirely envelop the sciatic nerve during THA. Accidental application of tranexamic acid onto the spinal cord in spinal anesthesia has been shown to produce seizures; therefore, we sought to investigate if topical application of tranexamic acid on the sciatic nerve has a deleterious effect. We explored whether there were any short- or long-term alterations in (1) electrophysiologic measures, (2) macrophage recruitment, or (3) blood-nerve barrier permeability. Our hypothesis was that local application of tranexamic acid would have a transient effect or no effect on histologic features and function of the sciatic nerve. We used a rat protocol to model sciatic nerve exposure in THA to determine the effects of tranexamic acid on neural histologic features and function. We evaluated 35 rats by the dorsal gluteal splitting approach to expose the sciatic nerve for topical use of control and tranexamic acid. We evaluated EMG changes (distal latency, amplitude, nerve conduction velocity), histologic signs of nerve injury via macrophage recruitment, and changes in blood-nerve barrier permeability at early (4 days) and late (1 month) times after surgery, after application of subtherapeutic (1 mg/kg body weight [1.6 mg]), therapeutic (10 mg/kg [16 mg]), and supratherapeutic (100 mg/kg [160 mg]) concentrations of tranexamic acid. Differences in blood-nerve barrier permeability, macrophage recruitment, and EMG between normal and tranexamic acid-treated nerves were calculated using one-way ANOVA, with Newman-Keuls post hoc analyses, at each time. A post hoc power calculation showed that with the numbers available, we had 16% power to detect a 50% difference in EMG changes between the control, 1 mg/kg group, 10 mg/kg group, and 100 mg/kg group. At the early and late times, with the numbers available, there were no differences in EMG except for distal latency at 4 days, macrophage recruitment, or changes in blood-nerve barrier between control rats and those with tranexamic acid-treated nerves. The distal latency in the 1 mg tranexamic acid-treated animals at 4 days was 1.06 ± 0.15 ms (p = 0.0036 versus all other groups, 95% CI, 0.89-1.25), whereas the distal latencies in the control, the 10 mg/kg, and 100 mg/kg tranexamic acid-treated animals were 0.83 ± 0.11, 0.89 ± 0.05, and 0.87 ± 0.13, respectively. Distal latencies were not increased in any of the groups at 1 month with the numbers available (0.81 ± 0.10, 0.89 ± 0.03, 0.81 ± 0.06, and 0.83 ± 0.08 ms, respectively, for controls; 1 mg/kg, 10 mg/kg, and 100 mg/kg for the tranexamic acid-treated groups). In our in vivo rat model study, tranexamic acid did not appear to have any clinically relevant effect on the sciatic nerve resulting from topical administration up to 1 month. However, because our statistical power was low, these data should be considered hypothesis-generating pilot data for larger, more-definitive studies. Topical tranexamic acid is effective in decreasing patient blood loss during THA, and results from our in vivo rat model study suggest there may be no electrophysiologic and histologic effects on the sciatic nerve, with the numbers available, up to 1 month.

Aplicación de un gel de ácido tranexámico en pacientes tratados con anticoagulantes orales

Background and objectivePatients treated with oral anticoagulants have increased susceptibility to bleeding, and therefore any surgical medical procedure and especially oral surgery requires a therapeutic approach that minimizes bleeding effects in these patients. Material and methodThe working hypothesis was based on studies of local application of tranexamic acid after maxillofacial interventions as effective therapeutic alternative for the prevention and control of bleeding. The aim was to assess the effectiveness of the application of a gel solution tranexamic acid after tooth extraction in anticoagulated patients in terms of healing time and degree of healing. ResultsThe results indicate that application of tranexamic acid gel is very effective for consistency and maintenance in the place of action and shows its efficacy as a procoagulant material. ConclusionsThe application of a gel solution of tranexamic acid in oral anticoagulants patients ameliorates healing time and the bleeding time within the first 48-72h.

Die lokale Anwendung von Tranexamsäure in der HNO-Chirurgie

Bleeding is a main complication in ENT surgery especially in oral and nasal interventions. Based on good results in local application of tranexamic acid after dental extraction, the different possibilities of local application of tranexamic acid in ENT surgery are discussed and the current literature is presented. In our experience, the rate of secondary hemorrhage after oral and nasal interventions can be reduced considerably by local application of tranexamic acid, which means risk reduction and better compliance especially in an increasingly aging patient population. Based on our experience, the local use of tranexamic acid in ENT surgery should be the focus of future studies.

Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty

The surgical stress of total knee arthroplasty (TKA) procedure and the application of intra-operative pneumatic thigh tourniquet increases local fibrinolytic activity, which contributes significantly to post-operative blood loss. Tranexamic acid, an antifibrinolytic drug, is commonly used to control post-operative blood loss. The recommended mode of administration of tranexamic acid is either oral or intravenous. However, the mechanism of action of the tranexamic acid points towards the possible effectiveness it may have following local/intra-articular application. This prospective, double-blinded, randomized preliminary study evaluated the efficacy of intra-articular tranexamic acid in reducing TKA-associated post-operative blood loss. Fifty consenting patients with osteoarthritis of the knee scheduled for primary unilateral cemented-TKA were randomly allocated to one of the two groups: Tranexamic Acid (TA) group (n = 25, 500 mg/5 ml tranexamic acid) and the control group (n = 25, 5 ml 0.9% saline). The drug and control solution were administered intra-articularly through the drain tube immediately after the wound closure. Parameters related to blood loss (drop in haemoglobin, haematocrit differential) and the drain output [volume (ml)] were compared between the two groups. On a comparative basis, TA-group obtained significant reduction in the drain output [95% CI: 360.41-539.59, p < 0.001] at 48 h post-operatively. Even though the control group received sixfold more blood transfusion than TA-group, it showed a greater drop in haemoglobin and haematocrit (p < 0.05). Local application of tranexamic acid seems to be effective in reducing post-TKA blood loss as well as blood transfusion requirements. Therapeutic study, Level II.

Can local application of Tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial

BackgroundDiffuse microvascular bleeding remains a common problem after cardiac procedures.Systemic use of antifibrinolytic reduces the postoperative blood loss.The purpose of this study was to examine the effectiveness of local application of tranexamic acid to reduce blood loss after coronary artery bypass grafting (CABG).MethodsThirty eight patients scheduled for primary isolated coronary artery bypass grafting were included in this double blind, prospective, randomized, placebo controlled study.Tranexamic acid (TA) group (19 patients) received 1 gram of TA diluted in 100 ml normal saline. Placebo group (19 patients) received 100 ml of normal saline only. The solution was purred in the pericardial and mediastinal cavities.ResultsBoth groups were comparable in their baseline demographic and surgical characteristics. During the first 24 hours post-operatively, cumulative blood loss was significantly less in TA group (median of 626 ml) compared to Placebo group (median of 1040 ml) (P = 0.04). There was no significant difference in the post-op Packed RBCs transfusion between both groups (median of one unit in each) (P = 0.82). Significant less platelets transfusion required in TA group (median zero unit) than in placebo group (median 2 units) (P = 0.03). Apart from re-exploration for excessive surgical bleeding in one patient in TA group, no difference was found in morbidity or mortality between both groups.ConclusionTopical application of tranexamic acid in patients undergoing primary coronary artery bypass grafting led to a significant reduction in postoperative blood loss without adding extra risk to the patient.

Managing stomal bleeds

Local application of tranexamic acid is an effective treatment for stomal bleeding. Lorna De Bourg and colleagues report

Managing stomal bleeds

Local application of tranexamic acid is an effective treatment for stomal bleeding. Lorna De Bourg and colleagues report