Tranexamic Group Research Articles

Efficacy of a vaginal suppository formulation prepared with Acacia arabica (Lam.) Willd. gum and Cinnamomum camphora (L.) J. Presl. in heavy menstrual bleeding analyzed using a machine learning technique.

Objective: This study aims to determine the efficacy of the Acacia arabica (Lam.) Willd. and Cinnamomum camphora (L.) J. Presl. vaginal suppository in addressing heavy menstrual bleeding (HMB) and their impact on participants' health-related quality of life (HRQoL) analyzed using machine learning algorithms. Method: A total of 62 participants were enrolled in a double-dummy, single-center study. They were randomly assigned to either the suppository group (SG), receiving a formulation prepared with Acacia arabica gum (Gond Babul) and camphor from Cinnamomum camphora (Kafoor) through two vaginal suppositories (each weighing 3,500mg) for 7days at bedtime along with oral placebo capsules, or the tranexamic group (TG), receiving oral tranexamic acid (500mg) twice a day for 5 days and two placebo vaginal suppositories during menstruation at bedtime for three consecutive menstrual cycles. The primary outcome was the pictorial blood loss assessment chart (PBLAC) for HMB, and secondary outcomes included hemoglobin level and SF-36 HRQoL questionnaire scores. Additionally, machine learning algorithms such as k-nearest neighbor (KNN), AdaBoost (AB), naive Bayes (NB), and random forest (RF) classifiers were employed for analysis. Results: In the SG and TG, the mean PBLAC score decreased from 635.322 ± 504.23 to 67.70 ± 22.37 and 512.93 ± 283.57 to 97.96 ± 39.25, respectively, at post-intervention (TF3), demonstrating a statistically significant difference (p < 0.001). A higher percentage of participants in the SG achieved normal menstrual blood loss compared to the TG (93.5% vs 74.2%). The SG showed a considerable improvement in total SF-36 scores (73.56%) compared to the TG (65.65%), with a statistically significant difference (p < 0.001). Additionally, no serious adverse events were reported in either group. Notably, machine learning algorithms, particularly AB and KNN, demonstrated the highest accuracy within cross-validation models for both primary and secondary outcomes. Conclusion: The A. arabica and C. camphora vaginal suppository is effective, cost-effective, and safe in controlling HMB. This botanical vaginal suppository provides a novel and innovative alternative to traditional interventions, demonstrating promise as an effective management approach for HMB.

Intravenous tranexamic acid vs. sublingual misoprostol in high-risk women for postpartum haemorrhage following cesarean delivery; a randomised clinical trial

ObjectiveThis study compares the effectiveness of administering sublingual misoprostol combined with oxytocin to that of IV tranexamic acid combined with oxytocin to reduce intra and post-operative blood loss in high-risk women for postpartum haemorrhage (PPH) following cesarean section (CS).MethodsAbout 315 high-risk pregnant women undergoing CS participated in this trial. They were randomly assigned into three groups; tranexamic group, misoprostol group, and control group, according to the medication given in the operative theatre. All patients received oxytocin intraoperatively. They were assessed regarding intraoperative blood loss, the incidence of PPH, and the reduction in haemoglobin and hematocrit values.ResultsBoth tranexamic and misoprostol groups had similar results in reducing intra and post-operative blood loss. However, the reduction in haemoglobin and hematocrit were significantly lower in tranexamic and misoprostol groups compared to the control group (-0.78 ± 0.57 vs. -0.83 ± 0.52 vs. -1.32 ± 0.57 gm/dl, P < 0.001 and − 3.05 ± 1.28 vs. -3.06 ± 1.13 vs. -4.94 ± 1.82%, P < 0.001 respectively). In addition, the estimated blood loss was significantly lower in the tranexamic and misoprostol groups compared to the control group (641.6 ± 271.9 vs. 617.9 ± 207.4 vs. 1002.4 ± 340.7 ml, P < 0.001).ConclusionBoth tranexamic acid and misoprostol are equally capable of reducing blood loss, but the results were significantly better compared to using oxytocin alone in high-risk patients.Clinical Trial RegistrationRegistered at www.clinicaltrials.govon07/10/2019 with registration number NCT04117243.

