Routine Use Of Tranexamic Acid Research Articles

Tranexamic Acid for reduction of intra- and postoperative TRansfusion requirements in elective Abdominal surgery (TATRA): study protocol for an investigator-initiated, multicenter, double-blind, placebo-controlled, randomized superiority trial with two parallel groups

BackgroundIntra- and postoperative hemorrhage is a relevant problem in major abdominal surgery, leading to acute anemia and necessitating transfusion of packed red blood cells. It is estimated that in 30% of abdominal surgeries, intra- or postoperative transfusion is required. Transfusion potentially has detrimental health effects and poses a considerable socioeconomic burden. Tranexamic acid, a lysine analog inhibiting plasminogen activation and providing clot stability, has been used to reduce hemorrhage. While there is ample evidence in other surgical disciplines, it is almost completely lacking in abdominal surgery.MethodsThis multicenter double-blind parallel group randomized superiority trial will compare tranexamic acid (loading dose 1000 mg over 10 min prior to skin incision, maintenance dose 125 mg/h continuously until skin closure or until 1000 mg have been administered) to placebo in patients ≥ 18 years undergoing elective esophagectomy, gastrectomy, colectomy, rectal resection, pancreatic resection, or hepatectomy. The primary efficacy endpoint is the intra- or postoperative transfusion of at least one unit of packed red blood cells. Key secondary endpoints are the number of transfused units per patient, estimated intraoperative blood loss, postoperative complications/mortality, length of hospital stay, operation/anesthesia time, D-dimer levels, and quality of life. Sample size calculation is based on the assumption that in the control group, 30% of patients require transfusion while the intervention achieves a risk reduction of 33%, reducing the probability to 20%. With a type one error of 5% and a power of 90%, using a two-sided χ2 test, this results in 412 patients per group. Accounting for non-compliance, 425 patients are to be randomized per group. The total trial duration will be 30 months with a recruitment period of 18 months.DiscussionIf the proposed trial yielded positive results, the routine use of tranexamic acid in major abdominal surgery would be supported. This would avoid acute anemia with detrimental effects such as tissue hypoxia and organ injury, as well as the negative immediate and delayed effects of transfusions.Trial registrationEU CT Nr: 2023–509970-43–01, NCT06414031. Registered on 10 May 2024.

Tranexamic Acid During Radical Cystectomy

Among cancer surgeries, patients requiring open radical cystectomy have the highest risk of red blood cell (RBC) transfusion. Prophylactic tranexamic acid (TXA) reduces blood loss during cardiac and orthopedic surgery, and it is possible that similar effects of TXA would be observed during radical cystectomy. To determine whether TXA, administered before incision and for the duration of radical cystectomy, reduced the number of RBC transfusions received by patients up to 30 days after surgery. The Tranexamic Acid During Cystectomy Trial (TACT) was a double-blind, placebo-controlled, randomized clinical trial with enrollment between June 2013 and January 2021. This multicenter trial was conducted in 10 academic centers. A consecutive sample of patients was eligible if the patients had a planned open radical cystectomy for the treatment of bladder cancer. Before incision, patients in the intervention arm received a loading dose of intravenous TXA, 10 mg/kg, followed by a maintenance infusion of 5 mg/kg per hour for the duration of the surgery. In the control arm, patients received indistinguishable matching placebo. The primary outcome was receipt of RBC transfusion up to 30 days after surgery. A total of 386 patients were assessed for eligibility, and 33 did not meet eligibility. Of 353 randomized patients (median [IQR] age, 69 [62-75] years; 263 male [74.5%]), 344 were included in the intention-to-treat analysis. RBC transfusion up to 30 days occurred in 64 of 173 patients (37.0%) in the TXA group and 64 of 171 patients (37.4%) in the placebo group (relative risk, 0.99; 95% CI, 0.83-1.18). There were no differences in secondary outcomes among the TXA group vs placebo group including mean (SD) number of RBC units transfused (0.9 [1.5] U vs 1.1 [1.8] U; P = .43), estimated blood loss (927 [733] mL vs 963 [624] mL; P = .52), intraoperative transfusion (28.3% [49 of 173] vs 24.0% [41 of 171]; P = .08), or venous thromboembolic events (3.5% [6 of 173] vs 2.9% [5 of 171]; P = .57). Non-transfusion-related adverse events were similar between groups. Results of this randomized clinical trial reveal that TXA did not reduce blood transfusion in patients undergoing open radical cystectomy for bladder cancer. Based on this trial, routine use of TXA during open radical cystectomy is not recommended. ClinicalTrials.gov Identifier: NCT01869413.

