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Clinical and Applied... Nov 2018The use of tranexamic acid (TXA) for reducing blood loss in intertrochanteric fracture (IF) surgery remains controversial. We therefore performed a meta-analysis of... (Meta-Analysis)
Meta-Analysis Review
The use of tranexamic acid (TXA) for reducing blood loss in intertrochanteric fracture (IF) surgery remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of TXA in reducing transfusion requirements and blood loss for IF surgery. Databases, including PubMED, Cochrane, and Embase, were searched for RCTs that were published before February 2018 and that addressed the efficacy and safety of TXA in patients who underwent IF surgery. A total of 746 patients from 7 RCTs were subjected to meta-analysis. The results showed that TXA group had reduced surgical blood loss (weighted mean difference [WMD] = -37.24, 95% confidence interval [CI]: -48.70 to -25.77, P <.00001), reduced total blood loss (WMD = -199.08, 95% CI: -305.16 to -93.01, P = .0002), higher postoperative hemoglobin (WMD = 0.46, 95% CI: 0.12 to 0.79, P = .007), and hematocrit levels (WMD = 1.55, 95% CI: 0.64 to 2.47, P = .008) compared to control group, while no significant differences were found in transfusion rates (relative risk [RR] = 0.75, 95% CI: 0.50 to 1.11, P = .15), postoperative drainage (WMD = -38.82, 95% CI: -86.87 to 9.22, P = .11), and thromboembolic events (RR = 0.94, 95% CI: 0.41 to 2.19, P = .89). In patients undergoing IF surgery, the administration of TXA significantly reduced surgical blood loss and total blood loss, while it had no significant effect on transfusion rate, postoperative drainage, and the risk of thromboembolic events. Nevertheless, due to the variations in the included studies, additional RCTs are required to further validate these conclusions.
Topics: Hip Fractures; Humans; Operative Blood Salvage; Postoperative Complications; Thromboembolism; Tranexamic Acid
PubMed: 29929380
DOI: 10.1177/1076029618783258 -
Deutsches Arzteblatt International Mar 2018
Topics: Arthroplasty, Replacement; Surveys and Questionnaires; Tranexamic Acid
PubMed: 29669677
DOI: 10.3238/arztebl.2018.0220a -
Yonsei Medical Journal Oct 2022Spinal surgeries are often associated with a high incidence of perioperative blood loss, which poses several complications. Much current research focuses on the...
PURPOSE
Spinal surgeries are often associated with a high incidence of perioperative blood loss, which poses several complications. Much current research focuses on the importance of antifibrinolytic drugs during spinal surgeries to reduce blood loss, which can also reduce the risk of the need for blood transfusions. We evaluated the effects of prophylactic, low-dose tranexamic acid (TXA) in spinal fusion surgeries on blood loss, blood transfusions, and associated complications.
MATERIALS AND METHODS
TXA was administered to 90 patients at a constant infusion rate of 10 mg/kg for 20 minutes after anesthesia induction, followed by a maintenance dose of 1 mg/kg/h until the end of the operation. An additional 91 patients were included as controls.
RESULTS
There were no significant differences between the study groups in terms of intraoperative blood loss, which was 500 mL for both groups (>0.999). Also, intraoperative blood transfusion requirements were similar between both groups (=0.330). Mean blood transfusion amounts were 125±35 mL for patients in the TXA group and 85±25 mL in the control group. However, there was a significant reduction in postoperative blood transfusion (=0.003) in the TXA group. Only three cases in the TXA group required blood transfusion, while 15 cases in the control group did.
CONCLUSION
We confirmed that low dose TXA has no effect on intraoperative blood loss volume or blood transfusion requirements and that it can significantly reduce the need for postoperative blood transfusions.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Blood Transfusion; Elective Surgical Procedures; Humans; Tranexamic Acid
PubMed: 36168245
DOI: 10.3349/ymj.2022.0163 -
JSLS : Journal of the Society of... 2014Postoperative pelvic adhesions are associated with chronic pelvic pain, dyspareunia, and infertility. The aim of this study was to evaluate the adhesion prevention...
BACKGROUND AND OBJECTIVES
Postoperative pelvic adhesions are associated with chronic pelvic pain, dyspareunia, and infertility. The aim of this study was to evaluate the adhesion prevention effects of tranexamic acid (TA) and hyaluronate/carboxymethylcellulose (HA/CMC) barrier in the rat uterine horn models on the basis of macroscopic and microscopic adhesion scores and histopathological as well as biochemical parameters of inflammation.
METHODS
Twenty-one Wistar rats were randomly divided into 3 groups. Ten lesions were created on the antimesenteric surface of both uterine horns by bipolar cautery. Three milliliters of 0.9% sodium chloride solution were administered in the control group. A single layer of 2×2 cm HA/CMC was plated in group 2. Two milliliters of TA was applied in the last group. All rats were sacrificed at postoperative day 21.
RESULTS
No significant difference was found among the control group, the HA/CMC group, and the TA group in terms of macro-adhesion score (P=.206) and microadhesion score (P=.056). No significant difference was found among the 3 groups in terms of inflammation score (P=.815) and inflammatory cell activity (P=.835). Malondialdehyde levels were significantly lower in the control group than in the TA group and HA/CMC group (P=.028). Superoxide dismutase and glutathione S-transferase activities were found to be higher in the control group than in the TA group (P=.005) and HA/CMC group (P=.009).
CONCLUSIONS
TA and HA/CMC had no efficacy in preventing macroscopic or microscopic adhesion formation and decreasing inflammatory cell activity or inflammation score in our rat models. TA and HA/CMC increased the levels of free radicals and reduced the activities of superoxide dismutase and glutathione S-transferase enzymes, which act to reduce tissue injury.
