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Interactive Cardiovascular and Thoracic... Dec 2013A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Does tranexamic acid stop haemoptysis'? Altogether... (Review)
Review
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Does tranexamic acid stop haemoptysis'? Altogether 49 papers were found using the reported search strategy, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. This consisted of one systematic review including a meta-analysis of two double-blind randomized controlled trials (RCTs), the two RCTs, one cohort study, two case-series and seven case reports. Main outcomes included bleeding time, bleeding volume and occurrence of thromboembolic complications after start of treatment. Based on results from the meta-analysis, no difference in remission of bleeding within 1 week was found between tranexamic acid (TA) and placebo groups (odds ratio 1.56, 95% CI: 0.44-5.46). However, overall bleeding time was significantly shorter for the TA group (weighted mean difference -19.47, 95% CI: -26.90, -12.03 h). In one RCT, TA reduced both the duration and the volume of bleeding compared with patients receiving placebo (both P < 0.0005). However, the other RCT failed to find a difference in bleeding time (P = 0.2). In these studies, no patient suffered from thromboembolic complications. Two case reports, however, describe development of pulmonary embolism during TA treatment. Several case reports on the use of TA for treatment of haemoptysis secondary to cystic fibrosis were found. In general, they suggest that TA may be a useful and well-tolerated medication for the treatment of intractable haemoptysis in this patient group. We conclude that limited research on the use of TA for treatment of haemoptysis exists. As aetiology of haemoptysis as well as length of treatment, dosage and form of TA administration varied between the studies, strong recommendations are difficult to give. Current best evidence, however, indicates that TA may reduce both the duration and volume of bleeding, with low risk of short-term thromboembolic complications, in patients with haemoptysis.
Topics: Antifibrinolytic Agents; Benchmarking; Evidence-Based Medicine; Hemoptysis; Humans; Patient Selection; Risk Factors; Thromboembolism; Time Factors; Tranexamic Acid; Treatment Outcome
PubMed: 23966576
DOI: 10.1093/icvts/ivt383 -
Medical Science Monitor : International... Nov 2015BACKGROUND Tranexamic acid (TXA) has been well documented to reduce blood loss and transfusion requirements in patients undergoing unilateral total knee arthroplasty... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND Tranexamic acid (TXA) has been well documented to reduce blood loss and transfusion requirements in patients undergoing unilateral total knee arthroplasty (TKA). However, the efficacy and safety of TXA in simultaneous bilateral TKA have not been clearly defined. The aim of our study was to systematically review the existing evidence regarding the role of TXA in patients undergoing simultaneous bilateral TKA. MATERIAL AND METHODS A systematic search of all studies published through June 2014 was performed using Medline, EMBASE, OVID, and other databases. All studies that compared the efficacy and safety of TXA administration in simultaneous bilateral TKA patients were identified. The data from the included trials were extracted and analyzed regarding blood loss and transfusion rates. The evidence quality levels of the selected articles were evaluated using a grading system. RESULTS Six studies were included, in which a total of 245 patients received TXA and 271 patients were controls. Overall, the results demonstrated that the use of TXA significantly reduced total blood loss by a mean of 371.1 ml (95% confidence interval (CI)=-412.12 to -330.09; p<0.001) and reduced the number of patients requiring blood transfusion (risk ratio (RR)=0.16; 95% CI=0.10 to 0.28; p<0.001). No significant differences in adverse effects such as deep vein thrombosis (DVT) or pulmonary embolism (PE) were noted in any group. CONCLUSIONS The intravenous use of TXA in patients undergoing simultaneous bilateral TKA is effective and safe and results in significantly reduced estimated blood loss and transfusion rates. No significant difference was observed in the incidence of side effects. Due to the limitations in the evidence quality of current meta-analyses, well-conducted, larger, high-quality randomized controlled trials (RCTs) are required.
Topics: Arthroplasty, Replacement, Knee; Humans; Tranexamic Acid
PubMed: 26619817
DOI: 10.12659/MSM.895027 -
Brazilian Journal of Anesthesiology... 2020
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Dose-Response Relationship, Drug; Humans; Tranexamic Acid
PubMed: 32773239
DOI: 10.1016/j.bjan.2020.07.001 -
Critical Care (London, England) Jul 2014Trauma is a leading cause of death in pediatrics. Currently, no medical treatment exists to reduce mortality in the setting of pediatric trauma; however, this evidence... (Comparative Study)
Comparative Study Review
Trauma is a leading cause of death in pediatrics. Currently, no medical treatment exists to reduce mortality in the setting of pediatric trauma; however, this evidence does exist in adults. Bleeding and coagulopathy after trauma increases mortality in both adults and children. Clinical research has demonstrated a reduction in mortality with early use of tranexamic acid in adult trauma patients in both civilian and military settings. Tranexamic acid used in the perioperative setting safely reduces transfusion requirements in children. This article compares the hematologic response to trauma between children and adults, and explores the potential use of tranexamic acid in pediatric hemorrhagic trauma.
