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International Journal of Gynaecology... Feb 2017The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear.
OBJECTIVES
To evaluate the antihemorrhagic effect of prophylactic TA treatment in major benign uterine surgery.
SEARCH STRATEGY
PubMed, Embase, Cochrane Library, and Web of Science were searched from 1980 to 2015 without language restriction using search terms related to major uterine surgery combined with TA.
SELECTION CRITERIA
Randomized controlled trials comparing prophylactic TA with placebo or no intervention in women undergoing elective major benign uterine surgery.
DATA COLLECTION AND ANALYSIS
Basic information and outcomes were collected and meta-analyses performed.
MAIN RESULTS
Sixteen trials were included, with five trials considered to have an overall low risk of bias. In cesarean delivery, TA significantly reduced intraoperative bleeding (mean -136 mL, 95% confidence interval [CI] -189 to -83), blood loss of more than 1000 mL (relative risk 0.38, 95% CI 0.18-0.81), and blood transfusion (relative risk 0.32, 95% CI 0.17-0.59). In abdominal myomectomy, TA also significantly reduced intraoperative bleeding (mean -251 mL, 95% CI -391 to -110).
CONCLUSIONS
Prophylactic TA treatment significantly reduced operative bleeding in women undergoing elective cesarean delivery or abdominal myomectomy. Additional randomized trials with low risk of bias are needed.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Blood Transfusion; Cesarean Section; Female; Gynecologic Surgical Procedures; Humans; Pregnancy; Randomized Controlled Trials as Topic; Tranexamic Acid
PubMed: 28099726
DOI: 10.1002/ijgo.12047 -
American Journal of Obstetrics and... Jun 1981Lippes Loop and Multiload intrauterine contraceptive devices (IUDs) were fitted with silicone rubber sleeves which either did not contain any compound (blank) or...
Lippes Loop and Multiload intrauterine contraceptive devices (IUDs) were fitted with silicone rubber sleeves which either did not contain any compound (blank) or contained the antifibrinolytic agent, epsilon-aminocaproic acid (EACA. In vitro measurements showed that the antifibrinolytic agent was released from the sleeves for a period of 20 days. After insertion into women, the blank Lippes Loop IUDs and Multiload IUDs as well as copper-containing Multiload IUDs caused a significant increase in blood loss beginning with the first menstrual cycle after insertion. The enhanced blood loss was generally retained during subsequent menstrual cycles. By contrast, the menstrual blood loss induced by IUDs containing EACA sleeves was not significantly greater during the first menstrual cycle after insertion that the preinsertion levels. When no more EACA was released, menstrual blood loss increased to approximately the same level as that observed with the blank and copper IUDs. Thus, release of EACA from an IUD retains menstrual blood loss at approximately physiologic levels. These results encourage the development of IUDs that are capable of releasing antifirbrinolytic agents over a long period so that the antimenorrhagic effect is maintained.
Topics: Aminocaproic Acid; Antifibrinolytic Agents; Female; Humans; Intrauterine Devices; Menorrhagia
PubMed: 7246636
DOI: 10.1016/0002-9378(81)90282-9 -
Journal of Perioperative Practice Nov 2019
Review
Topics: Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Humans; Preoperative Period; Tranexamic Acid
PubMed: 30650055
DOI: 10.1177/1750458919825812 -
Seminars in Thrombosis and Hemostasis Mar 2020Plasmin generation in trauma patients has wide-ranging effects, from breakdown of clots to remodeling the extracellular matrix. An evolving recognition of plasmin as a... (Review)
Review
Plasmin generation in trauma patients has wide-ranging effects, from breakdown of clots to remodeling the extracellular matrix. An evolving recognition of plasmin as a critical effector molecule in various inflammatory signals and pathways has rendered the study of plasmin(ogen) and its regulation by upstream activators and downstream targets and inhibitors key to understanding the inflammatory responses to trauma. Tranexamic acid, a widely available lysine analogue medication on the World Health Organization's list of essential medicines, has rapidly become one of the most commonly implemented adjunct treatments for bleeding after traumatic injury in clinical practice. In this article, we review the effects, both anti- and proinflammatory, of tranexamic acid, with a focus on the injured trauma patient.
Topics: Antifibrinolytic Agents; Fibrinolysis; Humans; Signal Transduction; Tranexamic Acid
PubMed: 32160643
DOI: 10.1055/s-0040-1702169 -
Nursing For Women's Health Feb 2022Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Mitigation of PPH is dependent on identification of risk, readiness, timely...
