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Plastic and Reconstructive Surgery Feb 2018Minimizing blood loss during surgery is critical, and many modalities have been used to decrease unwanted surgical bleeding. Among many methods, use of pharmacologic... (Review)
Review
Minimizing blood loss during surgery is critical, and many modalities have been used to decrease unwanted surgical bleeding. Among many methods, use of pharmacologic agents such as antifibrinolytic drugs has been shown to significantly reduce blood loss and the rates of postoperative blood transfusion in many articles. Tranexamic acid is an antifibrinolytic agent that has been widely used in other surgical specialties, especially in cardiac, orthopedic, and trauma surgery. Despite its known benefits, the use of tranexamic acid in plastic surgery is extremely limited, primarily because most plastic surgery procedures do not involve the extent of blood loss that can lead to anemia and the need for blood transfusion, as is common in major orthopedic and cardiac surgery procedures. Nevertheless, there are significant benefits to be gained from the use of antifibrinolytic drugs in the full range of plastic surgery. In this article, the authors introduce the benefits, dosages, and technical considerations of using tranexamic acid in plastic surgery procedures.
Topics: Anemia; Antifibrinolytic Agents; Blood Loss, Surgical; Blood Transfusion; Cardiac Surgical Procedures; Humans; Orthognathic Surgical Procedures; Orthopedic Procedures; Plastic Surgery Procedures; Tranexamic Acid
PubMed: 28938364
DOI: 10.1097/PRS.0000000000003926 -
Wilderness & Environmental Medicine Jun 2017The use of tranexamic acid (TXA) in the treatment of trauma patients was relatively unexplored until the landmark Clinical Randomisation of an Antifibrinolytic in... (Review)
Review
The use of tranexamic acid (TXA) in the treatment of trauma patients was relatively unexplored until the landmark Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial in 2010 demonstrated a reduction in mortality with the use of TXA. Although this trial was a randomized, double-blinded, placebo-controlled study incorporating >20,000 patients, numerous limitations and weaknesses have been described. As a result, additional studies have followed, delineating the potential risks and benefits of TXA administration. A systematic review of the literature to date reveals a mortality benefit of early (ideally <1 hour and no later than 3 hours after injury) TXA administration in the treatment of severely injured trauma patients (systolic blood pressure <90 mm Hg, heart rate >110). Combined with abundant literature showing a reduction in bleeding in elective surgery, the most significant benefit may be administration of TXA before the patient goes into shock. Those trials that failed to show a mortality benefit of TXA in the treatment of hemorrhagic shock acknowledged that most patients received blood products before TXA administration, thus confounding the results. Although the use of prehospital TXA in the severely injured trauma patient will become more clear with the trauma studies currently underway, the current literature supports the use of prehospital TXA in this high-risk population. We recommend considering a 1 g TXA bolus en route to definitive care in high-risk patients and withholding subsequent doses until hyperfibrinolysis is confirmed by thromboelastography.
Topics: Antifibrinolytic Agents; Hemorrhage; Humans; Tranexamic Acid
PubMed: 28601210
DOI: 10.1016/j.wem.2016.12.006 -
Orthopedics 2016Perioperative bleeding and postsurgical hemorrhage are common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic... (Review)
Review
Perioperative bleeding and postsurgical hemorrhage are common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic agent that acts through an antifibrinolytic mechanism to stabilize formed clots and reduce active bleeding. It has been used successfully in orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. Numerous research studies have reported favorable safety and efficacy in orthopedic cases, although there is no universal standard on its administration and its use has not yet become the standard of practice. Reported administration methods often depend on the surgeon's preference, with both topical and intravenous routes showing efficacy. The type and anatomic site of the surgery seem to influence the decision making but also result in conflicting opinions. Reported complication rates with TXA use are low. The incidence of both arterial and venous thromboembolic events, particularly deep venous thrombosis and pulmonary embolism, has not been found to be significantly different with TXA use for healthy patients. The route of administration and dosage do not appear to affect complication rates either. However, data on patients with higher-risk conditions are deficient. In addition, TXA has shown potential to reduce blood loss, transfusion rates and volumes, perioperative hemoglobin change, and hospital-related costs at various degrees among the published studies. Conservation of blood products, reduced laboratory costs, and shorter hospital stays are likely the major factors driving the cost savings associated with TXA use. This article reviews current data supporting the safety, efficacy, and cost-effectiveness of TXA in orthopedic surgery.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Cost-Benefit Analysis; Humans; Orthopedic Procedures; Orthopedics; Postoperative Hemorrhage; Tranexamic Acid
PubMed: 26942474
DOI: 10.3928/01477447-20160301-05 -
Revue Medicale Suisse Sep 2020
Topics: Antifibrinolytic Agents; Hemorrhage; Humans; Intestines; Tranexamic Acid; Treatment Failure
PubMed: 32969620
DOI: No ID Found -
Arthroscopy : the Journal of... Feb 2022Tranexamic acid (TXA) has been used to treat severe bleeding events for nearly 60 years and is on the list of World Health Organization essential medicines. Initially,...
