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American Journal of Respiratory and... Sep 2023
Topics: Humans; Vitamins; Thiamine; Shock, Septic; Pilot Projects; Ascorbic Acid; Vitamin A; Vitamin K
PubMed: 37490623
DOI: 10.1164/rccm.202307-1140ED -
Advances in Kidney Disease and Health Jul 2023Metabolic and respiratory acid-base disorders are common in individuals with liver disease and cirrhosis. The most common disorder is respiratory alkalosis, which may be... (Review)
Review
Metabolic and respiratory acid-base disorders are common in individuals with liver disease and cirrhosis. The most common disorder is respiratory alkalosis, which may be related to dyspnea or respiratory stimulation. Primary metabolic disorders are less common. Although the liver plays a role in metabolism of amino acids and generation of acid from dietary sources, it does not play a role in the regulation of pH. Instead, metabolic disorders may arise from alterations in normal metabolism or from medications, particularly diuretics and osmotic laxatives, used in the treatment of these complex patients. Understanding the mechanistic underpinnings of these disorders can aid in the management of individuals with liver disease in the hospital and in outpatient settings.
Topics: Humans; Liver Cirrhosis; Alkalosis, Respiratory; Amino Acids; Antifibrinolytic Agents
PubMed: 37657880
DOI: 10.1053/j.akdh.2023.04.002 -
British Journal of Anaesthesia Jun 2024Viscoelastic haemostatic testing (VHT) has been used to determine hyperfibrinolysis and hypofibrinolysis. When modified by addition of tissue plasminogen activator...
Viscoelastic haemostatic testing (VHT) has been used to determine hyperfibrinolysis and hypofibrinolysis. When modified by addition of tissue plasminogen activator (tPA), VHT has been suggested to assess responses to antifibrinolytic therapy and to estimate the concentration of tranexamic acid in patients undergoing cardiac surgery. Despite some evidence that tPA-modified VHT might allow individualisation of antifibrinolytic therapy, further studies are warranted to prove its clinical benefit for postsurgical bleeding, transfusion of blood products, and thromboembolic events.
Topics: Humans; Antifibrinolytic Agents; Postoperative Hemorrhage; Precision Medicine; Thrombelastography; Tissue Plasminogen Activator; Tranexamic Acid; Treatment Outcome
PubMed: 38729743
DOI: 10.1016/j.bja.2024.03.020 -
International Journal of Molecular... Dec 2023Selenocysteine (Sec) was discovered as the 21st genetically encoded amino acid. In nature, site-directed incorporation of Sec into proteins requires specialized... (Review)
Review
Selenocysteine (Sec) was discovered as the 21st genetically encoded amino acid. In nature, site-directed incorporation of Sec into proteins requires specialized biosynthesis and recoding machinery that evolved distinctly in bacteria compared to archaea and eukaryotes. Many organisms, including higher plants and most fungi, lack the Sec-decoding trait. We review the discovery of Sec and its role in redox enzymes that are essential to human health and important targets in disease. We highlight recent genetic code expansion efforts to engineer site-directed incorporation of Sec in bacteria and yeast. We also review methods to produce selenoproteins with 21 or more amino acids and approaches to delivering recombinant selenoproteins to mammalian cells as new applications for selenoproteins in synthetic biology.
Topics: Humans; Animals; Selenoproteins; Amino Acids; Antifibrinolytic Agents; Archaea; Saccharomyces cerevisiae; Selenocysteine; Mammals
PubMed: 38203392
DOI: 10.3390/ijms25010223 -
Annals of Medicine and Surgery (2012) Oct 2023Intraoperative and postoperative bleeding is considered one of the most common risks in rhytidectomy. Recently, the use of antifibrinolytic agents in facial plastic and... (Review)
Review
BACKGROUND
Intraoperative and postoperative bleeding is considered one of the most common risks in rhytidectomy. Recently, the use of antifibrinolytic agents in facial plastic and reconstructive surgeries has been evaluated, but their use in rhytidectomy remains a topic of ongoing discussion. Tranexamic acid (TXA) is an antifibrinolytic agent that prevents enzymatic degradation of the fibrin clot by blocking the conversion of plasminogen to plasmin, improves platelet function, and has a direct anti-inflammatory effect. This review covers pertinent literature to elucidate whether the use of TXA in rhytidectomy confers intraoperative and postoperative benefits.