Topics: Adult; Antifibrinolytic Agents; Child; Hemorrhage; Hospital Mortality; Humans; Multicenter Studies as Topic; Pediatrics; Perioperative Care; Randomized Controlled Trials as Topic; Survival Analysis; Tranexamic Acid; Wounds and Injuries
PubMed: 25043066
DOI: 10.1186/cc13965 -
Tranexamic acid in trauma patients in the emergency department: systematic review and meta-analysis.Emergencias : Revista de La Sociedad...The aim of this systematic review and meta-analysis was to evaluate the efficacy (mortality and functional status) and safety of emergency department (ED) use of... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this systematic review and meta-analysis was to evaluate the efficacy (mortality and functional status) and safety of emergency department (ED) use of tranexamic acid (TXA) in patients with severe trauma.
MATERIAL AND METHODS
MEDLINE, Embase, the Cochrane Library, the Web of Science, and ClinicalTrials.gov were searched to find relevant clinical trials published between January 1, 2008, and 1 August, 2018. The selected trials included trauma patients who received infusions of TXA within 8 hours. We extracted patient-related clinical variables and treatment variables. The main outcomes were mortality and functional status.
RESULTS
Five clinical trials were included in the systematic review. Four of them (20 697 patients) were included in the metaanalysis. We found that TXA versus placebo was associated with lower mortality (OR, 0.89 [95% CI, 0.83-0.96]; P = .004; 2 = 0%) and better functional status (OR, 0.60 [95% CI, 0.39-0.94]; P = .02; I2 = 0%). However, intensive care unit stays were longer in patients administered TXA (mean difference, 2.55 days [95% CI, 0.04-5.06 days]; P = .05; I2 = 0%).
CONCLUSION
ED infusion of TXA decreases mortality after severe trauma and improves patients' functional status.
Topics: Antifibrinolytic Agents; Clinical Trials as Topic; Emergency Service, Hospital; Humans; Odds Ratio; Physical Functional Performance; Time Factors; Tranexamic Acid; Wounds and Injuries
PubMed: 31347807
DOI: No ID Found -
International Journal of Surgery... Feb 2017To compare the safety and efficacy of combined use of intravenous and topical tranexamic acid with that of intravenous tranexamic acid in primary total joint... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the safety and efficacy of combined use of intravenous and topical tranexamic acid with that of intravenous tranexamic acid in primary total joint arthroplasty.
METHODS
Literature was searched in PubMed, Cochrane Library, Embase, Medline, and China National Knowledge Infrastructure databases. Only randomized controlled trials were included in our study. Data were using fixed-effects or random-effects models with standard mean differences and risk ratios for continuous and dichotomous variables, respectively.
RESULTS
Seven randomized controlled trials encompassing 683 patients were retrieved for this meta-analysis. Outcomes showed that when compared with intravenous tranexamic acid, combined use of intravenous and topical tranexamic acid could significantly reduce total blood loss by a mean of 138.70 mL [95% confidence interval (CI): -196.14 to -81.26, p < 0.001], transfusion rates (risk ratio 0.42, 95% CI: 0.2 to 0.85, p < 0.001). No significant difference in the occurrence of deep vein thrombosis, pulmonary embolism was found between the two groups.
CONCLUSIONS
This meta-analysis indicated that comparing with only intravenous tranexamic acid, combined use of intravenous and topical tranexamic acid can significantly reduce blood loss and transfusion rate in primary total joint arthroplasty without increasing the risk of thrombotic complications. Therefore, we suggest that tranexamic acid should be intravenously combined with topically administered in primary total joint arthroplasty.
Topics: Administration, Intravenous; Administration, Topical; Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Humans; Pulmonary Embolism; Randomized Controlled Trials as Topic; Tranexamic Acid; Venous Thrombosis
PubMed: 27913237
DOI: 10.1016/j.ijsu.2016.11.136 -
European Spine Journal : Official... Sep 2013The present meta-analysis aimed at assessing the effectiveness and safety of tranexamic acid (TXA) in reducing blood loss and transfusion in spinal surgery. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The present meta-analysis aimed at assessing the effectiveness and safety of tranexamic acid (TXA) in reducing blood loss and transfusion in spinal surgery.
METHODS
Systematic searches of all studies published through March 2012 were identified from PubMed, EMBase, Cochrane library, Science Direct, and other databases. Only randomized controlled trials (RCTs) were included in the present study. Two independent reviewers searched and assessed the literature. Mean difference (MD) of blood loss and blood transfusions, risk ratios (RR) of transfusion rate and of deep vein thrombosis rate in the TXA-treated group versus placebo group were pooled throughout the study. The meta-analysis was conducted by RevMan 5.1 software.
