Tranexamic Acid Reduces Blood Loss Research Articles

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 May 2013This Month in Adult Urology William D. Steers William D. SteersWilliam D. Steers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.01.095AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 189(5), pp. 1615–1616 References 1 : Surgically induced chronic kidney disease may be associated with a lower risk of progression and mortality than medical chronic kidney disease. J Urol2013; 189: 1649. Link, Google Scholar 2 : Pooled analysis of clinical outcomes with neoadjuvant cisplatin and gemcitabine chemotherapy for muscle invasive bladder cancer. J Urol2013; 189: 1682. Link, Google Scholar 3 : Personalized prostate specific antigen testing using genetic variants may reduce unnecessary prostate biopsies. J Urol2013; 189: 1697. Link, Google Scholar 4 : Tranexamic acid reduces blood loss during percutaneous nephrolithotomy: a prospective randomized controlled study. J Urol2013; 189: 1757. Link, Google Scholar 5 : Day of surgery urine cultures identify urogynecologic patients at increased risk for postoperative urinary tract infection. J Urol2013; 189: 1721. Link, Google Scholar 6 : Urinary functional outcome following radical cystoprostatectomy and ileal neobladder reconstruction in male patients. J Urol2013; 189: 1782. Link, Google Scholar 7 : Prediction of cancer specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: development of an optimized postoperative nomogram using decision curve analysis. J Urol2013; 189: 1662. Link, Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 5May 2013Page: 1615-1616 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information William D. Steers More articles by this author Expand All Advertisement Loading ...

Tranexamic Acid Reduces Blood Loss During Percutaneous Nephrolithotomy: A Prospective Randomized Controlled Study

Bleeding is a significant morbidity associated with percutaneous nephrolithotomy. This study was conducted to evaluate the safety and efficacy of the antifibrinolytic agent tranexamic acid in reducing blood loss in patients undergoing percutaneous nephrolithotomy. A total of 200 patients undergoing percutaneous nephrolithotomy were randomized into 2 equal groups. Patients in the tranexamic acid group received 1 gm tranexamic acid at induction followed by 3 oral doses of 500 mg during 24 hours, while those in the control group did not receive tranexamic acid. The patient demographics and clinical data of the 2 groups were compared. Baseline patient demographics were similar in both groups. Mean hemoglobin decrease in the tranexamic acid group was significantly lower than that of the control group (1.39 vs 2.31 gm/dl, p <0.0001). Mean operative time in the tranexamic acid group was significantly lower than that in the control group (48.3 vs 70.8 minutes, p <0.0001). The stone clearance rate was similar in both groups (91% vs 82%, p = 0.06). The blood transfusion rate was lower in the tranexamic acid group (2% vs 11%, p = 0.018), as was the complication rate (33% vs 59%, p <0.0001). Two patients with a solitary functioning kidney in the tranexamic acid group required ureteral stenting to relieve anuria due to clot obstruction. The use of tranexamic acid in percutaneous nephrolithotomy is safe, and is associated with reduced blood loss and a lower complication rate.