Association Between Tranexamic Acid and Decreased Periprosthetic Joint Infection Risk in Patients Undergoing Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Over 2 Million Patients

BackgroundThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the association between tranexamic acid (TXA) use during primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA), and the risk of developing periprosthetic joint infection (PJI) after these procedures. MethodsA systematic review was carried out from inception to October 17, 2022. There were 6 studies that were ultimately included in the meta-analysis. The association between the development of PJI and TXA was analyzed using odds ratios (ORs) with 95% confidence intervals (CIs) and estimates of risk difference (RD). Subgroup analysis was performed to evaluate only studies reporting out to 90 days of follow-up versus more than 90 days of follow-up. ResultsAmong 2,098,469 arthroplasties, TXA utilization was associated with an overall lower risk of PJI (OR = 0.63 [95% CI 0.42 to 0.96], P < .001) and a 0.4% lower incidence of PJI (RD = −0.0038, 95% CI [-0.005 to −0.002], P < .001). When subgrouping the studies according to length of follow-up, TXA was associated with a lower risk of PJI (OR = 0.43 [95% CI 0.35 to 0.53], P < .001) and a 1% lower incidence of PJI (RD = −0.0095 [95% CI −0.013 to −0.005], P < .001) in patients followed for more than 90 days. ConclusionsThis meta-analysis demonstrates that TXA use is associated with a reduced risk of PJI, with our RD analysis identifying an approximately 0.4% reduction in PJI rates with TXA use. These findings provide even more data to support the routine use of TXA during primary THA and primary TKA.

Tranexamic Acid Reduces the Amount of Blood Transfused in Revision Total Hip Arthroplasty for Vancouver B2/B3 Periprosthetic Femur Fractures.

Periprosthetic fractures around total hip arthroplasty (THA) represent a significant source of morbidity and mortality. The use of tranexamic acid (TXA) in arthroplasty is well described, yet little literature supports its role in periprosthetic femur fractures (PFFs). This study investigated the effect of preoperative TXA administration on transfusion rate and volume, length of stay, and 90-day complication rates in patients undergoing revision THA for PFF. All patients undergoing revision THA for PFF (Vancouver B2/B3) at our institution from August 2016 to June 2022 were identified. Routine TXA administration at surgical start was introduced in 2018. Patient demographics, operative time, blood product use, length of stay, and 90-day complications were collected. Patients were divided into those who received TXA preoperatively and those who did not. A total of 56 patients were included. There was no difference in age, sex, anesthetic type, fracture classification, or preoperative blood values between cohorts. TXA significantly lowered the amount of blood product required (2.3 units vs 3.2 units, P=.023). Preoperative TXA did not independently reduce length of stay; however, blood transfusion was associated with increased length of stay (7 days vs 4.7 days, P=.003). There were no differences in 90-day complications. Among patients who underwent revision THA for Vancouver B2/B3 PFF, TXA did not affect transfusion rates but did result in the use of fewer blood products without an increase in complications. We support routine use of TXA in this patient population. Future studies should assess earlier administration of TXA in the emergency department or once patients' conditions have been medically optimized. [Orthopedics. 2024;47(5):e261-e267.].

