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Current Opinion in Otolaryngology &... Aug 2023Although tranexamic acid is commonly used in surgical fields such as obstetrics, orthopedics, and trauma, its utilization in facial plastic surgery is a recently... (Review)
Review
PURPOSE OF REVIEW
Although tranexamic acid is commonly used in surgical fields such as obstetrics, orthopedics, and trauma, its utilization in facial plastic surgery is a recently emerging concept, and studies examining its potential impact have been few. This review highlights how tranexamic acid may be employed during facial plastic procedures and the promising impact it may have.
RECENT FINDINGS
Tranexamic acid is primarily being studied in rhinoplasties and rhytidectomies, with intravenous administration and local infiltration being the most common routs of application, respectively. During rhinoplasties, tranexamic acid has the potential to improve the visualization of the surgical field by decreasing blood loss and to improve postoperative edema and ecchymosis. For rhytidectomies, on the contrary, it may shorten time to attain hemostasis, lessen the rate of hematoma formation, and lead to lower surgical drain output. Its efficacy is preserved at low doses, and significant medication side effects have not been reported after facial plastic procedures.
SUMMARY
Altogether, tranexamic acid may present a valuable adjuvant to facial plastic surgery, as it could increase both surgeon and patient satisfaction while exhibiting a benign safety profile.
Topics: Humans; Antifibrinolytic Agents; Blood Loss, Surgical; Plastic Surgery Procedures; Rhinoplasty; Surgery, Plastic; Tranexamic Acid
PubMed: 37052603
DOI: 10.1097/MOO.0000000000000886 -
Advances in Anesthesia Dec 2019
Review
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Dose-Response Relationship, Drug; Humans; Postoperative Hemorrhage; Shock, Hemorrhagic; Surgical Procedures, Operative; Tranexamic Acid; Treatment Outcome
PubMed: 31677661
DOI: 10.1016/j.aan.2019.08.009 -
Annals of Neurology Jan 2016Antifibrinolytic drugs are routinely used worldwide to reduce the bleeding that results from a wide range of hemorrhagic conditions. The most commonly used... (Review)
Review
Antifibrinolytic drugs are routinely used worldwide to reduce the bleeding that results from a wide range of hemorrhagic conditions. The most commonly used antifibrinolytic drug, tranexamic acid, is associated with an increased incidence of postoperative seizures. The reported increase in the frequency of seizures is alarming, as these events are associated with adverse neurological outcomes, longer hospital stays, and increased in-hospital mortality. However, many clinicians are unaware that tranexamic acid causes seizures. The goal of this review is to summarize the incidence, risk factors, and clinical features of these seizures. This review also highlights several clinical and preclinical studies that offer mechanistic insights into the potential causes of and treatments for tranexamic acid-associated seizures. This review will aid the medical community by increasing awareness about tranexamic acid-associated seizures and by translating scientific findings into therapeutic interventions for patients.
Topics: Animals; Antifibrinolytic Agents; Humans; Seizures; Tranexamic Acid
PubMed: 26580862
DOI: 10.1002/ana.24558 -
Advanced Emergency Nursing Journal 2014Trauma-related deaths represent a leading cause of mortality among persons younger than 45 years. A significant percentage of these are secondary to hemorrhage. In... (Review)
Review
Trauma-related deaths represent a leading cause of mortality among persons younger than 45 years. A significant percentage of these are secondary to hemorrhage. In trauma, massive and rapid loss of blood creates an imbalance in hemostasis. Mainstays of resuscitation include surgical interventions, restoring intravascular volume, and pharmacologic interventions. Providers continue to search for improved pharmacologic options for achieving hemostasis. Tranexamic acid is an antifibrinolytic and inhibits fibrinolysis by blocking the lysine-binding sites on plasminogen. Tranexamic acid works to stabilize and inhibit the degradation of existing clots. Tranexamic acid has been prospectively proven to reduce mortality in trauma-related hemorrhage. Its use will likely expand into such areas as resuscitation and massive transfusion protocols and the prehospital setting. Therefore, it is critical for emergency medicine providers to be familiar with appropriate use of tranexamic acid in order to maximize efficacy and decrease the potential adverse events.