O201 HIGH DOSE TRANEXAMIC ACID REDUCES BLOOD LOSS IN POST-PARTUM HAEMORRHAGE

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S331-S331 Free communication (oral) presentations O201 HIGH DOSE TRANEXAMIC ACID REDUCES BLOOD LOSS IN POST-PARTUM HAEMORRHAGE A.-S. Ducloy-Bouthors, A.-S. Ducloy-BouthorsSearch for more papers by this authorA. Duhamel, A. DuhamelSearch for more papers by this authorB. Jude, B. JudeSearch for more papers by this authorF. Broisin, F. BroisinSearch for more papers by this authorC. Huissoud, C. HuissoudSearch for more papers by this authorL. Mandelbrot, L. MandelbrotSearch for more papers by this authorH. Keita-Meyer, H. Keita-MeyerSearch for more papers by this authorN. Tillouche, N. TilloucheSearch for more papers by this authorS. Fontaine, S. FontaineSearch for more papers by this authorS. Susen, S. SusenSearch for more papers by this author A.-S. Ducloy-Bouthors, A.-S. Ducloy-BouthorsSearch for more papers by this authorA. Duhamel, A. DuhamelSearch for more papers by this authorB. Jude, B. JudeSearch for more papers by this authorF. Broisin, F. BroisinSearch for more papers by this authorC. Huissoud, C. HuissoudSearch for more papers by this authorL. Mandelbrot, L. MandelbrotSearch for more papers by this authorH. Keita-Meyer, H. Keita-MeyerSearch for more papers by this authorN. Tillouche, N. TilloucheSearch for more papers by this authorS. Fontaine, S. FontaineSearch for more papers by this authorS. Susen, S. SusenSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60631-6Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S331-S331 RelatedInformation

Tranexamic acid reduces blood loss and financial cost in primary total hip and knee replacement surgery

Blood conservation strategies have been developed to diminish blood transfusion requirements in patients undergoing hip or knee replacement surgery. Tranexamic acid (TA) is an inexpensive antifibrinolytic agent that is little used in orthopaedic surgery due to the absence of standardised optimal administration regimens. Blood transfusion requirements and induced costs can be diminished by using TA according to a standardised administration protocol in a large cohort of patients. A retrospective study in patients who underwent joint replacement surgery by a single surgeon compared two periods, 2007-2008 without TA and 2008-2009 with TA. The 451 included patients underwent primary unilateral hip (n=261) or knee (n=190) replacement for osteoarthritis. Standardised protocols were used for surgery and anaesthesia. TA was given intravenously in a dose of 1g (i.e., 15mg/kg) at incision and wound closure then at 6-hour intervals for 24 hours. Blood losses were estimated using the Mercuriali formula. Haemoglobin on D -1 and D 8 and the number and volume of autologous (from intra-operative blood salvage) and homologous blood transfusions were collected. The costs of TA, blood salvage systems, and homologous blood units were recorded. The two groups were compared using Student's test, Wilcoxon's test, and the Khi(2) test, and multivariate analyses were performed. Values of p less than 0.05 were considered significant. TA use was associated with a significant decrease in the homologous blood transfusion rate (from 4% to 0%) and with 38% and 68% reductions in the rate and volume of autologous blood transfusions, respectively, due to a 34% decrease in blood losses. After taking into account the additional cost of TA therapy, there was a 25% reduction in the cost of the blood conservation strategy. TA therapy abolished the need for homologous blood transfusion and induced no notable side effects. TA therapy decreased the amount of blood salvaged intra-operatively, allowing a more rational use of the blood salvage system and decreasing the cost of anaesthesia. IV. Retrospective case-control.

Can Topical Application of Tranexamic Acid Reduce Blood Loss in Thoracic Surgery? A Prospective Randomised Double Blind Investigation

The systemic or topical use of antifibrinolytic agents is effective in reducing postoperative bleeding and blood product transfusion in cardiac surgery. We sought to study the effect of the topical application of tranexamic acid into the pleural space to reduce postoperative bleeding after lung surgery. This was a prospective randomised double blind placebo controlled investigation. From May-2010 to February-2012, 89-patients, scheduled for pulmonary resection, were randomly allocated to one of the two study groups. Group-A received 5 g of tranexamic-acid in 100 ml of saline solution. Group-B received 100 ml of saline solution as placebo. The blood loss in the first 12-h was significantly less in group-A. The same trend was observed in the first 24-h but without reaching a true statistical significance. The mean volume of blood transfusion was statistically lower in group-A. The analysis between post-operative haemoglobin concentration, haematocrit, platelet-count, international-normalised-ratio, fibrinogen and partial-thromboplastin-time of both groups was not statistically significant. In our experience, the topical use of tranexamic-acid after lung surgery reduces postoperative bleeding and blood transfusion volume. The topical administration of tranexamic-acid is safe without increasing the risk of post-operative complications related to pharmacological side-effects.