The cost-effectiveness of tranexamic acid for preventing blood transfusions following reverse total shoulder arthroplasty: a break-even analysis

BackgroundThe administration of tranexamic acid (TXA) in patients undergoing shoulder arthroplasty is a safe and effective means of reducing blood loss and blood transfusions. Due to its low cost and ability to prevent costly complications, TXA’s use is thought to be a cost-saving practice. The purpose of this study was to determine the cost-effectiveness of TXA in preventing blood transfusions in patients undergoing reverse shoulder arthroplasty (RSA). MethodsThe cost of TXA ($5.22) and the cost of a blood transfusion ($299.31) from our institution, as well as baseline published blood transfusion rates following RSA (14.3%) without the administration of TXA, were included in a break-even model to calculate the absolute risk reduction (ARR) that the routine use of TXA would need to be considered economically justifiable. To account for variance in baseline transfusion rates, the cost of TXA, and the cost of blood transfusion across institutions, sensitivity analyses were conducted in which the break-even transfusion rate and ARR were calculated across a wide range for each variable. ResultsTXA is deemed cost-effective if it prevents one blood transfusion out of 57 RSAs (ARR = 1.74%). It is economically viable at varying drug costs ($1-$25), blood transfusion costs ($50-$5000), and baseline transfusion rates (2.00%-50.00%). ConclusionUsing the cost parameters at a single institution, the current study found that TXA would be cost-effective in preventing blood transfusion if its routine use achieves an ARR greater than 1.74% following RSA. As the ARR has been demonstrated in the literature to be greater than 1.74%, TXA can be considered cost-effective in preventing blood transfusion following RSA.

Oral and intravenous tranexamic acid administration demonstrate no significant difference in objective measures of blood loss in primary total shoulder arthroplasty

IntroductionThe routine use of tranexamic acid (TXA) in shoulder arthroplasty has grown in popularity due to the perceived benefits of reduction in intra-operative blood loss and the related adverse sequelae. Both intravenous (IV) and oral (PO) formulations of TXA exist and there is minimal data regarding the optimal route of administration. This study aimed to assess whether there was a significant difference in efficacy between the administration of PO vs. IV TXA prior to total shoulder arthroplasty. We hypothesized equivalence in preoperative (preop) to postoperative change in hemoglobin (Hg) and hematocrit (Hct) as well as the length of stay (LOS), 90-day readmission, transfusion rates and adverse events between the two routes. Materials and methodsA single-center retrospective chart review was conducted between May 2022 and January 2023. All patients undergoing primary anatomic or reverse total shoulder arthroplasty during this period were included. Patients undergoing revision shoulder arthroplasty or arthroplasty for fracture were excluded. The primary outcome of interest was the change (Δ) in preop to postoperative day 1 Hg and Hct reported as ΔHg and ΔHct. Intraoperative estimated blood loss (EBL), transfusion rates, patient demographics, LOS, and adverse event data were also collected. ResultsTwo hundred and thirty patients who underwent shoulder arthroplasty met the inclusion criteria. A total of 176 patients received preoppreop IV TXA and 54 patients received preop PO TXA. There was no significant difference between groups in the mean ΔHg (1.69 in the IV group and 2.52 in the PO group, P = .11) or ΔHct (5.19 in the IV group and 5.04 in the PO group, P = .42). There was no significant difference in LOS, transfusion rates, or 90-day readmission between groups. There was a significant difference in the mean EBL between the two groups (123.78cc in the IV group and 173.06cc in the PO group, P < .001). Our study was adequately powered at 0.95. ConclusionThere was no statistically significant difference between the IV and PO TXA groups when comparing preop to postoperative day 1 change in Hg and Hct, LOS, transfusion rates, surgical site infections, and 90-day readmission indicating similar efficacy between the two routes of administration. EBL was found to be significantly higher in the PO TXA group, though the clinical significance of this finding is indeterminate. Given these findings, however, PO TXA may be a reliable alternative to IV TXA in primary shoulder arthroplasty.