METHODS
A systematic literature search was conducted in online databases: PubMed, Google Scholar, Cochrane, Scopus, and Web of Science for all articles on the topic of TXA in facelift published up to and including June, 2023 using the following terms: "TXA," "tranexamic acid," "plastic surgery," "aesthetic surgery," "facelift," "rhytidectomy". They were either searched individually or in combination. All relevant original research articles, of any study design were included and narratively discussed in this review. Studies not carried out in humans and studies centred on the use of TXA in other specialties were excluded. English Language was included.
RESULTS
Eight articles were reviewed in this paper. Through these articles, the authors provided in detail the possible beneficial effects of TXA in facelift patients in evaluating several clinical outcomes: intraoperative blood loss, postoperative drain output, postoperative oedema, ecchymosis, operative time, and surgical field quality.
CONCLUSION
Although there is still a lack of information on TXA in facelift patients, we are not able to deny the beneficial effects of TXA on this topic. Therefore, further investigations including prospective, case-controlled multi-institutional studies comparing routes of delivery should be performed until reaching, at the end, an evidence-based guideline providing a clear protocol in terms of the administration and dosage of TXA in facelift.
PubMed: 37811108
DOI: 10.1097/MS9.0000000000001224 -
Thrombosis Journal Sep 2023Tranexamic acid (TXA) is a widely used antifibrinolytic agent that has been used since the 1960's to reduce blood loss in various conditions. TXA is a lysine analogue... (Review)
Review
Tranexamic acid (TXA) is a widely used antifibrinolytic agent that has been used since the 1960's to reduce blood loss in various conditions. TXA is a lysine analogue that competes for the lysine binding sites in plasminogen and tissue-type plasminogen activator impairing its interaction with the exposed lysine residues on the fibrin surface. The presence of TXA therefore, impairs the plasminogen and tPA engagement and subsequent plasmin generation on the fibrin surface, protecting fibrin clot from proteolytic degradation. However, critical lysine binding sites for plasmin(ogen) also exist on other proteins and on various cell-surface receptors allowing plasmin to exert potent effects on other targets that are unrelated to classical fibrinolysis, notably in relation to immunity and inflammation. Indeed, TXA was reported to significantly reduce post-surgical infection rates in patients after cardiac surgery unrelated to its haemostatic effects. This has provided an impetus to consider TXA in other indications beyond inhibition of fibrinolysis. While there is extensive literature on the optimal dosage of TXA to reduce bleeding rates and transfusion needs, it remains to be determined if these dosages also apply to blocking the non-canonical effects of plasmin.
PubMed: 37700271
DOI: 10.1186/s12959-023-00540-0 -
The New England Journal of Medicine Jul 2023
Topics: Female; Humans; Pregnancy; Antifibrinolytic Agents; Postpartum Hemorrhage; Tranexamic Acid; Combined Modality Therapy; Early Diagnosis
PubMed: 37407006
DOI: 10.1056/NEJMe2305857 -
Current Neurology and Neuroscience... Nov 2023Hereditary bleeding disorders may have a wide variety of clinical presentations ranging from mild mucosal and joint bleeding to severe central nervous system (CNS)... (Review)
Review
PURPOSE OF REVIEW
Hereditary bleeding disorders may have a wide variety of clinical presentations ranging from mild mucosal and joint bleeding to severe central nervous system (CNS) bleeding, of which intracranial hemorrhage (ICH) is the most dreaded complication. In this review, we will discuss the pathophysiology of specific hereditary bleeding disorders, namely, hemophilia A, hemophilia B, and von Willebrand disease (vWD); their clinical manifestations with a particular emphasis on neurological complications; a brief overview of management strategies pertaining to neurological complications; and a review of literature guiding treatment strategies.