Temporary clamping of drain combined with tranexamic acid reduce blood loss after total knee arthroplasty: a prospective randomized controlled trial

BackgroundTotal knee arthroplasty (TKA) is associated with a significant blood loss. Several methods have been reported to reduce postoperative blood loss and avoid homologous blood transfusions. In this study, we investigated the efficacy of temporary clamping of the drain either or not in combination with tranexamic acid administration for controlling blood loss after TKA.MethodsThe prospective, randomized, and double-blinded study was conducted in our institute. Total of 240 patients, who diagnosed primary osteoarthritis and scheduled to undergo a primary TKA,,were randomized into one of the four groups: Group A or control group, the drain was not clamped and the patient received a placebo; Group B, the drain was not clamped and the patient received tranexamic acid; Group C, the drain was clamped and the patient received a placebo; and Group D, the drain was clamped and the patient received tranexamic acid. The volume of drained blood at 48 hours postoperatively, the decreasing of hemoglobin (Hb) level at 12 hours postoperatively and the number of patients requiring blood transfusion were recorded and compared.ResultsThe mean postoperative volumes of drained blood and the amount of blood transfusion in the three study groups (group B, C and D) were significantly lower than those in the control group (p < 0.05), which group D had the lowest values. Furthermore, group B and D could maintain the Hb level better than group A and C (p < 0.001). In terms of blood transfusions rate, although the patients in group D required transfusion less than group A and C (p < 0.05), there was no significant difference between group D and B. The relative risks for transfusion requirement were 4.4 for group A, 1.4 for group B and 3.0 for group C when compared to group D.ConclusionsThe clamping of drain combined with tranexamic acid administration could reduce postoperative blood loss and blood transfusion after TKA, significantly greater than using tranexamic acid or drain clamping alone.Trial registrationClinicalTrials.gov NCT01449552

Intra-operative tranexamic acid reduces blood loss and length of hospital stay after unilateral knee replacement surgery

Intra-operative tranexamic acid reduces blood loss and length of hospital stay after unilateral knee replacement surgery

Oral tranexamic acid reduces blood loss in total knee replacement arthroplasty

Background Tranexamic acid is a potent antifibrinolytic, which has shown efficacy in reducing blood loss in total knee arthroplasty when administered intravenously. We performed a double-blind randomized controlled trial of oral tranexamic acid in total knee arthroplasty to assess the blood sparing effect of this preparation. We asked whether the oral formulation of tranexamic acid had significant benefit in the prevention of blood loss in total knee replacement arthroplasty. Methods Forty-six patients undergoing unilateral total knee replacement arthroplasty for osteoarthritis were randomized to a treatment or control group (26 active tranexamic acid and 20 placebo). The treatment arm received three doses of 1500 mg encapsulated oral tranexamic acid at 8-hour intervals preoperatively, with the third dose occurring within 2 hours of surgery, and a fourth dose 6 hours postoperatively. The control arm received an identically encapsulated nonactive formulation at the same dosing intervals. Outcome measures were hemoglobin and hematocrit taken 24 hours postoperatively and total blood loss in wound drains at 24 hours. A record was made of any transfusion events occurring in either group as well as any thromboembolic complications. A follow-up phone call at 3 months was made to identify any late thromboembolic events. Results There was a significant reduction in blood drained at 24 hours (248 mL; P=0.34) as well as a significant decrease in the fall of both hemoglobin (P=0.02) and hematocrit (P=0.03) within the tranexamic acid group. No significant difference in transfusion events was found. Only one case of deep venous thrombosis occurred, and this was in the placebo group. Conclusions Our study showed that oral tranexamic acid is efficacious as a blood sparing medication in total knee replacement arthroplasty and appears to be safe in a selected population. Level of Evidence Therapeutic level 1.