Effect of Tranexamic Acid on Coagulation Profile in Patients Undergoing Brain Tumour Resection Surgery

Introduction; The majority of researchers currently believe that the haemostatic anomalies in brain tumour resection patients undergoing surgery are caused by hyperfibrinolysis, either primary or subsequent to a condition of disseminated intravascular coagulation. This Study explored the changes in haemostatic profile occurring during surgery for primary brain tumours and effect on Tranexamic acid on coagulogram. Aims &amp; objectives:To study effect of tranexamic acid on coagulation profile in brain tumour resection patients. Materials &amp; methods: Patients of either sex, aged 18-65 years were randomly allocated to either group - the study group and the control group (30 patients in each group) using computer generated random numbers in sealed envelopes. The investigator was present during the procedure for data collection purpose only and was not involved in the conduct of anaesthesia. Blood samples were collected preoperatively, 6hrs postoperatively and 24hrs postoperatively for coagulogram; fibrinogen levels; platelet count; D-dimer levels Results: In our study we found that there were no significant differences in PT, INR, aPTT, D- dimer preoperatively and at 6 and 24 hrs postoperatively. However, fibrinogen levels increased in tranexamic group and significantly decreased in saline group as compared to preoperatively. Conclusion: Tranexamic acid prevented decrease in levels of fibrinogen and even increased levels fibrinogen significantly during the operative and postoperative period in brain tumour resection surgery. Keywords: Coagulation profile, Meningioma

Tranexamic acid for the prevention of postpartum hemorrhage and decreasing blood loss after vaginal delivery in high-risky parturient: A double-blind randomized controlled trial

Background and objective: The purpose of this study was to examine the effectiveness of Tranexamic acid administered in the third stage of labor to reduce vaginal blood loss and prevent postpartum hemorrhage in women with high-risk factors for postpartum Hemorrhage. Methods: A double-blind randomized placebo-controlled trial with two parallel groups was conducted in women scheduled to undergo vaginal delivery at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq. The women were randomly assigned to receive tranexamic acid (97 women) or placebo (99 women) immediately after fetal delivery in the third stage of labor. The vaginal blood loss and the time from fetal to placental delivery were measured. Results: The mean blood loss in the placebo group (Group 1) was 354.5 gram, which was considerably greater than the mean blood loss in the tranexamic group (Group 2), which was 284.4 gram. The incidence of postpartum hemorrhage (blood loss of ≥500 ml.) and (blood loss of ≥250 ml.) was significantly higher in G1 than G2. The length of the third stage of labor lasted 10.28 minutes in G1, which was longer than in G2, which lasted 7.82 minutes. Oxytocin was given to both groups as an active management of the third stage of labor. Conclusion: In this single-center study, women with risk factors for postpartum hemorrhage who received tranexamic acid had lower postpartum blood loss and a shorter time for placental delivery than those women who received placebo. Larger multicenter randomized clinical trials are needed to generalize these findings.

Compare Mean Blood Loss in Patients Undergoing Tonsillectomy with and without Tranexamic Acid

Introduction: Tonsillectomy is one of the most common surgeries in ENT department and bleeding is one of the most serious complications related to tonsillectomy. Tranexamic acid is a plasminogen inhibitor which has been successfully used to control bleeding in a variety of surgeries. Objective: The objective of this study is to compare mean blood loss in patients undergoing tonsillectomy with and without Tranexamic acid. Study Design: Randomized controlled trail Setting: This study was carried out at the Department of ENT Jinnah Hospital Lahore Sample Technique: Non-probability, consecutive sampling Study Duration: The study was done in 6 months after the approval of synopsis [March 8, 2017 till September 8, 2017] Materials and Methods: Sixty Patients were randomly divided into 2 equal groups using lottery method in group-A and group-B. Patients in Group-A received tranexamic acid after induction intravenously as 15 mg/kg (single bolus dose) over 10 min. Patients in group B were served as control group and they did not receive tranexamic acid before tonsillectomy. All surgeries were carried out by a single consultant having more than 5 years of experience after post-graduation. Blood loss was measured by researcher himself as per operational definition. Results: The mean age of cases in Tranexamic group was 19.70 ± 12.12 years while in control group was 21.53 ± 15.44 years. In Tranexamic acid group there were 18(60%) male and 12(40%) female cases while in control group there were 21(70%) male and 9(30%) female cases. The mean blood loss in Tranexamic acid group were 30.27 ±8.85 ml and in control group was 67.67 ± 14.91 ml. The mean blood loss was significantly less in Tranexamic acid group as compared to control group, p-value &lt; 0.05. Conclusion: The mean blood loos in cases with Tranexamic acid were significantly lower as compared to control group. So in future every patient selected for tonsillectomy must be given TXA to reduce the blood transfusion and related complications of the patients. Keywords: ENT, Tonsillectomy, Bleeding, blood transfusion, Tranexamic acid

Intravenous Tranexamic acid versus placebo during Caesarian section: A comparative study.

