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Chinese Medical Sciences Journal =... Mar 2020Objective To summarize cases of acute myocardial infarction (AMI) after tranexamic acid (TXA) administration. Methods Electronic databases were searched to identify all... (Review)
Review
Objective To summarize cases of acute myocardial infarction (AMI) after tranexamic acid (TXA) administration. Methods Electronic databases were searched to identify all case reports presenting AMI after use of TXA. Two authors independently extracted data of patients' manifestation, examinations, medical history, treatment and outcome. Results Our search yielded seven case reports including seven patients. Among the seven reports, two were from USA, and the other five were from India, Turkey, UK, Italy and France, respectively. Of the seven patients aged between 28- and 77-year-old who developed AMI after TXA, five patients were female and two were male. TXA was prescribed for four patients to reduce surgical bleeding, for two patients to treat menorrhagia and for one patient to manage hemoptysis. The diagnosis of AMI was made based upon patients' symptoms, ECG, myocardium-specific enzymes, and confirmed by coronary angiography. Coronary stents were placed in four patients, for whom anti-platelet and anti-coagulation drugs were prescribed. No death or major cardiovascular events were reported during hospitalization and follow-up. Conclusion These case reports suggested a possible association of TXA administration and an increased risk of AMI, even in patients with relatively low thrombotic risk.
Topics: Adult; Aged; Blood Loss, Surgical; Female; Humans; Male; Middle Aged; Myocardial Infarction; Risk Factors; Tranexamic Acid
PubMed: 32299539
DOI: 10.24920/003596 -
The British Journal of Surgery Nov 2022
Topics: Humans; Tranexamic Acid; Antifibrinolytic Agents; Blood Loss, Surgical
PubMed: 36058554
DOI: 10.1093/bjs/znac252 -
Emergency Medicine Journal : EMJ Aug 2018A short-cut review was carried out to see if administering tranexamic acid reduced mortality in patients with postpartum haemorrhage. The author, date and country of... (Review)
Review
A short-cut review was carried out to see if administering tranexamic acid reduced mortality in patients with postpartum haemorrhage. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. Two randomised controlled trials were found, a smaller one suggesting that treatment with tranexamic acid reduced the volume of blood lost and a much larger study that showed a reduction in mortality due to bleeding in this patient group. There were no significant side effects from this treatment found in either study.
Topics: Administration, Intravenous; Antifibrinolytic Agents; Female; Humans; Postpartum Hemorrhage; Tranexamic Acid
PubMed: 30030237
DOI: 10.1136/emermed-2018-207944.2 -
Emergency Nurse : the Journal of the... Dec 2013In the UK, care for people with major injuries has improved since the introduction of trauma networks and major trauma centres, and since ambulance services began to use... (Review)
Review
In the UK, care for people with major injuries has improved since the introduction of trauma networks and major trauma centres, and since ambulance services began to use specific triage tools to identify major trauma. The advent of consultant-led trauma teams in emergency departments and implementation of the relevant protocols have also raised the standard of trauma care. One such protocol governs the use of tranexamic acid (TXA), which is used to control bleeding. This drug is cheap and widely available, and can save lives if administered within three hours of injury. This article reviews two recent major studies of the effects of TXA on trauma patients.
Topics: Antifibrinolytic Agents; Hemorrhage; Humans; Multiple Trauma; Time Factors; Tranexamic Acid; United Kingdom
PubMed: 24313420
DOI: 10.7748/en2013.12.21.8.24.e12329 -
The Orthopedic Clinics of North America Jan 2016Tranexamic acid has gained recent interest in orthopedics and trauma surgery because of its demonstrated benefit in several clinical trials. It is inexpensive and... (Review)
Review
Tranexamic acid has gained recent interest in orthopedics and trauma surgery because of its demonstrated benefit in several clinical trials. It is inexpensive and effective at reducing blood loss and blood transfusion requirements without a significant increase in morbidity or mortality. The optimal timing, dosing, and route of administration in orthopedics are yet to be elucidated. Significant investigation of tranexamic acid use in joint replacement and spine surgery has promoted its incorporation into the everyday practice of many of these surgeons. The paucity of studies regarding its use in orthopedic trauma has limited its integration into a field that may stand to benefit most from the drug.
Topics: Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Orthopedic Procedures; Tranexamic Acid; Wounds and Injuries
PubMed: 26614928
DOI: 10.1016/j.ocl.2015.08.014 -
European Journal of Emergency Medicine... Apr 2020
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Emergency Medical Services; Emergency Treatment; Humans; Tranexamic Acid
PubMed: 32101959
DOI: 10.1097/MEJ.0000000000000673 -
Arthroscopy : the Journal of... Dec 2023To investigate whether tranexamic acid (TXA) is cytotoxic in chondrocyte and cartilage tissues, as well as explore the mechanisms behind the possible toxicity in detail.