Hematological profile and transfusion requirement during hysteroscopic myomectomy: A comparative study between oxytocin and tranexamic acid infusion

BackgroundOxytocin is uterotonic drug reducing uterine blood loss. Tranexamic acid reduce blood loss in various settings. Data on their efficacy are limited in gynecological hysteroscopy. This study was conducted to compare the effect of oxytocin versus tranexamic acid on hematological profile and transfusion requirement during hysteroscopic myomectomy (HM).MethodsFifty women scheduled for HM were randomly assigned into two groups. Ttranexamic acid (TXA) or oxytocin (OXY). TXA was injected with 15 mg kg−1 of tranexamic acid, followed by infusion of 10 mg kg−1 h−1. In OXY, 10 Unites of oxytocin were added to 500 mL saline (400 mU/min) during surgery. Spinal anesthesia was induced for all patients. Hemodynamics, hematological data, number of transfusions, serum sodium and central venous pressure were measured.ResultsTXA showed significant decrease of heart rate 30 and 45 min and 1 and 2 h when compared with OXY. Post operative Hb and Hct showed significant decrease (p < 0.001) in TXA compared with OXY. CVP in TXA displayed significant increase (p < 0.001) 15 min after spinal blockade and 30 min, 45 min, 1 h and 2 h. Serum sodium showed significant decrease in TXA (p < 0.001) compared with OXY nearly throughout study period.ConclusionUse of oxytocin during HM was accompanied with stable hemodynamics, hematological profile and less transfusion requirement compared with the use of tranexamic acid.

Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery

A retrospective review of consecutive adult patients undergoing scoliosis correction surgery was performed to compare the effects of aprotinin and tranexamic acid in blood conservation and to define a comprehensive blood conservation strategy for such surgery. Medical records of all patients who underwent scoliosis correction surgery in this unit between January 2003 and December 2008 were reviewed. The patients were divided into three cohorts: group 1 receiving no antifibrinolytics, group 2 aprotinin and group 3 tranexamic acid. Information was collected regarding number of vertebral levels fused, pre- and post-operative haemoglobin, intra-operative blood loss and peri-operative autologous and allogenic blood transfusion performed. Aprotinin was used in 28 patients (38%), tranexamic acid in 26 (36%), while 19 (26%) received no antifibrinolytics. 21 patients had anterior surgery, 34 patients had posterior surgery and 18 had combined anterior and posterior procedures. Mean blood loss in the patients who received aprotinin and tranexamic acid was 710 and 738ml, respectively. This was significantly less than the patients receiving no antifibrinolytics (972ml, p=0.037). Blood transfusion was required in only two patients undergoing anterior correction surgery. Aprotinin and tranexamic acid reduce blood loss in adult spinal deformity correction surgery. With aprotinin being unavailable for clinical use, we recommend the use of tranexamic acid along with other blood conservation measures for adult spinal deformity correction surgery.

Tranexamic acid for postpartum bleeding

The randomized controlled trial of the effect of tranexamic acid (TXA) on blood loss during and after cesarean delivery reported by Movafegh et al. [1] in this issue of IJGO is clinically important for two reasons. First, because hemorrhage is a serious complication of cesarean delivery and their data show that bleeding can be reduced by TXA administration; and second, because it raises the possibility that TXA could contribute importantly to reducing the unacceptable high maternal mortality from postpartum hemorrhage. However, the trial by Movafegh et al. [1] cannot be considered in isolation. Four other trials of TXA used at cesarean delivery have been published to date [2–5]. When blood loss data from Movafegh et al. are pooled with data from previous trials, it is clear that there is strong evidence that TXA reduces blood loss during and after cesarean delivery (Fig. 1). But is this important? At this stage, we cannot be completely sure because the trials to date have not been large enough to assess the effect of TXA on outcomes that matter to women. However, there is every reason to expect that a reduction in bleeding would reduce maternal morbidity. Severe anemia following postpartum bleeding is an important cause of maternal morbidity and is likely to makemore women vulnerable to fatal postpartum hemorrhage (PPH) in future pregnancies. Reducing operative blood loss would also reduce the risks and costs associated with blood transfusion. Blood is a scarce resource but even when blood is available, it can transmit potentially fatal viral infections. Economic evaluation has shown that giving TXA to reduce bleeding in elective surgery would be lifesaving in Sub-Saharan Africa where there is a shortage of blood, because more blood will be available for thosewhoneed it [6]. In those countrieswhere blood is readily available,