Objectives:To evaluate the effectiveness of Tranexamic Acid in preventing postpartum hemorrhage against placebo in high-risk women undergoing cesarean section.Methods:A double-blinded placebo-controlled comparative trial was conducted at the Obstetrics and Gynecology Department of Nishtar Hospital for one year, from 15th June 2020 to 15th June 2021. A total of 60 women who were at high risk of postpartum hemorrhage and had to undergo elective cesarean sections were included in the study. Among them, initial 30 patients were administered Tranexamic Acid before skin incision whereas later 30 were treated as the placebo group. These women were then observed for blood loss during surgery and within 24 hrs. after surgery and any postoperative complications such as thromboembolic events, the need for additional uterotonic agents, and blood transfusions.Results:Out of 60 women, 30 were placed in each group. The groups had no significant difference in terms of baseline data and post-partum hemorrhage-associated risk factors (p>0.05). However, the occurrence rate of primary post-partum hemorrhage (blood loss greater than 1000 ml) was significantly less in a tranexamic acid group than the placebo group (16.6% vs 60%, respectively, p<0.01). Similarly, the requirement of additional uterotonic agents (13.3% vs 43.3%, respectively) and the need for blood transfusion (6.0% vs 23.3%, respectively) was lower in a tranexamic group than in the placebo group.Conclusion:The study highlighted the significance of tranexamic acid in controlling post-partum hemorrhages, the requirement of additional uterotonic agents, improving post-partum hemoglobin, and the need for blood transfusion.

Is There Any Clinical Benefit for Peri-operative Administration of Tranexamic Acid for Patients Undergoing Percutaneous Nephrolithotomy? A Systematic Review and Meta-analysis.

The purpose of current systematic review and meta-analysis is to determine the efficacy and safety of the administration of tranexamic acid in patients undergoing PCNL. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. This systematic review and meta-analysis includes randomized comparative prospective studies. The primary endpoints were the hemoglobin drop, the bleeding complications, and the transfusion rate. Secondary endpoints included the operative time, the stone-free rate, the hospital stay, and the overall complications. Two-thousand five-hundred six publications were screened for this study. Six RCTs (1262 patients) were included in the meta-analysis. As for our primary endpoints, the hemoglobin drop was lower in the tranexamic group than in the control group, with mean difference (MD) of - 0.65 (p < 0.0001); the bleeding complications were rarer in the tranexamic group than in the control group, with an odds ratio (OR) of 0.32 (p < 0.00001); and the transfusion rate was lower in the tranexamic group with an OR of 0.34 (p = 0.0007). Concerning the secondary endpoints, the operative time was less in the tranexamic group with an MD of - 10.39 (p < 0.0001), the meta-analysis of the stone-free status data showed no statistical significance between the two groups with an OR of 1.58 (p = 0.09), the hospital stay was significantly less in the tranexamic group with an MD of - 1.38 (p = 0.005), and the overall complications were rarer in the tranexamic group than in the control group with an OR of 0.34 (p = 0.12). The peri-operative use of TA contributes to the reduction of blood loss, bleeding complications, mean operative time, and hospital stay. The use of TA seemed to be safe and well tolerated in patients undergoing PCNL. PROSPERO protocol (Registration number: CRD42019122818).

Effect of Intraveous Tranexamic Acid and Sublingual Misoprostol on Reducing Post Cesarean Section Bleeding

Background and Aim: Cesarean section rates are rising around the globe and are considered as the major surgical procedure conducted on females. Cesarean-related hemorrhage contributes to increasing mortality rates around the world. Due to the rise in cesarean rate and its associated complications, post-cesarean severe bleeding without proper management is a major concern. Therefore, the present study aimed to assess the intravenous tranexamic acid (TA) and sublingual misoprostol effect on reducing post-cesarean section bleeding. Materials and Methods: This cross-sectional study was conducted on 146 term pregnant women undergoing emergency or elective cesarean section at the Department of Obstetrics and Gynaecology, Qazi Hussain Ahmad Medical Complex, Noshehra during the period from 7th September 2020 to 6th March 2021. All the participants were randomly categorized into two groups. Each group comprised of 73 participants whereas groups I and II received sublingual misoprostol (600 µg) and 500 mg intravenous tranexamic at card clamping respectively. Both groups were administrated for postoperative 48 hours and blood loss was measured. The packed cell volume and postoperative Hb were evaluated and compared with initial values before surgery. The need for blood transfusion, drug side effects, and additional uterotonics was evaluated. SPSS version 20 was used for data analysis. Results: The mean age of groups I and II were 28.32±4.73 and 28.17±4.83 years whereas the overall mean age was 28.25±4.78years. A higher reduction of hemoglobin level was observed in an intravenous tranexamic group compared to the sublingual group (-2.39±0.93 versus -2.09±1.28g/dL) (p=0.001). Moreover, the intravenous tranexamic group had significantly higher blood suction and gauze usage than sublingual misoprostol (256.73± 83.25versus 189.68± 102.4 cubic centimeter (cc) and 4.59±1.43 versus 3.19±1.27) for a significant value of 0.001. The decrease in mean blood pressure during the cesarean section procedure was significant in intravenous tranexamic than sublingual misoprostol (p=0.001). Conclusion: Our study concluded that sublingual misoprostol significantly reduced total bleeding when compared to tranexamic acid. Furthermore, hemodynamic variables were stabilized more in the misoprostol group than in the tranexamic acid group. Keywords: Cesarean Section Bleeding; Intravenous Tranexamic acid; Sublingual misoprostol.