RECENT FINDINGS
ICH is the most significant cause of morbidity and mortality in patients with hemophilia. Adequate control of bleeding with the administration of specific factors or blood products, identification of risk factors for bleeding, and maintaining optimal coagulant activity are essential for appropriately managing CNS bleeding complications in these patients. The administration of specific recombinant factors is tailored to a patient's pharmacokinetics and steady-state levels. During acute bleeding episodes, initial factor activity should be maintained between 80 and 100%. Availability of monoclonal antibody Emicizumab has revolutionized prophylactic therapies in patients with hemophilia. Management of ICH in patients with vWD involves using plasma-derived factor concentrates, recombinant von Willebrand factor, and supportive antifibrinolytic agents individualized to the type and severity of vWD. Hemophilia and vWD are the most common hereditary bleeding disorders that can predispose patients to life-threatening CNS complications-intracranial bleeds, intraspinal bleeding, and peripheral nerve syndromes. Early care coordination with a hematologist can help develop an effective prophylactic regimen to avoid life-threatening bleeding complications in these patients. Further research is needed to evaluate using emicizumab as an on-demand treatment option for acute bleeding episodes in patients with hemophilia.
Topics: Humans; Hemophilia A; von Willebrand Diseases; Hemorrhage; Intracranial Hemorrhages; Central Nervous System
PubMed: 37864642
DOI: 10.1007/s11910-023-01313-y -
Seminars in Thrombosis and Hemostasis Jul 2024Tranexamic acid (TXA) is an important antifibrinolytic agent, which inhibits plasminogen activation and fibrinolysis. Several controlled randomized trials have... (Review)
Review
Tranexamic acid (TXA) is an important antifibrinolytic agent, which inhibits plasminogen activation and fibrinolysis. Several controlled randomized trials have investigated the role of TXA in preventing or decreasing blood loss across different surgical interventions or medical conditions characterized by excessive bleeding, consistently documenting its effectiveness and safety. Although the first clinical use of TXA dates back to more than 60 years ago, TXA remains the focus of intense research. This narrative review summarizes the more recent results and indications on the clinical use of TXA.
Topics: Tranexamic Acid; Humans; Hemostatics; Antifibrinolytic Agents
PubMed: 38335995
DOI: 10.1055/s-0044-1779632 -
Journal of Thrombosis and Haemostasis :... Mar 2024Tranexamic acid (TXA) is an antifibrinolytic agent originally developed for the management of bleeding in the setting of postpartum hemorrhage (PPH). Over the last 15... (Review)
Review
Tranexamic acid (TXA) is an antifibrinolytic agent originally developed for the management of bleeding in the setting of postpartum hemorrhage (PPH). Over the last 15 years, there has been accumulating evidence on the use of TXA for the treatment of active bleeding in a variety of clinical contexts. Clinical trials have shown that the efficacy and safety of TXA for the treatment of bleeding differ according to the clinical context in which it is being administered, timing of administration, and dose. Early administration is important for efficacy, particularly in trauma and PPH. Further studies are needed to understand the mechanisms by which TXA provides benefit, optimal modes of administration and dosing, and its effect in some clinical settings, such as spontaneous intracerebral hemorrhage. There is no evidence that TXA increases the risk of thrombotic events in patients with major bleeding overall. However, there is evidence of increased risk of venous thrombosis in patients with gastrointestinal bleeding. There is also evidence of increased risk of seizures with the use of higher doses. This review summarizes the current evidence for the use of TXA for patients with active bleeding and highlights the importance of generating evidence of efficacy and safety of hemostatic interventions specific to the bleeding contexts-as findings from 1 clinical setting may not be generalizable to other contexts-and that of individual patient assessment for bleeding, thrombotic, and other risks, as well as important logistical and other practical considerations, to optimize care and outcomes in these settings.
Topics: Pregnancy; Female; Humans; Tranexamic Acid; Antifibrinolytic Agents; Postpartum Hemorrhage; Thrombosis; Gastrointestinal Hemorrhage
PubMed: 37827378
DOI: 10.1016/j.jtha.2023.10.001