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TEG tranexamic acid

Lewis S Gall, Ross A Davenport
PURPOSE OF REVIEW: The role of antifibrinolytics in trauma haemorrhage and early coagulopathy remains controversial with respect to patient selection, dosage, timing of treatment, and risk of thrombotic complications. This review presents our current understanding of the mechanisms of fibrinolysis in trauma, diagnostic evaluation, and the evidence base for treatment. RECENT FINDINGS: Excessive fibrinolysis following severe injury is a major component of acute traumatic coagulopathy and contributes to the high mortality from trauma haemorrhage...
April 2018: Current Opinion in Anaesthesiology
Chaoyun Xi, Liguo Zhu, Yuan Zhuang, Shufang Wang, Guixiang Sun, Yaqian Liu, Deqing Wang
We evaluated the effectiveness of a novel hemostatic powder called Tranexamic Acid-loaded Porous Starch (TAPS) developed recently on blood clotting activity and hemostasis. The effectiveness of TAPS was evaluated by comparing hemostatic properties with those of Quick-acting Styptic Powder (QSP) and Compound Microporous Polysaccharide Haemostatic powder (CMPHP). The blood clotting activities of human blood were analyzed by thromboela-stogram (TEG) assays in vitro. The hemostatic effectiveness in vivo was evaluated using a rat model with hepatic traumatic hemorrhage...
March 2018: Clinical and Applied Thrombosis/hemostasis
Nicholas H Saadah, Pieter F van der Meer, Herm Jan M Brinkman, Dirk de Korte, Ido J Bontekoe, Herbert H Korsten, Rutger A Middelburg, Johanna G van der Bom, Martin R Schipperus
BACKGROUND: Hyperfibrinolysis has been observed in patients heavily transfused with solvent/detergent-treated pooled plasma (S/D plasma). We compared coagulation and fibrinolytic variables in blood containing S/D plasma with blood containing fresh-frozen plasma (FFP), with and without α2-antiplasmin or tranexamic acid (TXA) supplementation. STUDY DESIGN AND METHODS: Whole blood samples were reconstituted from red blood cells, platelet (PLT) concentrates, and varying mixtures of FFP and S/D plasma...
October 2017: Transfusion
Mark Walsh, Jacob Shreve, Scott Thomas, Ernest Moore, Hunter Moore, Daniel Hake, Tim Pohlman, Patrick Davis, Victoria Ploplis, Andres Piscoya, Julie Wegner, John Bryant, Anton Crepinsek, James Lantry, Forest Sheppard, Francis Castellino
The emphasis on fibrinolysis as an important contributor to trauma-induced coagulopathy (TIC) has led to a debate regarding the relative clinical significance of fibrinolysis in the setting of trauma. The debate has centered on two camps. The one camp defines fibrinolysis in trauma by standard coagulation tests as well as fibrin split products, D-dimers, and plasmin/antiplasmin levels. This camp favors a more liberal use of tranexamic acid and attributes more significance to hyperfibrinolysis in TIC. The other camp favors a definition of fibrinolysis based on the viscoelastic tests (VET), rotational thromboelastometry (ROTEM), and thromboelastography (TEG)...
March 2017: Seminars in Thrombosis and Hemostasis
Leyla Calmette, Anne-Céline Martin, Bernard Le Bonniec, Diane Zlotnik, Isabelle Gouin-Thibault, Christilla Bachelot-Loza, Pascale Gaussem, Anne Godier
AIM: Management of ticagrelor-induced bleeding is challenging as platelet transfusion is ineffective. An effective strategy is needed. This study aimed to investigate in vitro the efficacy of four haemostatic drugs (HDs), namely recombinant activated factor VII (rFVIIa), fibrinogen concentrate (Fib), tranexamic acid (TXA) and factor XIII concentrate (FXIII) to improve the haemostatic capacity in the presence of ticagrelor. METHODS: Blood was spiked with ticagrelor then supplemented by either HD or control...
September 2017: Journal of Clinical Pathology
Paul J Karanicolas, Yulia Lin, Jordan Tarshis, Calvin H L Law, Natalie G Coburn, Julie Hallet, Barto Nascimento, Janusz Pawliszyn, Stuart A McCluskey
BACKGROUND: Hyperfibrinolysis may occur due to systemic inflammation or hepatic injury that occurs during liver resection. Tranexamic acid (TXA) is an antifibrinolytic agent that decreases bleeding in various settings, but has not been well studied in patients undergoing liver resection. METHODS: In this prospective, phase II trial, 18 patients undergoing major liver resection were sequentially assigned to one of three cohorts: (i) Control (no TXA); (ii) TXA Dose I - 1 g bolus followed by 1 g infusion over 8 h; (iii) TXA Dose II - 1 g bolus followed by 10 mg/kg/hr until the end of surgery...