Effect of tranexamic acid on blood loss, coagulation profile, and quality of surgical field in intracranial meningioma resection: A prospective randomized, double-blind, placebo-controlled study.

Background: Resection of intracranial meningioma has been associated with significant blood loss. Providing a clear surgical field and maintaining hemodynamic stability are the major goals of anesthesia during meningioma surgery. Tranexamic acid has been used to reduce blood loss in various neurosurgical settings with limited evidence in literature. A randomized, double-blind, and placebo-controlled trial was conducted to evaluate the efficacy of tranexamic acid on blood loss, coagulation profile, and quality of surgical field during resection of intracranial meningioma.Methods: Thirty patients aged 18–65 years undergoing elective meningioma resection surgery were given either tranexamic acid or placebo (0.9% saline), tranexamic acid at a loading dose of 20 mg/kg, and infusion of 1 mg/kg/h during surgery. The intraoperative blood loss, coagulation profile, and the surgical field using Likert scale were assessed.Results: The patients in tranexamic group had significantly decreased intraoperative blood loss compared to the placebo group (616.42 ± 393.42 ml vs. 1150.02 ± 416.1 ml) (P = 0.02). The quality of the surgical field was better in the tranexamic group (median score 4 vs. 2 on Likert Scale) (P < 0.001). Patients in tranexamic group had an improved coagulation profile and decreased blood transfusion requirement (p=0.016). The blood collected in closed suction drain in 24 h postsurgery was less in the tranexamic acid group compared to placebo group (84.7 ± 50.4 ml vs. 127.6 ± 62.2 ml) (P = 0.047).Conclusion: Tranexamic acid bolus followed by infusion reduces perioperative blood loss by 46.43% and blood transfusion requirement with improved surgical field and coagulation profile in patients undergoing intracranial meningioma resection surgery.

Hemostatic and histopathological effects of local mineral zeolite and tranexamic acid in experimental femoral artery bleeding model

Background/Aim: This study aimed to evaluate the effect of local zeolite and tranexamic acid application on hemostasis duration and histopathological changes in the experimental bleeding model, created by puncturing femoral arteries in rats. Material and Methods: A total of 36 Sprague Dawley female rats weighing an average of 240 ± 20 g were used in the study. The three main study groups were the zeolite, zeolite+tranexamic acid, and control groups. Each group was sacrificed on the seventh and fourteenth days of the study, using subgroups for histopathological findings. After piercing the femoral artery of each rat, one gram of the material assigned to the group was applied to the bleeding site after which a 100gram scale weight was placed on the site for 30 SEC intervals, during which temperature was measured. The same sequence of procedures was repeated for the control group, using only standard compression. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) 15 statistical software. Significance was evaluated at the level of p&lt; 0.05. Results: The bleeding stop time of the control group was significantly longer than the zeolite and zeolite+tranexamic groups (p&lt; 0.05). There was no statistically significant difference between the zeolite and zeolite+tranexamic groups' bleeding stop times (p&gt; 0.05) or between the mean wound temperatures of the control and zeolite+tranexamic acid groups when bleeding stopped (p&gt; 0.05). Conclusions: The effectiveness of the zeolite group and zeolite+tranexamic acid mixture is more than the control group in ensuring bleeding control. Their efficacy has been clearly observed in providing hemostasis. In addition, it has been determined that zeolite tranexamic acid mixture causes less exothermic reaction than zeolite group. We believe that this new formula should be developed and used to guide new studies.