Topics: Animals; Carboxymethylcellulose Sodium; Disease Models, Animal; Female; Hyaluronic Acid; Membranes, Artificial; Peritoneum; Rats; Rats, Wistar; Tissue Adhesions; Tranexamic Acid; Uterus
PubMed: 25392658
DOI: 10.4293/JSLS.2014.00044 -
British Journal of Anaesthesia Mar 2017
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Humans; Tranexamic Acid
PubMed: 28203768
DOI: 10.1093/bja/aew470 -
Blood Sep 2022
Topics: Antifibrinolytic Agents; Blood Platelets; Hematologic Neoplasms; Humans; Tranexamic Acid
PubMed: 36107459
DOI: 10.1182/blood.2022017207 -
Journal of Orthopaedic Surgery and... Jul 2023Calcaneal fractures are a common orthopedic disease, account for approximately 2% of all bone fractures, and represent 60% of fractures of tarsal bones. Tranexamic acid... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Calcaneal fractures are a common orthopedic disease, account for approximately 2% of all bone fractures, and represent 60% of fractures of tarsal bones. Tranexamic acid (TXA) is a synthetic antifibrinolytic drug that competitively blocks the lysine-binding sites of plasminogen, plasmin, and tissue plasminogen activator, delaying fibrinolysis and blood clot degradation. However, the effect of TXA on patients with calcaneal surgery remains controversial. Our objective was to evaluate the effectiveness of TXA in calcaneal fractures surgeries.
METHODS
The electronic literature databases of Pubmed, Embase, and Cochrane library were searched in December 2022. The data on blood loss, the stay in the hospital, the duration of surgery, hemoglobin, hematocrit, platelet count, prothrombin time, activated partial thromboplastin time, and wound complication were extracted. The Stata 22.0 software was used for the meta-analysis.
RESULTS
Four randomized controlled studies met our inclusion criteria. This meta-analysis showed that TXA significantly reduced postoperative blood loss during the first 24 h (p < 0.001), improved the level of hemoglobin (p < 0.001) and hematocrit (p = 0.03), and reduced the risk of wound complications (p = 0.04). There was no significant difference between the two groups regarding total and intraoperative blood loss, hospital stay, duration of surgery, platelet count, activated partial thromboplastin time, and prothrombin time.
CONCLUSION
TXA significantly reduced blood loss during the first 24 h postoperatively, improved the level of hemoglobin and hematocrit, and reduced the risk of wound complications. Given the evidence, TXA can be used in patients with calcaneal fractures and had the potential benefit of blood reduction.
PROTOCOL REGISTRATION
The protocol was registered in PROSPERO (registration No. CRD42023391211).
Topics: Humans; Tranexamic Acid; Tissue Plasminogen Activator; Randomized Controlled Trials as Topic; Calcaneus; Tarsal Bones; Ankle Injuries
PubMed: 37438798
DOI: 10.1186/s13018-023-03924-0 -
British Journal of Anaesthesia Nov 2022
Topics: Humans; Tranexamic Acid; Retrospective Studies; Myocardial Infarction; Antifibrinolytic Agents; Databases, Factual
PubMed: 36031418
DOI: 10.1016/j.bja.2022.07.045 -
Journal of Orthopaedic Surgery and... Jan 2021This study aimed to evaluate the efficacy and safety of using high-dose intravenous tranexamic acid (TXA) to reduce blood loss in idiopathic scoliosis surgery. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study aimed to evaluate the efficacy and safety of using high-dose intravenous tranexamic acid (TXA) to reduce blood loss in idiopathic scoliosis surgery.
METHODS
This study was a meta-analysis, which consisted of retrospective cohort studies (RCSs) and randomized control trials (RCTs) found by searching electronic databases, namely PubMed, Web of Science, The Cochrane Central Register of Controlled Trials (CENTRAL), and the Google Scholar Database, dating from 1960 to 2019. The points of interest included total blood loss, a need for transfusion and transfusion criteria, surgery time, and the evidence of intraoperative and postoperative complications, such as seizures or thromboembolic events. The weighted mean differences (WMD) and 95% confidence interval (CI) of blood loss in the TXA intervention group compared to the control or placebo group were extracted and combined using the random effects model.
RESULTS
In this meta-analysis, there was a total of three RCSs and two RCTs, which involved 334 patients. The results showed that blood loss is significantly reduced, with a weighted mean difference in the TXA group (WMD = - 525.14, P = 0.0000, CI ranged from - 839.83, - 210.44, I = 82%). Heterogeneity was assessed using the random effects model.
CONCLUSIONS
A high dose of intravenous TXA reduced blood loss during adolescent idiopathic scoliosis surgery and did not lead to any significant thromboembolic event. Therefore, a high dose appears to be effective and safe for adolescent idiopathic scoliosis surgery. However, more high-quality research based on larger randomized controlled trials is still needed.
Topics: Adolescent; Blood Loss, Surgical; Female; Humans; Infusions, Intravenous; Intraoperative Complications; Male; Postoperative Complications; Pulse Therapy, Drug; Randomized Controlled Trials as Topic; Retrospective Studies; Safety; Scoliosis; Seizures; Spinal Fusion; Thromboembolism; Time Factors; Tranexamic Acid
PubMed: 33446219
DOI: 10.1186/s13018-020-02158-8 -
Pediatric Critical Care Medicine : a... Dec 2018
Topics: Child; Humans; Seizures; Tranexamic Acid
PubMed: 30520845
DOI: 10.1097/PCC.0000000000001732