December 2016: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Eric Etchill, Jason Sperry, Brian Zuckerbraun, Louis Alarcon, Joshua Brown, Kevin Schuster, Lewis Kaplan, Greta Piper, Andrew Peitzman, Matthew D Neal
BACKGROUND: Massive transfusion practices have undergone several recent developments. We sought to examine institutional practices guiding hemostatic resuscitation in the setting of massive hemorrhage. STUDY DESIGN AND METHODS: A 37-question online survey was sent to American Association for the Surgery of Trauma members. RESULTS: A total of 191 surgeons from 125 institutions completed the survey. Level I and II centers composed 70 and 18% of responding sites, respectively...
October 2016: Transfusion
Anne Godier, Kiran Parmar, Karuna Manandhar, Beverley J Hunt
AIMS: Acute traumatic coagulopathy is characterised by fibrinolysis and low fibrinogen. It is unclear how much fibrinogenolysis contributes to reduce fibrinogen levels. The study aim was to: investigate in vitro the effects of tissue-plasminogen activator (t-PA) and tranexamic acid (TXA) on coagulation and fibrinolysis. METHODS: Whole blood was spiked with varying t-PA concentrations. Clauss fibrinogen levels and thrombelastography (TEG, Haemonetics) were performed, including functional fibrinogen level (FLEV)...
February 2017: Journal of Clinical Pathology
Ian Roberts
Administration of tranexamic acid (TXA) to bleeding trauma patients who are within 3 hours of injury has been shown to safely reduce mortality in bleeding trauma patients. However, some believe that thromboelastography (TEG or ROTEM) can be used to subdivide these patients into those that will benefit from TXA and those that will be harmed by it. If thromboelastography can be used in this way there could be important patient benefits. However, if the approach is misguided, patients could be denied a lifesaving treatment...
April 2016: Transfusion
Ernest E Moore, Hunter B Moore, Eduardo Gonzalez, Angela Sauaia, Anirban Banerjee, Christopher C Silliman
Postinjury fibrinolysis can manifest as three distinguishable phenotypes: 1) hyperfibrinolysis, 2) physiologic, and 3) hypofibrinolysis (shutdown). Hyperfibrinolysis is associated with uncontrolled bleeding due to clot dissolution; whereas, fibrinolysis shutdown is associated with organ dysfunction due to microvascular occlusion. The incidence of fibrinolysis phenotypes at hospital arrival in severely injured patients is: 1) hyperfibrinolysis 18%, physiologic 18%, and shutdown 64%. The mechanisms responsible for dysregulated fibrinolysis following injury remain uncertain...
April 2016: Transfusion
Atul P Kulkarni, Devendra A Chaukar, Vijaya P Patil, Rajendra B Metgudmath, Rohini W Hawaldar, Jigeeshu V Divatia
BACKGROUND AND AIMS: Transfusion of blood and blood products poses several hazards. Antifibrinolytic agents are used to reduce perioperative blood loss. We decided to assess the effect of tranexamic acid (TA) on blood loss and the need for transfusion in head and neck cancer surgery. METHODS: After Institutional Review Board approval, 240 patients undergoing supramajor head and neck cancer surgeries were prospectively randomised to either TA (10 mg/kg) group or placebo (P) group...
January 2016: Indian Journal of Anaesthesia
E Abuelkasem, S Lu, K Tanaka, R Planinsic, T Sakai
BACKGROUND: Hyperfibrinolysis is one of the main causes of non-surgical bleeding during liver transplantation (LT). Viscoelastic haemostatic assays, including thromboelastometry (ROTEM(®)) and thrombelastography (TEG(®)), can detect hyperfibrinolysis at the bedside. No study has yet demonstrated which device or assay is more suitable for detecting hyperfibrinolysis. METHODS: This prospective observational study compared ROTEM(®) and TEG(®) in isolated adult LT...
April 2016: British Journal of Anaesthesia
V Albrecht, N Schäfer, E K Stürmer, A Driessen, L Betsche, M Schenk, M Maegele
PURPOSE: Early detection and management of trauma haemorrhage and coagulopathy have been associated with improved outcomes. We assessed infrastructure, logistics and management practice of trauma-associated haemorrhage and coagulopathy across German trauma centres. METHODS: A web-based survey of 20 questions was developed using the open source survey application LimeSurvey® . It was disseminated among surgeons and anaesthetists in Germany. RESULTS: 145 Questionnaires were returned of which 106 were completed and analysed...
