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British Journal of Anaesthesia Aug 2022There is emerging evidence of inequalities in healthcare provision between women and men. Trauma care is no exception with a number of studies indicating lower levels of...
There is emerging evidence of inequalities in healthcare provision between women and men. Trauma care is no exception with a number of studies indicating lower levels of prioritisation for injured female patients. The antifibrinolytic drug tranexamic acid, reduced trauma deaths to a similar extent in females and males in the international Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH) randomised controlled trials, but in real-world practice, national registry data shows females are less likely to receive tranexamic acid than males. Inequity in the provision of tranexamic acid may extend beyond sex (and gender), and further study is required to examine the effect of age and mechanism of injury differences between men and women in the decision to treat.
Topics: Antifibrinolytic Agents; Female; Hemorrhage; Humans; Male; Randomized Controlled Trials as Topic; Sexism; Tranexamic Acid
PubMed: 35753808
DOI: 10.1016/j.bja.2022.05.015 -
Academic Emergency Medicine : Official... Jun 2022
Topics: Antifibrinolytic Agents; Humans; Prospective Studies; Subarachnoid Hemorrhage; Tranexamic Acid
PubMed: 35266599
DOI: 10.1111/acem.14482 -
Drug Delivery Dec 2021Hyperpigmentation is a common complaint and distressing problem in dermatology, and tranexamic acid (TA) is an effective treatment agent but limited by the delivery to...
Hyperpigmentation is a common complaint and distressing problem in dermatology, and tranexamic acid (TA) is an effective treatment agent but limited by the delivery to melanocytes in the epidermis. Herein, a novel TA naogels (named HA/TA-LP), combining the advantages of liposomes and hyaluronic acid (HA), are prepared and assessed for topical hyperpigmentation treatment with targeting delivery and minimizing epidermal diffusion. Morphological characteristics indicate numerous TA-loaded liposomes packed in HA gels. o cell studies using human A375 melanoma cells show that HA/TA-LP can promote the uptake of TA by targeting delivery with resulting inhibition of tyrosinase activity and melanin production. Guinea pigs are used to construct hyperpigmentation models and investigate the topical delivery and treatment efficacy of HA/TA-LP. topical delivery studies indicate HA/TA-LP realize the effective delivery into melanocytes with an ideal balance of effective permeability and minimizing epidermal diffusion. Subsequently, hyperpigmentation treatment assessments reveal that HA/TA-LP inhibit tyrosinase activity and melanin production under the radiation of UVB. Our study identifies favorable properties of HA/TA-LP for treating hyperpigmentation, and provides an experimental basis for further clinical application.
Topics: Administration, Cutaneous; Animals; Ascomycota; Cell Line, Tumor; Cell Survival; Chemistry, Pharmaceutical; Drug Carriers; Guinea Pigs; Humans; Hyaluronic Acid; Hyperpigmentation; Liposomes; Melanocytes; Monophenol Monooxygenase; Nanogels; Tranexamic Acid
PubMed: 34596008
DOI: 10.1080/10717544.2021.1983081 -
The Journal of Surgical Research Dec 2022Tranexamic acid (TXA) protects the vasculature endothelium after hemorrhage, resulting in a decreased capillary leak. These properties may protect patients receiving TXA...
INTRODUCTION
Tranexamic acid (TXA) protects the vasculature endothelium after hemorrhage, resulting in a decreased capillary leak. These properties may protect patients receiving TXA from acute respiratory distress syndrome (ARDS), however, clinical studies have yet to examine this topic. We hypothesized that trauma patients receiving TXA would have lower incidence of ARDS.
METHODS
This was a retrospective review of adult (18+ y) patients who presented to a large Level I trauma center with an injury severity score ≥ 16 from admit years 2012-2020. Propensity matching was employed to examine how TXA administration is associated with ARDS.