PURPOSE
To investigate whether tranexamic acid (TXA) is cytotoxic in chondrocyte and cartilage tissues, as well as explore the mechanisms behind the possible toxicity in detail.
METHODS
We detected the cell viability of chondrocytes in vitro and the change of morphology and specific in vivo contents of cartilage after TXA treatment. Furthermore, we detected apoptosis in cartilage. We used apoptosis-specific staining, reactive oxygen species detection, mitochondrial membrane potential detection, flow cytometry, and western blot for apoptosis detection. Finally, we detected the activation of endoplasmic reticulum stress (ERS) in TXA-treated chondrocytes to clarify the mechanism behind chondrocyte apoptosis.
RESULTS
TXA presented an increasing toxic effect with increasing concentrations, especially in the 100 mg/mL group. In addition, we found that 50 mg/mL and 100 mg/mL TXA significantly increased apoptosis in cartilage and subchondral bone. TXA could induce chondrocyte apoptosis in cell and protein levels with reactive oxygen species generation and mitochondrial membrane depolarization. An apoptosis inhibitor could inhibit the induced apoptosis. Next, TXA induced calcium overload in chondrocytes and increased ERS-specific protein expression, whereas ERS inhibitor blocked ERS activation and further inhibited chondrocyte apoptosis.
CONCLUSIONS
We concluded that TXA had a toxic effect on chondrocytes by inducing apoptosis through ERS activation, especially in 50 mg/mL and 100 mg/mL groups. We recommend TXA concentrations of less than 50 mg/mL in joint surgeries.
CLINICAL RELEVANCE
It is still unclear whether TXA has a toxic effect on cartilage when topically used in joint surgeries. The concentration also varies. This study provides additional evidence that TXA at high concentrations will cause cartilage damage, which will help to provide a new understanding of the clinical administration of TXA.
Topics: Humans; Chondrocytes; Tranexamic Acid; Reactive Oxygen Species; Apoptosis; Endoplasmic Reticulum Stress
PubMed: 37683831
DOI: 10.1016/j.arthro.2023.08.019 -
JBJS Reviews Jun 2024The effectiveness of tranexamic acid (TXA) as an antifibrinolytic agent in total shoulder arthroplasty (TSA) is well documented; however, there remains considerable... (Review)
Review
BACKGROUND
The effectiveness of tranexamic acid (TXA) as an antifibrinolytic agent in total shoulder arthroplasty (TSA) is well documented; however, there remains considerable practice variability concerning the optimal route of administration and dosing protocols concerning the medication's use. Our aim was to conduct a scoping review of the literature regarding the efficacy of various methods of TXA administration in TSA and to identify knowledge gaps that may be addressed.
METHODS
A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The PubMed and MEDLINE electronic databases were searched to identify all articles published before March 2023 investigating the administration of TXA in TSA. Randomized controlled trials and cohort studies were included, and data were extracted to capture information regarding intervention details and related outcomes such as blood loss, transfusion needs, and complication rates.
RESULTS
A total of 15 studies were included in this review. All selected studies used either intravenous (IV) or topical TXA, with 1 study also including a combined approach of both topical and IV TXA. Of the studies that used an IV approach, the most commonly reported favorable outcomes were a reduction in blood volume loss, reduction in hemoglobin or hematocrit change, and decreased drain output. Dosing varied significantly between all identified studies because some used a standard dosing amount in grams or milligrams for all treatment group participants, whereas others used weight-based dosing amounts. All studies that used a weight-based dosing regimen as well as studies using a standard dosing amount between 1,000 and 5,000 mg reported favorable outcomes for postoperative blood loss.
CONCLUSION
Both IV and topical TXA clearly demonstrate favorable perioperative hematologic profiles in TSA. Although both approaches have demonstrated a successful association with decreased blood loss and transfusion requirements, there is no definitive benefit to choosing one over the other. Furthermore, the use of oral TXA either in combination or isolation warrants further study in TSA because of its comparable efficacy profiles and significantly lower associated costs of application.
Topics: Tranexamic Acid; Humans; Arthroplasty, Replacement, Shoulder; Antifibrinolytic Agents; Blood Loss, Surgical
PubMed: 38889236
DOI: 10.2106/JBJS.RVW.24.00035 -
Anesthesiology Jul 2021
Topics: Antifibrinolytic Agents; Arthroplasty; Blood Loss, Surgical; Humans; Tranexamic Acid
PubMed: 34046666
DOI: 10.1097/ALN.0000000000003842 -
European Urology Dec 2022
Topics: Humans; Tranexamic Acid; Blood Loss, Surgical; Blood Transfusion
PubMed: 36064478
DOI: 10.1016/j.eururo.2022.08.020