The Effect of Tranexamic Acid in Patients with Traumatic Brain Injury

Background: Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage secondary to TBI is associated with a high risk of coagulopathy, which leads to increasing risk of hemorrhage growth, poor functional outcome and higher mortality rate. The hemostatic drug tranexamic acid with anti-fibrinolytic activity is usually used in patients with trauma. Because of its potential role in reducing hematoma size, which prevents secondary TBI, it has been considered a possible therapy to improve the clinical outcome in patients with TBI. Objective: To evaluate the effect of tranexamic acid on volume changes of intracranial bleeding in patients with TBI admitted to Emergency Department at Mansoura University Emergency Hospital. Patients and methods: This is prospective interventional study randomized controlled trials carried out on 100 patients with TBI and admitted at Mansoura University Emergency Hospital; a level 1 trauma center with about 250,000 visits and 25000 trauma cases admission per year, through one year from October 2019 to October 2020. Results: The clinical outcome was better in tranexamic group as it was associated significantly with improved motor GCS and less need for neurosurgical intervention. The secondary outcome was much better in tranexamic acid group which was associated with less hospital LOS, better GOS and less mortality rate. Conclusion: Early administration of tranexamic acid (within 3 hours of injury onset) can limit the extent of bleeding before the hemorrhagic volume may become dangerous, while late administration can be useless.

The Effect of Tranexamic Acid in Patients with Traumatic Brain Injury

Background: Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage secondary to TBI is associated with a high risk of coagulopathy, which leads to increasing risk of hemorrhage growth, poor functional outcome and higher mortality rate. The hemostatic drug tranexamic acid with anti-fibrinolytic activity is usually used in patients with trauma. Because of its potential role in reducing hematoma size, which prevents secondary TBI, it has been considered a possible therapy to improve the clinical outcome in patients with TBI. Objective: To evaluate the effect of tranexamic acid on volume changes of intracranial bleeding in patients with TBI admitted to Emergency Department at Mansoura University Emergency Hospital. Patients and methods: This is prospective interventional study randomized controlled trials carried out on 100 patients with TBI and admitted at Mansoura University Emergency Hospital; a level 1 trauma center with about 250,000 visits and 25000 trauma cases admission per year, through one year from October 2019 to October 2020. Results: The clinical outcome was better in tranexamic group as it was associated significantly with improved motor GCS and less need for neurosurgical intervention. The secondary outcome was much better in tranexamic acid group which was associated with less hospital LOS, better GOS and less mortality rate. Conclusion: Early administration of tranexamic acid (within 3 hours of injury onset) can limit the extent of bleeding before the hemorrhagic volume may become dangerous, while late administration can be useless.

The role of tranexamic acid in decreasing intraoperative and postoperative blood loss in patients undergoing total hip replacement

We investigated 60 patients undergoing Total hip arthropasty in a prospective, interventional and randomized study. Here, patients were divided alternatively into two groups of 30 patients each, in group A and group B. Group A will receive intravenous infusion of tranexamic acid at dose of 15mg/kg and same will be given 3hrs after the first dose, while in group B no drug will be given. Direct and Indirect blood loss is calculated. Hence, direct blood loss is less (p value=0.000) in tranexamic group compared to control group i.e988 vs 1295 ml. Indirect blood loss, is also significantly lower in patients receiving drug as compared to placebo group. i.e (1018.87±160.76 vs 1335.2±194.4 ml)None of the patient in our study in either group developed any complication. In conclusion, we found Tranexamic acid, administrated before surgical incision, to be efficient in reducing Direct and Indirect blood loss during Total hip arthroplasty.Thus, we conclude that Tranexamic acid administration is an effective, safe and cheap method for reducing total blood loss, drain output, and hemoglobin drop without any increase in thromboembolic complications.

The effect of routine intraoperative tranexamic acid in elective cesarean section