RESULTS
There were a total of 2751 patients meeting study criteria, with 162 (5.9%) received TXA. Of the 162 patients that received TXA, only 12 (7.4%) received pre-hospital TXA, while 4 (2.5%) received TXA both pre-hospital and in hospital. Of the 63 patients developing ARDS, 62 (98.4%) did not receive TXA. After propensity matching, 304 patients remained, with 152 in each cohort. The incidence of ARDS (P = 0.08), pneumonia (P = 0.68), any pulmonary complication (P = 0.33), and mortality (P = 0.37) were not different in patients receiving TXA on propensity matching.
CONCLUSIONS
TXA did not protect trauma patients from pulmonary complications; however, nearly all patients developing ARDS did not receive TXA. Larger studies should examine this relationship to improve understanding of therapies that may prevent ARDS.
Topics: Humans; Adult; Tranexamic Acid; Antifibrinolytic Agents; Injury Severity Score; Trauma Centers; Respiratory Distress Syndrome
PubMed: 36058012
DOI: 10.1016/j.jss.2022.06.017 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Nov 2018The aim of this study was to determine if the use of tranexamic acid (TXA) during intramedullary reaming treatment for tibial diaphyseal fractures was safe, reduced... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The aim of this study was to determine if the use of tranexamic acid (TXA) during intramedullary reaming treatment for tibial diaphyseal fractures was safe, reduced blood loss, or affected cost effectiveness.
METHODS
A total of 70 patients with a tibia diaphysis fracture were randomized into 2 groups and prospectively followed for data on blood loss, thrombosis, and fracture healing. Preoperative TXA was administered intravenously to Group A, and Group B served as the control group.
RESULTS
While there was no significant difference between the preoperative and postoperative 1-hour hemoglobin (Hb) and hematocrit (Hct) levels of the patients, there was a statistically significant difference in the comparison of the postoperative 24-hour and 48-hour Hb and Hct levels. There was no need for an allogenic blood transfusion to any patient in Group A; however, 2 patients in Group B each received 1 unit of erythrocyte suspension because their Hct values dropped below 27%. There was no deep vein thrombosis or embolism observed in any of the patients.
CONCLUSION
The application of intravenous TXA during the preoperative period in the treatment of tibial fractures with intramedullary nailing reduced the bleeding seen in the postoperative period. It did not lead to intravascular thrombosis in the postoperative period, and had no adverse effect on bone healing.
Topics: Antifibrinolytic Agents; Blood Transfusion; Fracture Fixation, Intramedullary; Hematocrit; Humans; Tibia; Tibial Fractures; Tranexamic Acid
PubMed: 30516259
DOI: 10.5505/tjtes.2018.42147 -
Burns : Journal of the International... May 2024Burn wound conversion is the observed process where superficial partial thickness burns convert into deep partial or full thickness burn injuries. This conversion...
Burn wound conversion is the observed process where superficial partial thickness burns convert into deep partial or full thickness burn injuries. This conversion process often involves surgical excision to achieve timely wound healing. Unfortunately, the pathophysiology of this phenomenon is multifactorial and poorly understood. Thus, a therapeutic intervention that may prevent secondary progression and cell death in burn-injured tissue is desirable. Recent work by our group and others has established that tranexamic acid (TXA) has significant anti-inflammatory properties in addition to its well-known anti-fibrinolytic effects. This study investigates TXA as a novel therapeutic treatment to mitigate burn wound conversion and reduce systemic inflammation. Sprague-Dawley rats were subjected to a hot comb burn contact injury. A subset of animals underwent a similar comb burn with an adjacent 30%TBSA contact injury. The interspaces represent the ischemic zones simulating the zone of stasis. The treatment group received injections of TXA (100 mg/kg) immediately after injury and once daily until euthanasia. Animals were harvested for analyses at 6 h and 7 days after injury. Full-thickness biopsies from the ischemic zones and lung tissue were assessed with established histological techniques. Plasma was collected for measurement of damage associated molecular patterns (DAMPs), and liver samples were used to study inflammatory cytokines expression. Treatment with TXA was associated with reduced burn wound conversion and decreased burn-induced systemic inflammatory response syndrome (SIRS). Lung inflammation and capillary leak were also significantly reduced in TXA treated animals. Future research will elucidate the underlying anti-inflammatory properties of TXA responsible for these findings.