Tranexamic acid reduces blood loss in simultaneous bilateral total knee arthroplasty: a randomized control trial

Total knee arthroplasty (TKA) is a common procedure, and bilateral TKA ensures cost efficiency. Bilateral TKA is associated with increased requirement of blood transfusion (BT). BT is associated with hazards, therefore be avoided. Tranexamic acid (TXA) has been suggested to reduce the BT, and the use of TXA in bilateral TKA appears sparse in literature. This study aimed at assessing the effect of TXA in such patients. This prospective randomized controlled trial evaluated the use of TXA in bilateral TKA. Pre- and postoperative hemoglobin (Hb) and packed cell volume (PCV), blood loss and BT, hospital stay, and the cost of TXA compared to blood transfusion were the measured variables. 175 patients (n = 88 TXA, n = 87 CTRL) completed the study. The patients in the control (CTRL) group on an average received 0.3 units and 0.07 in TXA group. The average blood loss in the TXA group was significantly less than the CTRL (P < 0.0001). There was no significant difference in the perioperative complications, hospital stay in the two groups. The use of TXA reduces the postoperative blood loss. The allogenic BT requirement in patients undergoing bilateral TKA is significantly decreased. The routine use of this drug is cost-effective and reduces postoperative blood loss.

Tranexamic Acid Reduces Blood Loss After Off-Pump Coronary Surgery

Bleeding and the need for allogeneic transfusions are still problems after off-pump coronary artery bypass grafting (OPCAB) surgery. We therefore evaluated the effects of an antifibrinolytic, tranexamic acid, on postoperative bleeding and transfusion requirements in patients undergoing OPCAB surgery. Two hundred thirty-one consecutive patients scheduled for elective OPCAB were enrolled in the study. Using a double-blind method, the patients were randomly assigned to receive either tranexamic acid (bolus 1 g before surgical incision followed by an infusion of 400 mg/h during surgery; n = 116) or a placebo (infusion equivalent volume of saline solution; n = 115). The primary outcome was 24-hour postoperative chest tube drainage. Allogeneic transfusion, mortality, major morbidities, and resource utilization were also recorded. In comparison with the placebo group, the patients receiving tranexamic acid had a significant reduction in chest tube drainage at 6 hours (270 ± 118 mL vs 416 ± 179 mL, P < 0.001) and 24 hours (654 ± 224 mL vs 891 ± 295 mL, P < 0.001). There was also a significant reduction in allogeneic red blood cell transfusions (47 vs 31.9%, P = 0.019) and fresh frozen plasma (29.6% vs 17.2%, P = 0.027) transfusions. There were no differences in mortality, morbidity, and resource utilization between the 2 groups. Tranexamic acid reduces postoperative chest tube drainage and the requirement for allogeneic transfusion in off-pump coronary surgery.

Tranexamic Acid Reduces Blood Loss and Blood Transfusion after TKA: A Prospective Randomized Controlled Trial