Objective: To find the role of routine intraoperative tranexamic acid infusion at elective cesarean section.Study Design: Randomized case control studyStudy Setting: AlKarkh Maternity Hospital, Baghdad Iraq.Methodology: A total of 110 term pregnant women presenting in to our obstetric unit during the period between May, 2019 and January, 2020 and who were offered elective cesarean section, were randomly assigned to either receiving intraoperative tranexamic acid 1 gram in 100 milliliter saline infusion or saline infusion. Demographic characteristics were collected for all participants. Ten cases (1 in the tranexamic and 9 in the control group) were excluded as there were associated extensions of uterine incision in order to reduce confounders. A comparison of the outcomes of the two groups was done, it included an intraoperative blood loss determinator, a postoperative blood loss determinator, and an overall loss risk assessment. The corresponding parameters were the intraoperative surgical soaked packs count, average reduction in packed red blood cell volume 24 hour postoperatively, occurrance of postpartum hemorrhage and the overall need to receive blood transfusion. In term of associated side effects of receiving tranexamic acid, we sought whether there was any significant change in the blood pressure as well as the incidence of developing fever. Exclusion criterias were the contraindication to receive tranexamic acid assessed by referral to internist physician specialist review.Results: Confounding factors including patient’s age, parity and gestation length were taken into consideration and found to be similar between the two groups studied. There was a significant difference between the postpartum decline of packed red blood cell volume (PCV) (pvalue 0.001), with mean postpartum PCV in tranexamic group 35.2% versus 33.3% in the saline infusion group. 21.9% of women in the control group had decline of PCV exceeding 10% of preoperative value, versus only 3.3% in studied group. We found that the number of cesareans where additional packs got required was significantly less in tranexamic group (15.3% vs.22%, p=0.001), no cases in the tranexamic group did receive a blood transfusion vs. 7.3% in the saline group (pvalue 0.03).Slightly higher incidence of hypotensive episodes in the tranexamic group (27.1% vs. 12.2%, pvalue 0.07).Fever was found to be more likely following cesarean in the control group (34.1% vs. 18.6%, pvalue 0.06).Conclusion: The use of tranexamic infusion with inducton of anaesthesia at time of elective cesarean section is associated with less risk of intraoperative blood loss improving postoperative packed red blood cell volume decline significantly.

Tranexamic Acid Is Associated With Improved Operative Field in Orthognathic Surgery

In the past, both tranexamic acid and dexmedetomidine have been used separately to decrease intraoperative blood loss during orthognathic surgery. However, their combined use in the same setting has never been prospectively evaluated. The present study was conducted to evaluate the effect of tranexamic acid on operative field visibility and blood loss during orthognathic surgery after dexmedetomidine-induced hypotensive anesthesia. The present prospective, randomized clinical trial included patients who had undergone orthognathic surgery under general anesthesia. The patients were divided into 2 groups. The dexmedetomidine and tranexamic (DT) group received an intravenous bolus of tranexamic acid (15mg/kg) and intravenous dexmedetomidine (0.25 to 0.7μg/kg/hr) as maintenance infusion. The dexmedetomidine (DS) group received only intravenous dexmedetomidine at the same dosage. All the patients received a bolus dose of intravenous dexmedetomidine (1μg/kg) before the start of anesthesia induction. The operating surgeon rated the quality of the surgical visual field every 15minutes using the Fromme ordinal scale. Intraoperative blood loss was estimated using the modified gross formula. The operating surgeon's satisfaction was assessed using a Likert scale. Data were analyzed using SPSS, version 22.0 (IBM Corp, Armonk, NY). Kolmogorov-Smirnov tests were used to assess the normality of the measured data, and categorical variables were analyzed using the χ2 or Fischer exact test. The study sample included 36 patients, with a mean age of 23.67±11.298years in the DS group and 20.28±3.286years in the DT group. Of the patients in the DS and DT groups, 66.66 and 61.11% were male, respectively. No statistically significant differences were found in the baseline characteristics between the 2 treatment groups. The surgeon reported a significantly better surgical visual field in the DT group compared with that in the DS group (P=.001). Also, the intraoperative blood loss significantly less in the DT group (231.11±137.64mL vs 360.17±187.86mL; P=.025). Tranexamic acid improved surgical field visibility and reduced intraoperative blood loss when administered in conjunction with dexmedetomidine during orthognathic surgery under controlled hypotensive anesthesia.

Topical tranexamic acid in cemented primary total knee arthroplasty without tourniquet: a prospective randomized study.

Tranexamic acid (TXA) has been shown to be effective in reducing blood loss after total knee replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use, to reduce blood loss after primary total knee replacement without tourniquet, and to compare these outcomes with a control group that did not receive tranexamic acid. This is a prospective, randomized study to assess the effect of a 2-g topical tranexamic acid in 50mL physiological saline solution in total knee replacement without tourniquet and drain. Primary outcomes were total blood loss. Secondary outcomes were hemoglobin and hematocrit level, hemoglobin and hematocrit drop, transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events. Preoperative and intraoperative data were similar between the two groups. The mean total blood loss was 620mL in the topical tranexamic acid group and 1094mL in the control group with significant differences (p = 0.001), which meant 43% reduction in total blood loss. The hemoglobin and hematocrit postoperative value was significantly higher in the topical tranexamic acid group than in the control group (p = 0.002). Transfusion rates were 0% in the topical tranexamic group and 4.3% in the control group. The length of stay was significantly lower in the topical tranexamic acid group (p = 0.01). There were no DVT or PE in any group. A single dose of 2-g TXA in 50mL topical administration significantly reduces blood loss and improves postoperative blood chemistries in patients undergoing unilateral primary cemented TKA without tourniquet and drain compared to a control group, without increasing the risk of thromboembolic complications.