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Mitigation of PPH is dependent on identification of risk, readiness, timely identification of hemorrhage, accurate determination of blood loss, and effective treatment. Perinatal nurses must be prepared to participate in all these aspects of care, including the use of tranexamic acid, an antifibrinolytic agent that has more recently been added to the pharmacologic agents used to reduce blood loss associated with hemorrhage. The purpose of this article is to identify the nurse's role in the management of PPH and to introduce the use of tranexamic acid in PPH management as part of the nurse's role in implementing best practices for PPH.
Topics: Antifibrinolytic Agents; Female; Humans; Nurse's Role; Postpartum Hemorrhage; Pregnancy; Tranexamic Acid
PubMed: 35065079
DOI: 10.1016/j.nwh.2021.12.003 -
American Journal of Clinical Dermatology Jun 2017Melasma is a common acquired pigmentary disorder marked by irregular hyperpigmented macules or patches and most commonly occurs in women of darker skin color. It is a... (Review)
Review
Melasma is a common acquired pigmentary disorder marked by irregular hyperpigmented macules or patches and most commonly occurs in women of darker skin color. It is a chronic often-relapsing condition that causes negative psychosocial effects in those affected. Current treatments such as hydroquinone, kojic acid, and retinoids, among others, demonstrate variable efficacy and side-effect profiles. We conducted a comprehensive literature review examining the use of tranexamic acid (TA), a well-known anti-fibrinolytic agent, in the treatment of melasma. TA delivered orally, topically, and through physical methods works via the inhibition of ultraviolet (UV)-induced plasmin activity in keratinocytes. Predefined search terms were entered into PubMed. Articles were then independently screened by two authors to include only those written in the English language and relating to human subjects with at least mild melasma. The search identified 28 articles, 15 of which met the criteria for full review. The review revealed that TA treatment for melasma is equally effective or more effective than other standard therapies and may induce fewer side effects. Our comprehensive review suggests that TA may be a promising treatment option for melasma because of its demonstrated effectiveness alone and in combination with other modalities as well as its limited side-effect profile.
Topics: Administration, Cutaneous; Administration, Oral; Antifibrinolytic Agents; Dermatologic Agents; Female; Humans; Keratinocytes; Melanosis; Tranexamic Acid; Treatment Outcome; Ultraviolet Rays
PubMed: 28283893
DOI: 10.1007/s40257-017-0263-3 -
International Journal of Molecular... Jan 2022Aortic aneurysms are sometimes associated with enhanced-fibrinolytic-type disseminated intravascular coagulation (DIC). In enhanced-fibrinolytic-type DIC, both... (Review)
Review
Aortic aneurysms are sometimes associated with enhanced-fibrinolytic-type disseminated intravascular coagulation (DIC). In enhanced-fibrinolytic-type DIC, both coagulation and fibrinolysis are markedly activated. Typical cases show decreased platelet counts and fibrinogen levels, increased concentrations of fibrin/fibrinogen degradation products (FDP) and D-dimer, and increased FDP/D-dimer ratios. Thrombin-antithrombin complex or prothrombin fragment 1 + 2, as markers of coagulation activation, and plasmin-α plasmin inhibitor complex, a marker of fibrinolytic activation, are all markedly increased. Prolongation of prothrombin time (PT) is not so obvious, and the activated partial thromboplastin time (APTT) is rather shortened in some cases. As a result, DIC can be neither diagnosed nor excluded based on PT and APTT alone. Many of the factors involved in coagulation and fibrinolysis activation are serine proteases. Treatment of enhanced-fibrinolytic-type DIC requires consideration of how to control the function of these serine proteases. The cornerstone of DIC treatment is treatment of the underlying pathology. However, in some cases surgery is either not possible or exacerbates the DIC associated with aortic aneurysm. In such cases, pharmacotherapy becomes even more important. Unfractionated heparin, other heparins, synthetic protease inhibitors, recombinant thrombomodulin, and direct oral anticoagulants (DOACs) are agents that inhibit serine proteases, and all are effective against DIC. Inhibition of activated coagulation factors by anticoagulants is key to the treatment of DIC. Among them, DOACs can be taken orally and is useful for outpatient treatment. Combination therapy of heparin and nafamostat allows fine-adjustment of anticoagulant and antifibrinolytic effects. While warfarin is an anticoagulant, this agent is ineffective in the treatment of DIC because it inhibits the production of coagulation factors as substrates without inhibiting activated coagulation factors. In addition, monotherapy using tranexamic acid in cases of enhanced-fibrinolytic-type DIC may induce fatal thrombosis. If tranexamic acid is needed for DIC, combination with anticoagulant therapy is of critical importance.