April 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Efrat Kelmer, Gilad Segev, Victoria Papashvilli, Naomi Rahimi-Levene, Yaron Bruchim, Itamar Aroch, Sigal Klainbart
OBJECTIVE: To assess the effects of tranexamic acid (TA) on hematological, hemostatic, and thromboelastographic analytes in healthy adult dogs. DESIGN: Prospective study. SETTING: University teaching hospital. ANIMALS: Eleven healthy, staff-owned, adult dogs. MEASUREMENTS AND MAIN RESULTS: Dogs were administered TA as an IV bolus, followed by a 3-hour constant rate infusion (CRI). Complete blood count, prothrombin time, activated partial thromboplastin time, D-dimer, antithrombin, fibrinogen, and thromboelastography (TEG) were measured prior to, and immediately after TA administration...
July 2015: Journal of Veterinary Emergency and Critical Care
E H Kim, S H Song, G S Kim, J S Ko, M S Gwak, S K Lee
BACKGROUND: "Flat-line" (no clot formation) thromboelastography (TEG) is frequently observed after graft reperfusion during liver transplantation (LT). We aimed to evaluate the incidence and causes of flat-line TEG after graft reperfusion during LT. METHODS: With institutional review board approval, data of 208 consecutive recipients who underwent LT from May 2010 to May 2012 were retrospectively reviewed. We performed 3 different types of TEG measurements at 5 minutes after graft reperfusion: native TEG (nTEG), tranexamic acid-added TEG (tTEG), and protamine-added TEG (pTEG)...
March 2015: Transplantation Proceedings
Kim Ekelund, Gabriele Hanke, Jakob Stensballe, Anne Wikkelsøe, Charlotte Krebs Albrechtsen, Arash Afshari
BACKGROUND: Postpartum hemorrhage is a potentially life-threatening albeit preventable condition that persists as a leading cause of maternal death. Identification of safe and cost-effective hemostatic treatment options remains crucial as a supplement to surgery and uterotonic agents. OBJECTIVE: This review summarizes the background, current evidence and recommendations with regard to the role of fibrinogen, tranexamic acid, prothrombin complex concentrate, desmopressin, and recombinant factor VIIa in the treatment of patients with postpartum hemorrhage...
July 2015: Acta Obstetricia et Gynecologica Scandinavica
Qintong Xu, Yi Yang, Peng Shi, Jian Zhou, Wenda Dai, Zhenjun Yao, Chi Zhang
Fibrin sealant (FS) and tranexamic acid (TXA) have been used in total knee arthroplasty (TKA) to minimize perioperative blood loss. The efficacy of FS has been debated, and few studies have looked into the effects of FS and TXA on perioperative coagulability. The current study retrospectively reviewed 100 cases of unilateral primary TKA. Twenty-five cases served as blank controls, FS was used without TXA in 23, TXA was used without FS in 20, and both FS and TXA (FS + TXA) were used in 32. FS was sprayed before wound closure whereas 1 g of TXA was intravenously administered before incision and 1 g was administered 15 min before tourniquet release...
June 2014: Bioscience Trends
H Schöchl, C J Schlimp, W Voelckel
Exsanguination represents the most common and potentially preventable cause of death in major trauma patients. Rapid surgical intervention coupled with an early and aggressive hemostatic therapy not only results in survival benefits of coagulopathic trauma patients, but also reduces the incidence of complications and costs. Standard coagulation tests are not suitable to adequately characterize the complexity of trauma-induced coagulopathy (TIC). This fact has led to a renaissance of viscoelastic tests, such as rotational thromboelastometry (ROTEM®) and thrombelastography (TEG®), which can be used as point-of-care monitors...
February 2014: Der Unfallchirurg
Robert M Van Haren, Evan J Valle, Chad M Thorson, Jassin M Jouria, Alexander M Busko, Gerardo A Guarch, Nicholas Namias, Alan S Livingstone, Kenneth G Proctor
BACKGROUND: Thromboelastography (TEG) on hospital admission can identify hypercoagulable trauma patients at risk for venous thromboembolism (VTE), but the value of TEGs obtained after multiple interventions, including tranexamic acid (TXA), has not been defined. We test the following hypotheses. (1) TEG on intensive care unit (ICU) admission can help stratify patients screened with Greenfield's risk assessment profile (RAP) for VTE. (2) TXA is a VTE risk factor, and its effect on fibrinolysis can be identified with TEG...
February 2014: Journal of Trauma and Acute Care Surgery
C Fisher, A Mo, S Warrillow, C Smith, D Jones
Disorders of clotting and coagulation are common in the intensive care unit. Diagnosis, treatment and monitoring of these disorders are traditionally based on conventional coagulation tests such as activated partial thromboplastin time (APTT) and international normalised ratio (INR). We present here a patient who developed massive postoperative haemorrhage secondary to an acquired factor VIII inhibitor. The case highlights the utility and sensitivity of thromboelastography (TEG) in the diagnosis of the condition and monitoring the response to therapy...
November 2013: Anaesthesia and Intensive Care
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