Efficacy of tranexamic acid in reducing blood loss, blood and blood products requirements in Cesarian sections for patients with placenta accreta

BackgroundPlacenta accreta is an obstetric emergency and the main cause of maternal morbidity and mortality due to the associated bleeding and coagulopathy. Tranexamic acid has been widely used to decrease blood loss in trauma patients and patients with postpartum hemorrhage. We aimed at studying the effect of tranexamic acid in reducing blood loss and blood transfusion in patients with placenta accreta.MethodsIn a double-blinded randomized controlled study, 46 patients were recruited and divided into two groups, Group A is the tranexamic group where patients received 10 mg/kg tranexamic acid after cord clamping and continued on tranexamic infusion 10 mg/kg/h till the end of the surgery. Group B is the placebo where patients received normal saline instead. Primary outcome was the amount of intraoperative blood loss, and other outcomes included the number of blood and blood products transfused intraoperative and in the first 24 h postoperative, the immediate postoperative Hb level, platelet count, and coagulation profile. Data were collected, coded, tabulated, and then analyzed using Minitab® 16.1.0 statistics software package. Variables were presented as mean and standard deviation and analyzed using unpaired t test. Any difference with p value < 0.05 was considered statistically significant.ResultsAmount of intraoperative blood loss was significantly less in the tranexamic group 2232 ± 1204 ml compared to the placebo group 3405 ± 1193 ml (p value 0.002), and patients in the tranexamic group received less units of packed red blood cells, fresh frozen plasma, and platelets compared to those in the placebo group (4.2 ± 1.9 vs 6.1 ± 2.2 with p value 0.003, 3.4 ± 1.3 vs 4.2 ± 1.2 with P value 0.036 and 4.8 ± 2.1 vs 6.2 ± 2.4 with p value 0.041, respectively). There was no statistically significant difference in the first postoperative Hb level, platelet count, and coagulation profile between the two groups; however, the amount of blood and products transfused in the first 24 h postoperative were significantly less in the tranexamic groupConclusionTranexamic acid infusion was effective in reducing intraoperative blood loss and intraoperative and postoperative blood and blood products’ transfusion.

Tranexamic acid in open aortic aneurysm surgery: a randomised clinical trial

BackgroundBleeding and transfusions affect mortality in aortic surgery. Although tranexamic acid significantly reduced bleeding in multiple settings, its role in major vascular surgery was never studied. The aim of this study was to determine if tranexamic acid reduces blood loss in open abdominal aortic aneurysm (AAA) surgery. MethodsA total of 100 patients undergoing elective open AAA repair were randomised to receive tranexamic acid (a loading dose of 500 mg and a continuous infusion of 250 mg h−1) or placebo. The primary outcome was intraoperative blood loss, and the secondary outcomes were the number of patients receiving red blood cells, occurrence of thromboembolic events, and mortality. Data were analysed using the intention-to-treat principle. ResultsFifty patients were randomised into each group. Median (inter-quartile range) intraoperative blood loss was 400 (300–1050) ml in the tranexamic acid group vs 500 (360–1000) ml in the placebo group (P=0.44). Transfusion rate was seven/50 (14%) in the tranexamic group vs 12/50 (24%) in the placebo group (P=0.20). No thrombosis was recorded. In a post hoc analysis, postoperative blood loss was reduced in the tranexamic group both at 4 h (60 [40–80] ml vs 100 [60–140] ml, P<0.001) and 24 h (180 [120–275] vs 275 [190–395] ml, P=0.003) after surgery. At 1 yr, three patients were dead, all in the placebo group (P=0.24) and all after 28 days. ConclusionsTranexamic acid did not reduce intraoperative blood loss or blood transfusions in open AAA repair, although it may reduce postoperative blood loss without increasing adverse effects. Clinical trial registrationNCT02335359.