Prophylactic Tranexamic Acid Prevents Postpartum Hemorrhage and Transfusions in Cesarean Deliveries: A Systematic Review and Meta-analysis.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and PPH resulting in transfusion is the most common maternal morbidity in the United States. Literature demonstrates that tranexamic acid (TXA) can reduce blood loss in cesarean deliveries; however, there is little consensus on the impact on major morbidities like PPH and transfusions. We conducted a systematic review/meta-analysis of randomized controlled trials (RCTs) to evaluate if administration of prophylactic intravenous (IV) TXA prevents PPH and/or transfusions following low-risk cesarean delivery. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. Five databases were searched: Cochrane, EBSCO, Ovid, PubMed, and ClinicalKey. RCTs published in English between January 2000 and December 2021 were included. Studies compared PPH and transfusions in cesarean deliveries between prophylactic IV TXA and control (placebo or no placebo). The primary outcome was PPH, and the secondary outcome was transfusions. Random effects models were used to calculate effect size (ES) of exposure in Mantel-Haenszel risk ratios (RR). All analysis was done at a confidence level (CI) of α = 0.5. Modeling showed that TXA led to significantly less risk of PPH than control (RR: 0.43; 95% CI: 0.28-0.67). The effect on transfusion was comparable (RR: 0.39; 95% CI: 0.21-0.73). Heterogeneity was minimal (I 2 = 0%). Due to the large sample sizes needed, many RCTs are not powered to interpret TXA's effect on PPH and transfusions. Pooling these studies in a meta-analysis allows for more power and analysis but is limited by the heterogeneity of studies. Our results minimize heterogeneity while demonstrating that prophylactic TXA can lower PPH occurrence and reduce the need for blood transfusion. We suggest considering prophylactic IV TXA as the standard of care in low-risk cesarean deliveries. KEY POINTS: · Consider TXA prior to incision for singleton, term pregnancies undergoing elective cesarean.. · Prophylactic TXA is effective in preventing PPH and blood transfusions.. · Routine use of TXA has the potential to decrease transfusion-related complications and costs..

The Cost-Effectiveness of Tranexamic Acid for Preventing Periprosthetic Joint Infection following Total Shoulder Arthroplasty: A Break-Even Analysis.

The use of tranexamic acid has become widespread in orthopedics to promote hemostasis and has been successfully used to reduce blood loss and infection risk in joint arthroplasty. However, the cost-effectiveness of routine tranexamic acid use for the prevention of periprosthetic infections in total shoulder arthroplasty (TSA) remains unknown. The acquisition cost of tranexamic acid ($5.22) for our institution, along with values from the literature for the average cost of infection-related care ($55,243) and the baseline infection rates for patients without tranexamic acid use (0.70%), were used to perform a break-even analysis. The absolute risk reduction of infection necessary to justify the prophylactic use of tranexamic acid in shoulder arthroplasty was calculated from the non-treated and break-even infection rates. Tranexamic acid is considered cost effective if it prevents one infection out of 10,583 TSA's (absolute risk reduction [ARR] = 0.009%). It is economically justifiable with an ARR range of 0.001% at a cost of $0.50/g to 0.181% at $100/g. At varying costs of infection-related care ($10,000 - $100,000) and varying baseline infection rates (0.50% - 8.00%), routine use of tranexamic acid remained cost effective. The use of tranexamic acid is an economically viable practice for infection prevention following shoulder arthroplasty if it reduces the infection rate by 0.009%. Future, prospective studies should be conducted to observe whether tranexamic acid reduces the infection rate by more than 0.009%, showing cost-effectiveness.

The effect of a single dose of intravenous tranexamic acid on visual clarity in knee arthroscopic meniscectomy without a tourniquet

Background/Aim: Tranexamic acid (TXA) is known to reduce intra-articular bleeding during arthroscopic procedures, which can improve visibility and reduce postoperative pain and knee joint swelling from hemarthrosis. However, insufficient data supports the routine use of TXA in arthroscopic meniscectomy. This study aimed to evaluate the effect of a single dose of intravenous (IV) TXA on visual clarity in arthroscopic meniscectomy without a tourniquet.&#x0D; Methods: A randomized, double-blind, controlled trial was conducted to assess the use of TXA for visibility in routine arthroscopic meniscectomy without a tourniquet. Between January 2021 and February 2022, 53 patients undergoing arthroscopic meniscectomy were randomly assigned to either the TXA group (n=27), who received 1 g IV-TXA, or the control group (n=26), who received 100 ml of normal saline. Visual clarity was evaluated using a Numeric Rating Scale (NRS). Patients were also assessed for the need for a tourniquet, tourniquet time, total operative time, volume of irrigation fluid, postoperative pain, hemarthrosis, and knee function on postoperative day 3 and weeks 1, 2, and 4, using the Lysholm knee scoring scale.&#x0D; Results: There was no significant difference in intra-operative arthroscopic visibility between the TXA and control groups (P=0.394). Tourniquet was required in three cases in the TXA group and four cases in the control group (P=0.646). There was no significant difference between the two groups regarding postoperative pain, grade of postoperative hemarthrosis, knee motion, or the Lysholm Knee Score after the operation.&#x0D; Conclusion: The administration of IV-TXA in arthroscopic meniscectomy without a tourniquet did not provide any benefits such as enhanced surgical visualization, reduction in the need to inflate the tourniquet due to obstructed visibility, or decrease in hemarthrosis, VAS pain score, or improved range of motion of the knee in the postoperative period when compared to the control group.