RESULTS
Six placebo-controlled RCTs encompassing 411 patients met the inclusion criteria for our meta-analysis. The use of TXA significantly reduced both total blood loss [MD = -285.35, 95 % CI (-507.03 to -63.67), P = 0.01] as well as the number of patients requiring blood transfusion [RR = 0.71, 95 % CI (0.54-0.92), P = 0.01]. None of the patients in the treatment group had deep-vein thrombosis (DVT) or pulmonary embolism.
CONCLUSIONS
Intravenous use of TXA for patients undergoing spinal surgery is effective and safe. It reduces total blood loss and the need for blood transfusion, particularly in the using of high dosage of TXA (≥ 15 mg/kg), yet does not increase the risk of postoperative DVT. Due to the limitation of the quality of the evidence currently available, high-quality RCTs are required.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Hemorrhage; Humans; Randomized Controlled Trials as Topic; Spinal Diseases; Tranexamic Acid
PubMed: 23657623
DOI: 10.1007/s00586-013-2774-9 -
Blood Advances May 2019Tranexamic acid (TXA) is an antifibrinolytic agent that blocks plasmin formation. Because plasmin is known to promote inflammatory and immunosuppressive responses, we...
Tranexamic acid (TXA) is an antifibrinolytic agent that blocks plasmin formation. Because plasmin is known to promote inflammatory and immunosuppressive responses, we explored the possibility that plasmin-mediated immunosuppression in patients undergoing cardiac surgery can be directly reversed by TXA and decrease postoperative infection rates. The modulatory effect of TXA on inflammatory cytokine levels and on innate immune cell activation were evaluated with multiplex enzyme-linked immunosorbent assay and flow cytometry, respectively. Postoperative infection rates were determined in patients undergoing cardiac surgery and randomized to TXA (ACTRN12605000557639; http://www.anzca.edu.au). We demonstrate that TXA-mediated plasmin blockade modulates the immune system and reduces surgery-induced immunosuppression in patients following cardiac surgery. TXA enhanced the expression of immune-activating markers while reducing the expression of immunosuppressive markers on multiple myeloid and lymphoid cell populations in peripheral blood. TXA administration significantly reduced postoperative infection rates, despite the fact that patients were being administered prophylactic antibiotics. This effect was independent of the effect of TXA at reducing blood loss. TXA was also shown to exert an immune-modulatory effect in healthy volunteers, further supporting the fibrin-independent effect of TXA on immune function and indicating that baseline plasmin levels contribute to the regulation of the immune system in the absence of any comorbidity or surgical trauma. Finally, the capacity of TXA to reduce infection rates, modulate the innate immune cell profile, and generate an antifibrinolytic effect overall was markedly reduced in patients with diabetes, demonstrating for the first time that the diabetic condition renders patients partially refractory to TXA.
Topics: Adult; Antifibrinolytic Agents; Disease Transmission, Infectious; Humans; Postoperative Period; Prospective Studies; Tranexamic Acid; Volunteers
PubMed: 31126915
DOI: 10.1182/bloodadvances.2019000092 -
Current Opinion in Anaesthesiology Oct 2022Traumatic brain injury (TBI) is a leading cause of trauma-related deaths, and pharmacologic interventions to limit intracranial bleeding should improve outcomes.... (Review)
Review
PURPOSE OF REVIEW
Traumatic brain injury (TBI) is a leading cause of trauma-related deaths, and pharmacologic interventions to limit intracranial bleeding should improve outcomes. Tranexamic acid reduces mortality in injured patients with major systemic bleeding, but the effects of antifibrinolytic drugs on outcomes after TBI are less clear. We therefore summarize recent evidence to guide clinicians on when (not) to use antifibrinolytic drugs in TBI patients.
RECENT FINDINGS
Tranexamic acid is the only antifibrinolytic drug that has been studied in patients with TBI. Several recent studies failed to conclusively demonstrate a benefit on survival or neurologic outcome. A large trial with more than 12 000 patients found no significant effect of tranexamic acid on head-injury related death, all-cause mortality or disability across the overall study population, but observed benefit in patients with mild to moderate TBI. Observational evidence signals potential harm in patients with isolated severe TBI.
SUMMARY
Given that the effect of tranexamic acid likely depends on a variety of factors, it is unlikely that a 'one size fits all' approach of administering antifibrinolytics to all patients will be helpful. Tranexamic acid should be strongly considered in patients with mild to moderate TBI and should be avoided in isolated severe TBI.
Topics: Antifibrinolytic Agents; Brain Injuries, Traumatic; Hemorrhage; Humans; Tranexamic Acid
PubMed: 35900731
DOI: 10.1097/ACO.0000000000001171 -
Anaesthesia Jan 2015
Topics: Blood Transfusion; Erythrocyte Transfusion; Hemorrhage; Humans; Tranexamic Acid
PubMed: 25440388
DOI: 10.1111/anae.12930