Impact of Perioperative Tranexamic Acid on Risk of Bleeding in Total Hip and Knee Arthroplasty: An Analysis of the Epcat II Data

IntroductionTranexamic acid (TXA) is an anti-fibrinolytic agent that has been increasingly used in various surgeries to reduce bleeding complications. Recently, the use of TXA has extended to orthopedic surgeries, and in some centres it is routinely used during total hip and knee arthroplasties. The majority of data supporting this practice is from meta-analyses, as the trials evaluating TXA in this population consist of small numbers.The EPCATII study was a large, multicenter, double blind randomized trial following total hip and knee arthroplasty, evaluating thromboprophylaxis for venous thromboembolic disease. Data on intraoperative TXA use was collected, noting that the decision to use TXA was made by the attending surgical team. We analyzed the data from the EPCATII study looking at the effect of TXA use on estimated blood loss (EBL) during surgery.MethodsThe EPCATII study was a randomized controlled trial comparing aspirin to rivaroxaban for extended prophylaxis for venous thromboembolism in patients undergoing hip or knee arthroplasty. EPCATII participants were excluded from this analysis if either use of TXA or EBL were missing. We assessed whether use of TXA was associated with the primary outcome, EBL as reported by the study centre. A matched propensity score analysis was performed to account for confounding as TXA was given based on physician or site preference.ResultsAfter excluding 535 participants with missing values for TXA use or EBL during surgery, 2,889 participants were included in the analysis. 1,386 (47.98%) of participants did not receive TXA while 1,503 (52.02%) participants did receive TXA. The mean age in the group that did not receive TXA was 62.13 years, whereas the mean age in the group that did receive TXA was 63.20 years. More participants in the tranexamic group had a history of a major bleed (2.5% vs 0.9%, p=0.001). There were no differences in the remainder of the baseline characteristics. In the unadjusted analysis, participants who did not receive TXA had a mean EBL of 292.87 mL compared to 327.68 mL in the group that did receive TXA (p<0.001). A propensity score for use of TXA was estimated including the covariates age, sex, type of surgery, length of surgery, preoperative hemoglobin and platelet levels, site, body mass index, history of DVT/PE, history of cancer, smoking status, history of surgery and history of major bleed, with significant predictors being surgery type, length of surgery, smoking status and study site. 513 participants who received TXA were 1:1 propensity score matched to participants not receiving TXA. There was no significant difference in EBL between the two groups, as shown in Figure 1 (322.6 mL vs 341.5 mL, p=0.24).ConclusionsThe use of TXA in hip and knee arthroplasty did not have a significant effect on EBL in the EPCATII study population, after propensity score matching. This is contrary to recent evidence showing a benefit of TXA in this population. Variables such as surgery length, surgery type, smoking status and study site appear to be predictors of usage of TXA, and as such, these findings may be partially explained by a physician's identification of higher risk patients in the decision to use TXA. Further studies are needed to determine which patients may benefit most from intraoperative TXA. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The Effectiveness of Intravenous Tranexamic Acid on Blood Loss and Surgical Time During Endoscopic Sinus Surgery: A Systematic Review

Objective: To review the effectiveness of intravenous tranexamic acid in reduction of blood loss, surgical time and field visualization among patients who underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). &#x0D; Methods:&#x0D; Data Sources: MEDLINE (PubMed), EMBASE, ScienceDirect, HERDIN, and the Cochrane Library.&#x0D; Eligibility Criteria: Randomized controlled trials (RCT) between 2005-2014 that evaluated the effects of tranexamic acid or placebo in patients undergoing ESS for CRS.&#x0D; Appraisal and Synthesis Methods: Articles were selected by 2 independent reviewers and methodological quality was blindly evaluated using a Jadad scale. Data were compiled in tables for analysis of outcome measures (estimated blood loss, length of surgery and intraoperative surgical field visualization).&#x0D; Results: Two trials were included in the study, enrolling 128 patients. One arm of the study had been given tranexamic acid while the other arm was given placebo (saline solution). Results varied for both studies. The summary of the observed difference for blood loss had a standardized mean difference of -51.20 (CI95 [-59.44, -42.95]) showing that the blood loss in milliliters was less in the tranexamic group compared to saline solution. The summary of the observed difference in surgical time had a standardized mean difference of -19.32 (CI95 [-24.21, -14.43]) showing that the surgical time in minutes was shorter in the tranexamic group compared to saline solution. The secondary outcome on surgical field visualization was not pooled together because the studies used different measurement scales.&#x0D; Limitations: The most important weaknesses of the 2 included studies were the differences in dose of tranexamic acid, scales of measurement of field visibility and age groups of the patients. &#x0D; Conclusion: Tranexamic acid reduced blood loss and shortened surgical time after ESS among patients with CRS. However, the additional benefit of tranexamic acid for better field visualization was not clear. Adverse effects were not considered in this study, however results support the use of intravenous tranexamic acid intraoperatively as an option for ESS with blood loss as a concern. Further randomized clinical trials and an update on the systematic review will strengthen the evidence on the effectivity of tranexamic acid for ESS.&#x0D; Keywords: tranexamic acid, endoscopic sinus surgery, bleeding time