Safety and clinical outcomes associated with the routine use of tranexamic acid (TXA) in abdominal-based free flap autologous breast reconstruction — a case control study

Safety and clinical outcomes associated with the routine use of tranexamic acid (TXA) in abdominal-based free flap autologous breast reconstruction — a case control study

Intravenous Tranexamic Acid in Percutaneous Kidney Biopsy: A Randomized Controlled Trial

Background: Tranexamic acid is frequently reported to reduce bleeding-related complications in major surgery and trauma. We aimed to investigate whether tranexamic acid reduced hematoma size after percutaneous kidney biopsy. Methods: We conducted a double-blind, parallel three-group, randomized placebo-controlled trial at a teaching hospital in Japan between January 2016 and July 2018. Adult patients with clinical indication for ultrasound-guided percutaneous biopsy of a native kidney were included. Participants were randomly assigned into three groups: high-dose tranexamic acid (1,000 mg in total), low-dose tranexamic acid (500 mg in total), or placebo (counterpart saline). Intervention drugs were intravenously administered twice, as a bolus just before the biopsy and as a continuous infusion initiated just after the biopsy. Primary outcome was post-biopsy perirenal hematoma size as measured by ultrasound on the morning after the biopsy. Results: We assessed 90 adult patients for study eligibility, of whom 56 were randomly allocated into the three groups: 20 for high-dose tranexamic acid, 19 for low-dose tranexamic acid, and 17 for placebo. The median size of perirenal hematoma was 200 mm2 (interquartile range, 21–650) in the high-dose tranexamic acid group, 52 mm2 (0–139) in the low-dose tranexamic acid group, and 0 mm2 (0–339) in the placebo group (p = 0.048 for high-dose tranexamic acid vs. placebo). Conclusion: In this trial, the median size of post-kidney biopsy hematoma was unexpectedly larger in the high-dose tranexamic acid group than in the placebo group. Although our results do not support the routine use of tranexamic acid in percutaneous kidney biopsy at present, further studies are needed to confirm the results.

Efficacy of tranexamic acid in prevention of alveolar osteitis following surgical removal of impacted mandibular third molar.

Many preventive measures are described to avoid alveolar osteitis (AO) during third molar surgery (TMS), but very few are found to be effective. Tranexamic acid (TA), an antifibrinolytic agent, impedes the proteolytic degradation of fibrin and prevents blood clot disintegration. The study was conducted to determine the efficacy of intra-alveolar application of TA soaked in Gelfoam in prevention of AO. This was a randomized control trial. A total of 200 patients (100 in control group and 100 in study group) reporting for TMS were allocated randomly. Following surgery, TA soaked in gel foam was placed in socket and sutured in the study group, while in the control group, closure was done by suturing. Patients followed subsequently to observe the incidence of AO, pain severity, and duration of healing after AO. Z-test, Mann-Whitney test, and t-test were applied, respectively, to compare the incidence of AO, severity of pain, and duration of healing between the two groups. The incidence of AO in the control group was 18% and 6% in the study group. Patients in the control group experienced severe pain as compared to patients in the study group. The duration of healing varied from 12 to 16 days in the control group, but in the study group, it was <10 days. TA significantly reduces the incidence of AO in addition to the reduced severity of pain and enhanced healing. We recommend the routine use of TA, owing to its astonishing rewards.