Tranexamic acid (TXA) has been used to treat severe bleeding events for nearly 60 years and is on the list of World Health Organization essential medicines. Initially, it was described to treat heavy menstrual bleeding, but it is now used for a variety of applications. In orthopedic surgery, TXA is commonly used to reduce bleeding after total joint arthroplasty and spine surgery. The use of TXA for joint arthroplasty has been principally endorsed by various orthopedic societies, but they have also criticized a lack of evidence for high-risk patients with a history of pulmonary embolus, vascular stents, stroke, transient ischemic attack, and other cardiac, respiratory, or vascular conditions. TXA may also reduce bleeding complications in arthroscopic surgery, and the findings of recent meta-analyses suggest that intravenous application reduced drainage output and the need for knee joint aspiration and reduced knee swelling. It also had a positive short-term effect on clinical and functional outcomes. However, high risk of bias, low-study quality, and heterogeneity substantially reduced the quality of evidence and the validity of the study conclusions. In my opinion, on the basis of the current evidence, the routine use of TXA in arthroscopic surgery is not recommended.
Topics: Antifibrinolytic Agents; Arthroscopy; Blood Loss, Surgical; Humans; Pulmonary Embolism; Tranexamic Acid
PubMed: 35123721
DOI: 10.1016/j.arthro.2021.11.014 -
Journal of Burn Care & Research :... Mar 2023Acute burn surgery has long been associated with significant intra-operative bleeding. Several techniques were introduced to limit hemorrhage, including tourniquets,...
Acute burn surgery has long been associated with significant intra-operative bleeding. Several techniques were introduced to limit hemorrhage, including tourniquets, tumescent infiltration, and topical agents. To date, no study has comprehensively investigated the available data regarding topical hemostatic agents in burn surgery. A systematic review was performed by two independent reviewers using electronic databases (PubMed, Scopus, Web of Science) from first available to September 10, 2021. Articles were included if they were published in English and described or evaluated topical hemostatic agents used in burn excision and/or grafting. Data were extracted on the agent(s) used, their dosage, mode of delivery, hemostasis outcomes, and complications. The search identified 1982 nonduplicate citations, of which 134 underwent full-text review, and 49 met inclusion criteria. In total, 32 studies incorporated a vasoconstrictor agent, and 28 studies incorporated a procoagulant agent. Four studies incorporated other agents (hydrogen peroxide, tranexamic acid, collagen sheets, and TT-173). The most common vasoconstrictor used was epinephrine, with doses ranging from 1:1000 to 1:1,000,000. The most common procoagulant used was thrombin, with doses ranging from 10 to 1000 IU/ml. Among the comparative studies, outcomes of blood loss were not reported in a consistent manner, therefore meta-analysis could not be performed. The majority of studies (94%) were level of evidence III-V. Determining the optimal topical hemostatic agent is limited by low-quality data and challenges with consistent reporting of intra-operative blood loss. Given the routine use of topical hemostatic agents in burn surgery, high-quality research is essential to determine the optimal agent, dosage, and mode of delivery.
Topics: Humans; Burns; Administration, Topical; Vasoconstrictor Agents; Blood Loss, Surgical; Hemostatics; Antifibrinolytic Agents
PubMed: 36516423
DOI: 10.1093/jbcr/irac185 -
ANZ Journal of Surgery Apr 2020
Topics: Antifibrinolytic Agents; Blood Coagulation; Blood Loss, Surgical; Hemorrhage; Humans; Publications; Surgical Procedures, Operative; Tranexamic Acid
PubMed: 32339435
DOI: 10.1111/ans.15820 -
Nature Reviews. Cardiology Jun 2022
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Humans; Tranexamic Acid
PubMed: 35422522
DOI: 10.1038/s41569-022-00710-z -
International Journal of Obstetric... Nov 2021Antifibrinolytic agents such as tranexamic acid (TXA) inhibit the fibrinolytic pathway and protect blood clots from being degraded, thereby promoting hemostasis. They... (Review)
Review
Antifibrinolytic agents such as tranexamic acid (TXA) inhibit the fibrinolytic pathway and protect blood clots from being degraded, thereby promoting hemostasis. They have been used to reduce blood loss in various settings including obstetrics. Based on current evidence, TXA can be considered as a therapeutic adjunct to control postpartum hemorrhage (PPH) after vaginal and cesarean deliveries, with earlier administration preferred. This strategy has been demonstrated to reduce mortality due to bleeding (but not the incidence of transfusion) in developing countries. On the other hand, the benefit-risk ratio of TXA has not been fully assessed in developed countries which have much lower PPH-related mortality rates and better access to other management modalities. As a proposed prophylactic agent to prevent PPH, the level of evidence is currently insufficient to recommend the routine use of TXA to prevent blood loss after vaginal and cesarean deliveries. The results of large new multicenter studies assessing the impact of TXA on maternal blood loss-related outcomes after cesarean delivery are awaited. While most studies to date have focused on empirical and one-size-fit-all dosing of TXA, more selective and individualized treatment protocols (possibly guided by functional coagulation assays) are needed to pave the way for safer and more effective use of this inexpensive and widely used medication.
Topics: Antifibrinolytic Agents; Cesarean Section; Female; Humans; Incidence; Postpartum Hemorrhage; Pregnancy; Tranexamic Acid
PubMed: 34343820
DOI: 10.1016/j.ijoa.2021.103206 -
Plastic and Reconstructive Surgery Oct 2020
Review
Topics: Antifibrinolytic Agents; Free Tissue Flaps; Humans; Microvessels; Plastic Surgery Procedures; Tranexamic Acid
PubMed: 32649604
DOI: 10.1097/PRS.0000000000007190