Topics: Antifibrinolytic Agents; Education, Continuing; Hemorrhage; Humans; Tranexamic Acid; Wounds and Injuries
PubMed: 24785665
DOI: 10.1097/TME.0000000000000018 -
Drugs Mar 2012Tranexamic acid, a synthetic derivative of the amino acid lysine, is an antifibrinolytic agent that acts by binding to plasminogen and blocking the interaction of... (Review)
Review
Tranexamic acid, a synthetic derivative of the amino acid lysine, is an antifibrinolytic agent that acts by binding to plasminogen and blocking the interaction of plasmin(ogen) with fibrin, thereby preventing dissolution of the fibrin clot. Tranexamic acid (Transamin®) is indicated in Japan for use in certain conditions with abnormal bleeding or bleeding tendencies in which local or systemic hyperfibrinolysis is considered to be involved. This article reviews the efficacy and tolerability of tranexamic acid in conditions amenable to antifibrinolytic therapy and briefly overviews the pharmacological properties of the drug. In large, randomized controlled trials, tranexamic acid generally significantly reduced perioperative blood loss compared with placebo in a variety of surgical procedures, including cardiac surgery with or without cardiopulmonary bypass, total hip and knee replacement and prostatectomy. In many instances, tranexamic acid also reduced transfusion requirements associated with surgery. It also reduced blood loss in gynaecological bleeding disorders, such as heavy menstrual bleeding, postpartum haemorrhage and bleeding irregularities caused by contraceptive implants. Tranexamic acid significantly reduced all-cause mortality and death due to bleeding in trauma patients with significant bleeding, particularly when administered early after injury. It was also effective in traumatic hyphaema, gastrointestinal bleeding and hereditary angioneurotic oedema. While it reduces rebleeding in subarachnoid haemorrhage, it may increase ischaemic complications. Pharmacoeconomic analyses predicted that tranexamic acid use in surgery and trauma would be very cost effective and potentially life saving. In direct comparisons with other marketed agents, tranexamic acid was at least as effective as ε-aminocaproic acid and more effective than desmopressin in surgical procedures. It was more effective than desmopressin, etamsylate, flurbiprofen, mefenamic acid and norethisterone, but less effective than the levonorgestrel-releasing intra-uterine device in heavy menstrual bleeding and was as effective as prednisolone in traumatic hyphaema. Tranexamic acid was generally well tolerated. Most adverse events in clinical trials were of mild or moderate severity; severe or serious events were rare. Therefore, while high-quality published evidence is limited for some approved indications, tranexamic acid is an effective and well tolerated antifibrinolytic agent.
Topics: Antifibrinolytic Agents; Cost-Benefit Analysis; Fibrinolysis; Hemorrhage; Humans; Randomized Controlled Trials as Topic; Tranexamic Acid
PubMed: 22397329
DOI: 10.2165/11209070-000000000-00000 -
Compendium of Continuing Education in... Jun 2018Clinicians often perform dental procedures and dentoalveolar surgery on patients who take prescribed anticoagulant medications. Such medications can present clinical... (Review)
Review
Clinicians often perform dental procedures and dentoalveolar surgery on patients who take prescribed anticoagulant medications. Such medications can present clinical challenges with regard to modifying or temporarily discontinuing a patient's anticoagulant regimen, which may not be medically indicated. In many instances discontinuation or altering of anticoagulation can be avoided through use of local hemostatic factors while patients are therapeutically continued on their prescribed warfarin doses. This article discusses a useful adjunct to dental treatment for the warfarin-anticoagulated patient- tranexamic acid (TA). The purpose of TA in these dental patients is to promote safe surgical site hemostasis for improved intraoperative visibility and postoperative hemostasis.
Topics: Aged; Anticoagulants; Antifibrinolytic Agents; Hemostasis, Surgical; Humans; Male; Tooth Extraction; Tranexamic Acid; Warfarin
PubMed: 29847965
DOI: No ID Found -
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 -
Nature Reviews. Cardiology Jun 2022
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Humans; Tranexamic Acid
PubMed: 35422522
DOI: 10.1038/s41569-022-00710-z -
Journal of Biomedical Materials... Feb 2022Fast acting topical hemostatic agents play a key role in hemorrhage control. Retarding fibrinolysis is also critical in improving coagulation, thereby expanding chances...
Fast acting topical hemostatic agents play a key role in hemorrhage control. Retarding fibrinolysis is also critical in improving coagulation, thereby expanding chances of survival. The purpose of the present work was to investigate the physical properties, loading capacity and hemostatic efficacy of newly developed nanoclay microsphere frameworks (NMFs) loaded with tranexamic acid (TA), as antifibrinolytic agent. Nanoclay compositions were prepared with increasing levels of TA. Results showed that TA was successfully incorporated into the nanoclay structure and released when solvated with ethanol. Both doped and undoped NMFs significantly decreased activated partial thromboplastin time and increased clot stiffness, which was attributed to significantly thinner fibrin fibers and a denser clot structure.
Topics: Fibrinolysis; Hemostasis; Hemostatics; Microspheres; Tranexamic Acid
PubMed: 34288380
DOI: 10.1002/jbm.b.34918 -
Air Medical Journal 2018
Review
Topics: Antifibrinolytic Agents; Hemorrhage; Humans; Resuscitation; Tranexamic Acid
PubMed: 29735224
DOI: 10.1016/j.amj.2018.02.007