Mean Blood Loss in Third Stage of Labour Treated with and without Prophylactic Tranexamic Acid

Background: Massive obstetrical hemorrhage, a leading contributor towards maternal fatality in economically developing countries, is occasionally related with the passive and apathetic management of the third stage of labor. The increasing frequency of anaemia among pregnant women in developing countries, mild to moderate blood loss during labour necessitates massive transfusions with associated complications. Aim: Recent studies claimed that prophylactic tranexamic acid can significantly reduce the mean blood loss during 3rd stage of labour and advocated it in future practice. Methods: The research was conducted as randomized controlled trial carried out from February 2021 to October 2021 in the Department of Diagnostic Radiology and Obstetrics &amp; Gynaecology Department, Ganga Ram Hospital, Lahore. A total of 116 pregnant women aged between 18-35 years presenting in labor at term (37-42 weeks of gestation as per dating scan) which were randomly allocated into two groups. Patients in Group-A were given additional tranexamic acid at the end of 2nd stage of labor while those in Group-B received conventional treatment alone. Results: Patients were 28.33±4.77 years with the mean age while the mean gestational age at delivery was 39.39±1.69 weeks. 30(25.9%) women were primiparas and 86 (74.1%) were multiaparas. The mean BMI of these patients was 27.50±3.90 Kg/m2 while the average duration of 3rd stage of labor was 4.69±1.83 minutes. Patients taking prophylactic tranexamic acid lost significantly less blood in the third stage of labors than controls (244.83±21.47 vs. 354.09±22.36 ml; p-value&lt;0.001). Conclusion: In the present study, prophylactic tranexamic acid was found to significantly reduce the mean blood loss during 3rd stage of labor which along with low cost, widespread availability and oral administration advocates the routine use of tranexamic acid (during 3rd stage of labor) in future obstetric practice to minimize blood loss with subsequent decreased need for blood transfusion and better patient’s recovery. Keywords: Third Stage of Labor, Blood Loss, Tranexamic Acid

The efficacy and safety of the routine use of tranexamic acid perioperatively in breast surgery

Introduction: Bleeding is an important consideration in breast surgery as the operation site is confined and any uncontrolled bleeding might result in skin necrosis, which in turn delays the healing. Tranexamic acid (TXA) is a synthetic amino acid that blocks plasminogen from being converted to the enzyme plasmin. Plasmin works by breaking down fibrin already formed in blood clots resulting in fibrinolysis and therefore clot lysis. It is used safely in several medical and surgical settings and has been demonstrated to effectively reduce perioperative blood loss without any significant safety concerns.

Importance of tranexamic acid in pediatric monosutural craniosynostosis surgery.

Tranexamic acid (TXA) is an antifibrinolytic drug that has achieved significant reduction in perioperative blood loss and the quantity of blood transfused in many pediatric surgical procedures, without morbidity. Despite the accumulation of evidence regarding its effectiveness in craniosynostosis repair surgery, TXA is not unanimously employed by pediatric neurosurgery teams. The purpose of this study was to evaluate the impact of the routine use of TXA in a homogeneous population of children who underwent open surgery for monosutural craniosynostosis. The authors retrospectively reviewed 3 cohorts of patients that were subdivided from 2 cohorts surrounding the initiation of TXA (group 1, TXA- [2008-2011] and group 2, TXA+ [2011-2013]) and a third cohort of more recent patients (group 3, TXA+ [2016-2017]). TXA was administered using the same protocol comprising a loading dose of 10 mg/kg over 15 minutes after induction of general anesthesia followed by a 10 mg/kg per hour infusion until skin closure. Patients in all 3 groups underwent similar standardized procedures for scaphocephaly, trigonocephaly, and unicoronal craniosynostosis by the same pediatric neurosurgeon. Overall, 102 infants were included in the study: 32 infants in group 1, 36 in group 2, and 34 in group 3. Significant reductions in transfusion of packed erythrocytes (PE) and fresh-frozen plasma (FFP) were observed between the TXA- and TXA+ time periods. The median volume of PE transfusion was reduced by > 50% with the use of TXA (42.8 mL/kg in the TXA- group vs 20.0 in the TXA+ groups, p < 0.0001). Reduction in PE transfusion was 100% postoperatively in the TXA+ groups (20.0 mL/kg in the TXA- group vs 0.0 in the TXA+ groups, p < 0.0001). The median volume of FFP transfusion was reduced by 100% with the use of TXA (12.8 mL/kg in the TXA- group vs 0.0 in the TXA+ groups, p < 0.0001). All children in group 1 received a transfusion, whereas 3 children (8%) and 7 children (20%) in groups 2 and 3, respectively, did not. Significant reductions in postoperative drain output were also noted between the TXA- and TXA+ time periods. The total hospital length of stay was significantly lower in the TXA+ groups (p < 0.0001). Use of TXA reduced blood loss and the need for transfusions but also decreased the hospital length of stay and, thus, minimized overall medical care costs. Intraoperative administration of TXA in craniosynostosis repair surgery should be routinely used in all centers that practice these procedures.