Topics: Anticoagulants; Antifibrinolytic Agents; Aortic Aneurysm; Disseminated Intravascular Coagulation; Fibrin Fibrinogen Degradation Products; Fibrinolysin; Fibrinolysis; Heparin; Humans; Partial Thromboplastin Time; Prothrombin Time; alpha-2-Antiplasmin
PubMed: 35163216
DOI: 10.3390/ijms23031296 -
Internal and Emergency Medicine Jan 2023Tranexamic acid (TXA) is a common haemorrhage control agent in both emergency department (ED) settings and intra-operatively. While efficacy and potential harms are... (Review)
Review
Tranexamic acid (TXA) is a common haemorrhage control agent in both emergency department (ED) settings and intra-operatively. While efficacy and potential harms are well-studied, there are no overviews of reviews completed on TXA efficacy in the ED setting. We set out to provide an overview of systematic reviews on TXA efficacy in trauma, gastrointestinal bleeding, and subarachnoid haemorrhage in the ED setting, with outcomes including short and long-term mortality, thromboembolic (TE) events, and whether bleeding continued. Our review is guided by the PRIOR statement. We searched Pubmed, Medline, and EMBASE using broad search terms for systematic reviews, and calculated pooled relative-risk ratios using random and fixed-effects modelling from these studies. A risk-of-bias assessment was also completed for each review. We identified 13 systematic reviews for inclusion, with a variety of different outcomes. We identified improvements in 24-h mortality for trauma (RR 0.88, 95% CI 0.84-0.92) and gastrointestinal bleeds (RR 0.30, 95% CI 0.23-0.39), and decreased long-term gastrointestinal bleed mortality (RR 0.57, 95% CI 0.48-0.69). We also identified an increase in TE risk in gastrointestinal bleeding scenarios (RR 1.45, 95% CI 1.09-1.94), but no other clinical scenarios. TXA is effective in reducing mortality following trauma and gastrointestinal bleeds, however, there is limited evidence at this time to support TXA administration in the context of subarachnoid haemorrhage. TE risk is elevated when used in gastrointestinal bleeds. Selective use in high-risk patients may be warranted. TXA should strongly be considered in management in ED and prehospital settings.
Topics: Humans; Tranexamic Acid; Antifibrinolytic Agents; Subarachnoid Hemorrhage; Systematic Reviews as Topic; Gastrointestinal Hemorrhage; Emergency Medicine
PubMed: 36562900
DOI: 10.1007/s11739-022-03155-x -
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 -
Shock (Augusta, Ga.) Mar 2020Tranexamic acid (TXA) is an antifibrinolytic agent used to prevent traumatic exsanguination. It was first introduced to clinical practice for the management of patients... (Review)
Review
The Use of Tranexamic Acid (TXA) for the Management of Hemorrhage in Trauma Patients in the Prehospital Environment: Literature Review and Descriptive Analysis of Principal Themes.
Tranexamic acid (TXA) is an antifibrinolytic agent used to prevent traumatic exsanguination. It was first introduced to clinical practice for the management of patients with bleeding disorders, especially adapted to reduce bleeding in hemophiliacs undergoing oral surgical interventions. TXA exerts its action on the coagulation process by competitively inhibiting plasminogen activation, thereby reducing conversion of plasminogen into plasmin. This ultimately prevents fibrinolysis and reduces hemorrhage. Thus, TXA may be well suited for the management of traumatic hemorrhage in the prehospital setting.Despite multiplicity of studies on the use of TXA in clinical practice, there is no consensus regarding the use of TXA for the management of hemorrhage in trauma patients in the prehospital environment. Thus, a review on this topic was warranted. An extensive literature search yielded 14 full journal articles which met the inclusion criteria. These articles were thoroughly analyzed and the following themes were identified: "dose of TXA administration," "route of TXA administration," "optimal window of TXA administration," "safety of TXA use," "clinical effectiveness of TXA application," and the "feasibility of TXA use in the prehospital setting."Overall, to achieve the best possible outcomes, the literature supports the use of a loading dose of 1 g of TXA, followed by 1 g infusion over 8 h, given by intravenous administration within a 3-h window period of traumatic injury. TXA is very effective and safe to use in the prehospital setting, and its use is clinically and economically feasible.
Topics: Antifibrinolytic Agents; Emergency Medical Services; Humans; Shock, Hemorrhagic; Tranexamic Acid; Wounds and Injuries
PubMed: 32044848
DOI: 10.1097/SHK.0000000000001389