Topics: Animals; Tranexamic Acid; Burns; Rats, Sprague-Dawley; Rats; Antifibrinolytic Agents; Inflammation; Disease Models, Animal; Edema; Male; Wound Healing; Skin; Liver; Lung
PubMed: 38336496
DOI: 10.1016/j.burns.2024.01.024 -
JAMA Network Open Mar 2022Tranexamic acid is widely available and used off-label in patients with bleeding traumatic injury, although the literature does not consistently agree on its efficacy... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Tranexamic acid is widely available and used off-label in patients with bleeding traumatic injury, although the literature does not consistently agree on its efficacy and safety.
OBJECTIVE
To examine the association of tranexamic acid administration with mortality and thromboembolic events compared with no treatment or with placebo in patients with traumatic injury in the literature.
DATA SOURCES
On March 23, 2021, PubMed, Embase, and the Cochrane Library were searched for eligible studies published between 1986 and 2021.
STUDY SELECTION
Randomized clinical trials and observational studies investigating tranexamic acid administration compared with no treatment or placebo among patients with traumatic injury and traumatic brain injury who were 15 years or older were included. Included studies were published in English or German. The electronic search yielded 1546 records, of which 71 were considered for full-text screening. The selection process was performed independently by 2 reviewers.
DATA EXTRACTION AND SYNTHESIS
The study followed the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted by 2 independent reviewers and pooled using the inverse-variance random-effects model.
MAIN OUTCOMES AND MEASURES
Outcomes were formulated before data collection and included mortality at 24 hours and 28 and 30 days (1 month) as well as the incidence of thromboembolic events and the amount of blood products administered. Owing to missing data, overall mortality was added and the amount of blood products administered was discarded.
RESULTS
Thirty-one studies with a total of 43 473 patients were included in the systematic review. The meta-analysis demonstrated that administration of tranexamic acid was associated with a significant decrease in 1-month mortality compared with the control cohort (risk ratio, 0.83 [95% CI, 0.71-0.97]; I2 = 35%). The results of meta-analyses for 24-hour and overall mortality and thromboembolic events were heterogeneous and could not be pooled. Further investigations on clinical heterogeneity showed that populations with trauma and trial conditions differed markedly.
CONCLUSIONS AND RELEVANCE
These findings suggest that tranexamic acid may be beneficial in various patient populations with trauma. However, reasonable concerns about potential thromboembolic events with tranexamic acid remain.
Topics: Antifibrinolytic Agents; Brain Injuries, Traumatic; Hemorrhage; Humans; Thromboembolism; Tranexamic Acid
PubMed: 35230436
DOI: 10.1001/jamanetworkopen.2022.0625 -
The Medical Journal of Malaysia Nov 2020Some surgeons advocate the usage of tranexamic acid (TXA) in traumatic brain injury (TBI). The aim of this study is to determine the effectiveness and safety of TXA in... (Observational Study)
Observational Study
BACKGROUND
Some surgeons advocate the usage of tranexamic acid (TXA) in traumatic brain injury (TBI). The aim of this study is to determine the effectiveness and safety of TXA in improving the outcome of TBI patients and in reducing the rate of clot expansion and mortality in TBI as compared to those without TXA.
METHODS
This is a prospective observational cohort study conducted in Sarawak General Hospital, Malaysia. Patients 12 years of age and older with mild to severe TBI who had a brain computed tomography (CT) done within eight hours of injury were enrolled in the study. A total of 334 patients were recruited from the 5th of August 2016 until the 8th of March 2018 in Sarawak General Hospital. In all 167 of them were administered with TXA and another 167 of the patients were not. The primary outcome expected is the number of good outcomes in isolated TBI patients given TXA. Good outcome is defined by Glasgow Outcome Score-Extended (GOSE) of five and above. Secondary outcome was clot expansion of an intracranial bleed seen on the first scan that had expanded by 25% or more on any dimension on the second scan.