The effect of tranexamic acid on hidden blood loss in total hip arthroplasty.

Objectives In this study, we aimed to examine the effect of tranexamic acid (TXA) on hidden blood loss in total hip arthroplasty (THA) patients.Patients and methods Between June 2015 and June 2021, a total of 120 patients (45 males, 75 females; mean age 57.2±4.9 years; range, 45 to 67 years) with primary osteoarthritis who underwent THA without the use of TXA and 53 patients who received TXA were retrospectively analyzed. Demographic data, amount of transfusion, early complications, preoperative and postoperative hemoglobin and hematocrit values, total blood loss, visible blood loss, and hidden blood loss values were compared.Results There was a significant difference between the groups with and without the use of TXA in terms of intraoperative bleeding, amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion (p<0.05). A significant positive correlation was found between intraoperative blood loss and hidden blood loss (r=0.325 p<0.01), while no significant correlation was found between postoperative drainage volume and hidden blood loss (r=-0.006 p=0.946).Conclusion The use of TXA in patients undergoing THA reduces blood loss, including hidden blood loss, thereby reducing the need for blood transfusion after hip arthroplasty. However, there seems to be no linear relationship between postoperative blood loss and hidden blood loss. Considering these results, the routine use of TXA can be recommended in THA, unless there is a contraindication.

Tranexamic acid reduces postoperative blood loss in Chinese pediatric patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis.

Background:Tranexamic acid has been increasingly used for blood conservation in cardiac surgery. However, the evidence supporting the routine use of tranexamic acid in Chinese pediatric patients undergoing cardiac surgery remains weak. This meta-analysis aimed to systematically review the efficacy of tranexamic acid when applying to Chinese pediatric patients undergoing cardiac surgery.Participants:Chinese pediatric patients undergoing cardiac surgery.Interventions:Tranexamic acid or control drugs (saline/blank).Methods:PUBMED, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Data till May 4, 2021, database search was updated on August 1. Primary outcomes of interest included postoperative bleeding, allogeneic transfusion, and reoperation for bleeding. Secondary outcomes of interest included postoperative recovery. For continuous/dichotomous variables, treatment effects were calculated as weighted mean difference (WMD)/odds ratio and 95% confidence interval.Results:A database search yielded 15 randomized controlled trials including 1641 patients, where 8 studies were allocated into non-cyanotic congenital group, 5 were allocated into cyanotic congenital group, and the other 2 were allocated into combined cyanotic/non-cyanotic group. This meta-analysis demonstrate that tranexamic acid administration can reduce the postoperative 24 hours blood loss in non-cyanotic, cyanotic, and combined cyanotic/non-cyanotic patients, the red blood cell transfusion in non-cyanotic and cyanotic patients, and the fresh frozen plasma transfusion in non-cyanotic and combined cyanotic/non-cyanotic patients.Conclusion:This meta-analysis demonstrates that tranexamic acid is highly effective in reducing the blood loss in Chinese pediatric cardiac surgery, but it behaves poorly when it comes to the transfusion requirement. To further confirm this, more well-designed and adequately-powered randomized trials are needed.