TKA may be associated with considerable blood loss, and transfusion carries substantial risk of immunologic reaction and disease transmission. Blood transfusion also involves additional cost, therefore a reduction in its use is important. Several methods reportedly reduce postoperative blood loss and avoid homologous blood transfusion with traditional TKA approaches, but it is unclear these reductions apply to a minimally invasive technique. We asked whether tranexamic acid administration could reduce blood loss and blood transfusion requirements after TKA. Between March 2008 and May 2008, we enrolled 100 patients with primary osteoarthritis undergoing a unilateral cemented TKA in a prospective, randomized, double-blind study. Patients were randomized into one of two groups: the control group received a placebo and the study group received tranexamic acid intravenously (10 mg/kg) 10 minutes before inflation of the tourniquet and 3 hours postoperatively and orally (250 mg/capsule; two capsules three times daily) for 5 days. We measured volume of drained blood 48 hours postoperatively, decrease in hemoglobin levels 12 hours postoperatively, amount of blood transfused, and number of patients requiring allogenic blood transfusion. The minimum followup was 6 months (mean, 10.4 months; range, 6-12 months). Mean (± SD) postoperative volume of drained blood was lower in the group receiving tranexamic acid (727.50 ± 234 mL) than in control subjects (1208.77 ± 421 mL). The mean hemoglobin decrease 12 hours postoperatively was lower in patients receiving tranexamic acid (2.12 ± 0.64 g/dL) than in control subjects (3.33 ± 0.88 g/dL). The amount of blood transfused and number of patients requiring blood transfusion were lower in patients receiving tranexamic acid than in control subjects. Tranexamic acid reduced postoperative blood loss after TKA, as reflected in reduction in the number of blood transfusions. We did not observe any change in symptomatic thromboembolic phenomenon. Level 1, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

0.11a Tranexamic acid reduces blood loss in post-partum haemorrhage

0.11a Tranexamic acid reduces blood loss in post-partum haemorrhage

High-dose tranexamic acid reduces blood loss in postpartum haemorrhage

IntroductionOur purpose in conducting this study was to determine whether administration of high-dose tranexamic acid (TA) at the time of diagnosis of postpartum haemorrhage (PPH) could reduce blood loss.MethodsThis was a randomised, controlled, multicentred, open-label trial. Women with PPH >800 mL following vaginal delivery were randomly assigned to receive TA (loading dose 4 g over 1 hour, then infusion of 1 g/hour over 6 hours) or not. In both groups, packed red blood cells (PRBCs) and colloids could be used according to French guidelines. The use of additional procoagulant treatments was permitted only in cases involving intractable bleeding. The primary objective was to assess the efficacy of TA in the reduction of blood loss in women with PPH, and the secondary objectives were the effect of TA on PPH duration, anaemia, transfusion and the need for invasive procedures.ResultsA total of 144 women fully completed the protocol (72 in each group). Blood loss between enrolment and 6 hours later was significantly lower in the TA group than in the control group (median, 173 mL; first to third quartiles, 59 to 377) than in controls (221 mL; first to third quartiles 105 to 564) (P = 0.041). In the TA group, bleeding duration was shorter and progression to severe PPH and PRBC transfusion was less frequent than in controls (P < 0.03). Invasive procedures were performed in four women in the TA group and in seven controls (P = NS). PPH stopped after only uterotonics and PRBC transfusion in 93% of women in the TA group versus 79% of controls (P = 0.016). Mild, transient adverse manifestations occurred more often in the TA group than in the control group (P = 0.03).ConclusionsThis study is the first to demonstrate that high-dose TA can reduce blood loss and maternal morbidity in women with PPH. Although the study was not adequately powered to address safety issues, the observed side effects were mild and transient. A larger international study is needed to investigate whether TA can decrease the need for invasive procedures and reduce maternal morbidity in women with PPH.Trial registrationControlled Trials ISRCTN09968140.

Tranexamic Acid Is Associated With Less Blood Transfusion in Off-Pump Coronary Artery Bypass Graft Surgery: A Systematic Review and Meta-analysis