RESULTS
The TXA did not show significant trend of good outcome in terms of GOSE (p=0.763). However, for moderate and severe acute subdural haemorrhage (SDH) subgroups, there was a significant difference (p=0.042). Clot expansion was present in 14 patients (12.7%) with TXA given and in 54 patients (38.8%) without TXA. The difference was statistically significant (p<0.001). Of the patients who received TXA, there was one case (0.6%) of deep vein thrombosis. Apart from that, TXA showed non-significant trend in reducing mortality (p=0.474).
CONCLUSIONS
Tranexamic acid reduces the rate of clot expansion in TBI by 26.1% (38.8-12.7%) without significantly increasing the risk of a thrombotic event. It can also improve the outcome of moderate and severe TBI patients with acute SDH.
Topics: Antifibrinolytic Agents; Brain Injuries, Traumatic; Humans; Prospective Studies; Thrombosis; Tranexamic Acid
PubMed: 33219174
DOI: No ID Found -
Anaesthesia Jan 2015There has been an explosion of interest in the ability of tranexamic acid to reduce morbidity and mortality in surgical and traumatic bleeding. Tranexamic acid has been... (Review)
Review
There has been an explosion of interest in the ability of tranexamic acid to reduce morbidity and mortality in surgical and traumatic bleeding. Tranexamic acid has been shown to reduce mortality due to traumatic bleeding by a third, without apparent safety issues. It is now clearly established that intravenous tranexamic acid reduces blood loss in patients with surgical bleeding and the need for transfusion. It can also be used topically to reduce bleeding. Its use is being explored further in large pragmatic trials in traumatic head injury, postpartum haemorrhage and in upper gastro-intestinal haemorrhage. There are few side effects from the use of tranexamic acid except when administered in high dose where neurological events have been noted, possibly relating to tranexamic acid interfering with cerebral GABA and glycine receptors. However, clinical studies suggest that there is no increased efficacy in using a higher dose, and that a dose of 1 g intravenously in an adult patient has maximal efficacy, which is not increased by higher doses. The CRASH-2 trauma trial clearly showed no increase in thrombotic events after its use in trauma, indeed there was a significant reduction in myocardial infarction. However, trials of tranexamic acid in surgery have failed to adequately study its effects on the risk of postoperative venous and possible reduction in arterial thrombo-embolism, and this needs to be the subject of future research.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Hemorrhage; Humans; Postpartum Hemorrhage; Thrombosis; Tranexamic Acid
PubMed: 25440395
DOI: 10.1111/anae.12910 -
Journal of Thrombosis and Haemostasis :... Jun 2015Tranexamic acid (TXA) reduces blood loss by inhibiting the enzymatic breakdown of fibrin. It is often used in surgery to decrease bleeding and the need for blood... (Review)
Review
Tranexamic acid (TXA) reduces blood loss by inhibiting the enzymatic breakdown of fibrin. It is often used in surgery to decrease bleeding and the need for blood transfusion. In 2011, results from a multi-center, randomized, and placebo-controlled trial (CRASH-2 trial) showed that TXA (1 g loading dose over 10 min followed by an infusion of 1 g over 8 h) safely reduces mortality in bleeding trauma patients. Initiation of TXA treatment within 3 h of injury reduces the risk of hemorrhage death by about one-third, regardless of baseline risk. Because it does not have any serious adverse effects, TXA can be administered to a wide spectrum of bleeding trauma patients. Limiting its use to the most severely injured or those with a diagnosis of 'hyperfibrinolysis' would result in thousands of avoidable deaths. A clinical trial (CRASH-3 trial) of TXA in patients with traumatic brain injury is now in progress.
Topics: Animals; Antifibrinolytic Agents; Fibrinolysis; Hemorrhage; Humans; Patient Selection; Risk Assessment; Risk Factors; Tranexamic Acid; Treatment Outcome; Wounds and Injuries
PubMed: 26149023
DOI: 10.1111/jth.12878