Effect of Tranexamic Acid on Bleeding Outcomes After Percutaneous Nephrolithotomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Purpose: We performed a systematic review and meta-analysis of the literature to evaluate the efficacy of the routine use of tranexamic acid (TXA) during percutaneous nephrolithotomy (PCNL). Methods: This systematic review was conducted following the updated reporting guidelines from PRISMA 2020. Results: In total, 275 titles and abstracts were reviewed, of which 20 were screened to be eligible for full text review. Of these 20 articles, 11 were selected for inclusion after full article evaluations. Seven of these 11 studies were seen as having a low risk of bias with a Jadad score of ≥3. These studies were included for data extraction. Once data were extracted, 964 patients were included. The primary outcome, blood transfusion rate, showed significant reduction with a ratio for transfusion rate of 0.34 [95% confidence interval (CI) (0.19 to 0.61), z = 3.61, p = 0.0003]. Mean hemoglobin (Hgb) drop and operative time were both shown to be reduced with the use of TXA. The mean difference for Hgb drop was -0.86 [95% CI (-1.26 to -0.46), z = 4.23, p < 0.0001]. Reduction in operative time showed a mean difference of -8.45 minutes [95% CI (-15.04 to -1.86), z = 2.51, p = 0.01]. Stone clearance was not shown to differ significantly between experimental and control groups, with a risk ratio of 1.28 [95% CI (0.89 to 1.84), z = 1.31, p = 0.19]. Conclusions: This meta-analysis revealed that the routine use of TXA at time of PCNL reduces the rates of blood transfusion, mean Hgb drop, and operative time. With the low cost of TXA and strong safety profile, stronger consideration should be given to the routine use of TXA during PCNL by endoscopic surgeons.

Efficacy and safety of tranexamic acid in aneurysmal subarachnoid hemorrhage: A meta-analysis of randomized controlled trials.

Tranexamic acid, as a traditional hemostatic agent, is commonly used to treat or prevent excessive blood loss. However, the role of tranexamic acid in promoting good clinical outcomes and reducing mortality and risk of adverse events during the treatment of aneurysmal subarachnoid hemorrhage remains unclear. In strict accordance with the inclusion and exclusion criteria, Cochrane Library, Embase, Web of Science, and PubMed databases were assessed for randomized controlled trials (published between 1980 and 2021). Data were analyzed using STATA 16.0 and RevMan 5.3. In addition, the fixed-effects model (M-H method) and effect size (risk difference; RD) were used as a pooled measure to combine data. We also performed a post hoc sensitivity analysis and subgroup analysis to evaluate each outcome with low heterogeneity. A meta-analysis revealed that although tranexamic acid was related to less rebleeding (RD=-0.06; 95% CI [-0.09, -0.03]; P=0.0006), there is evidence that it has no an effect on good clinical outcomes or mortality (RD=-0.01; 95% CI [-0.05, 0.02]; P=0.51; RD=0.00; 95% CI [-0.03, 0.04]; P=0.91). Tranexamic acid was associated with increased hydrocephalus (RD=0.04; 95% CI [0.01, 0.08]; P=0.02) and seizure (RD=0.04; 95% CI [0.00, 0.08]; P=0.05). The incidence of thromboembolic complications or delayed cerebral ischemia was not different in the two groups (RD=-0.01; 95% CI [-0.04, 0.03]; P=0.62; RD=0.00; 95% CI [-0.03, 0.03]; P=0.96), and significant drug-related overall adverse events were identified (RD=0.02; 95% CI [0.00, 0.04]; P=0.03). These findings indicate that the routine use of tranexamic acid is not suggested for patients with aneurysmal subarachnoid hemorrhage.

P.26 Routine use of tranexamic acid during elective caesarean section: A district general’s experience

Introduction: The use of tranexamic acid (TXA) to help reduce bleeding or blood transfusions is widely acknowledged, with NICE [1] NICE guideline Blood Transfusion 2015, https://www.nice.org.uk/guidance/ng24 Google Scholar recommending that TXA is offered to all adult patients undergoing surgery, where moderate blood loss is expected. In addition the WOMAN [2] Woman trial collaborators. Effect of early tranexamic acid administration on mortality,hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international randomised, double-blind, placebo-controlled trial. Lancet 2017;389:2105-16 Google Scholar trial also supports its use within the obstetric population, for patients with postpartum haemorrhage. As part of development of our enhanced recovery protocol for elective caesarean patients, we decided to introduce routine administration of TXA, 1g intravenous dose at cord clamping, for all eligible patients, from 1 January 2018.