Tranexamic acid reduces blood loss and transfusion in on-pump coronary artery bypass graft (CABG) surgery. Compared with on-pump, off-pump surgery is associated with less blood loss and transfusion. Therefore, tranexamic acid may be less effective for off-pump surgery, and its safety profile may be different in this setting. The aim of this study was to determine the efficacy and safety of tranexamic acid for off-pump CABG surgery. Systematic review and meta-analysis. University of Edinburgh. The administration of tranexamic acid. A systematic review of randomized controlled trials administering tranexamic acid to patients undergoing off-pump CABG surgery. A meta-analysis of 24-hour blood loss, postoperative allogeneic transfusion, and thromboembolic events. Eight trials were identified. The lack of appropriate data limited the meta-analysis on blood loss. Tranexamic acid significantly reduced the overall risk of allogeneic blood component transfusion (risk ratio = 0.47; 95% confidence intervals, 0.33-0.66; p < 0.0001) and packed red blood cell transfusions (risk ratio = 0.51; 95% CI, 0.36-0.71; p = 0.0001). No association was found between tranexamic acid and myocardial infarction, stroke, or pulmonary embolism. Population sizes of meta-analyses ranged from 466 to 544. Tranexamic acid reduces blood transfusion after off-pump surgery. Although no association with adverse events was found, the population sample size was too small to detect rare but clinically significant adverse events. A well-designed randomized controlled trial with an appropriate sample size is required to confirm tranexamic acid effectiveness and safety in off-pump CABG surgery.

One Intraoperative Dose of Tranexamic Acid for Patients Having Primary Hip or Knee Arthroplasty

Multiple studies suggest tranexamic acid reduces blood loss and red cell transfusions in patients undergoing THA or TKA. However, many of the dosing schedules in these studies are not ideally suited for routine application. We asked whether one 20-mg per kg intraoperative dose of tranexamic acid in patients having primary THA or TKA would (1) decrease perioperative blood loss and red cell transfusion rates and (2) be a cost-effective protocol. We retrospectively reviewed the records of 234 patients operated on from April 1 to June 30, 2007 (before our study protocol) and 259 patients from April 1 to June 30, 2008 with the single-dose protocol. We then compared change in hemoglobin, transfusion rates, hemoglobin at discharge, hospital length of stay, and complications between the two groups. No other routine patient care practices or blood conservation program strategies were altered during this time. We found a reduction in the decrease in hemoglobin in 2008 compared with 2007 for THA and TKA (39 from 46 g/L and 36 from 45 g/L, respectively),which led to a reduction in transfusion rates (3.6% from 13.5% and 2.0% from 13.4%, respectively) and higher hemoglobin levels at discharge [corrected].There were no recorded major adverse events associated with the introduction of this protocol. One 20-mg per kg intraoperative dose of tranexamic acid reduced the perioperative decrease in hemoglobin and red blood cell transfusion rates in patients having TKA and THA compared with those of a similar cohort of patients in whom the protocol was not used. This weight increment dosing facilitated pharmacy drug preparation, led to minimal dose variability and wastage, and resulted in a substantial estimated cost savings. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Tranexamic acid reduces blood loss in postpartum haemorrhage

Postpartum haemorrhage (PPH) is a leading cause of maternal death. Present guidelines for PPH management focus on uterotonic treatments, while the potential efficacy of antifibrinolytic drugs has been poorly explored in this indication.

Tranexamic Acid Reduces Blood Loss in Off-Pump Coronary Artery Bypass Surgery

This study was designed to evaluate the hemostatic effect of tranexamic acid in off-pump coronary artery bypass surgery. A prospective, randomized, double-blind, placebo-controlled study. The Department of Anesthesiology and Cardiac Surgery, Medical Sciences University. One hundred eight patients undergoing off-pump coronary artery bypass surgery were enrolled into the study. Eight patients were withdrawn, and 100 patients were divided into 2 groups. Fifty patients received tranexamic acid (bolus 1 g before skin incision and followed by maintenance dose of 400 mg/h during surgery), and 50 patients received saline. Hematologic parameters, volume of blood loss, blood transfusion, and other clinical data were recorded throughout the perioperative period. Twenty-four-hour postoperative blood loss was significantly less in the tranexamic acid group compared with the control group (471 +/- 182 v 844 +/- 303). Patients in the tranexamic acid group received significantly less allogeneic blood (8 v 31 units). Bleeding and hemorrhagic complications and the consequent need for allogeneic transfusion are still major problems after off-pump coronary artery bypass surgery. Tranexamic acid appears to be effective in reducing postoperative bleeding and the need for allogeneic blood products.