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https://www.readbyqxmd.com/read/28107785/blood-management-strategies-to-reduce-transfusions-after-elective-lower-extremity-joint-arthroplasty-surgeries
#1
Ankit Kansagra, Chester Andrzejewski, Robert Krushell, Andrew Lehman, Jordan Greenbaum, Paul Visintainer, Joan McGirr, Kathleen Mahoney, Darlene Cloutier, Alice Ehresman, Mihaela S Stefan
Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post...
January 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/28103911/comparison-of-the-effectiveness-and-safety-of-topical-versus-intravenous-tranexamic-acid-in-primary-total-knee-arthroplasty-a-meta-analysis-of-randomized-controlled-trials
#2
Tao-Ping Chen, Yu-Min Chen, Jian-Bao Jiao, Yun-Fei Wang, Li-Gang Qian, Zhao Guo, Zheng Ma, Cui-Yu Han, Tong-Huan Shi
BACKGROUND: This study aims to compare the effectiveness and safety of topical versus intravenous tranexamic acid (TXA) in reducing blood loss in primary total knee arthroplasty (TKA). METHODS: PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedicine Literature (CBM), Wanfang Database and China National Knowledge Infrastructure (CNKI), and Google Scholar were searched for randomized controlled studies (RCTs) that compared topical versus intravenous TXA in terms of reducing blood loss during TKA from their inception to September 2015...
January 19, 2017: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/28102879/the-conservative-and-pharmacological-management-of-chronic-subdural-haematoma
#3
Jehuda Soleman, Fabio Noccera, Luigi Mariani
Chronic subdural haematoma (cSDH), one of the most common neurosurgical entities, occurs typically in elderly patients. The incidence is expected to double by the year 2030, owing to the continuous aging of the population. Surgery is usually the treatment of choice, but conservative treatment may be a good alternative in some situations. We provide a systematic review of studies analysing the conservative treatment options and the natural history of cSDH. Of 231 articles screened, 35 were included in this systematic review...
January 19, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28102538/comparing-early-liver-graft-function-from-heart-beating-and-living-donors-a-pilot-study-aiming-to-identify-new-biomarkers-of-liver-injury
#4
Qi Joy Yang, Michael Kluger, Krzysztof Goryński, Janusz Pawliszyn, Barbara Bojko, Ai-Ming Yu, Keumhan Noh, Markus Selzner, Angela Jerath, Stuart McCluskey, K Sandy Pang, Marcin Wąsowicz
: Liver and kidney functions among recipients of liver transplantation (LT) surgery with heart beating (HBD, n = 13) or living donors (LD, n = 9) with different cold ischemic times were examined during the neohepatic phase for clearing rocuronium bromide (ROC, cleared by liver and kidney) and tranexamic acid (TXA, cleared by kidney). Solid phase micro-extraction and LC-MS/MS was applied to determine the plasma concentrations of ROC and TXA, and creatinine was determined by standard laboratory methods...
January 19, 2017: Biopharmaceutics & Drug Disposition
https://www.readbyqxmd.com/read/28099726/a-systematic-review-and-meta-analysis-of-the-effect-of-prophylactic-tranexamic-acid-treatment-in-major-benign-uterine-surgery
#5
REVIEW
Märta F Topsoee, Annette Settnes, Bent Ottesen, Thomas Bergholt
BACKGROUND: The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear. OBJECTIVES: To evaluate the antihemorrhagic effect of prophylactic TA treatment in major benign uterine surgery. SEARCH STRATEGY: PubMed, Embase, Cochrane Library, and Web of Science were searched from 1980 to 2015 without language restriction using search terms related to major uterine surgery combined with TA. SELECTION CRITERIA: Randomized controlled trials comparing prophylactic TA with placebo or no intervention in women undergoing elective major benign uterine surgery...
February 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28093896/intravenous-combined-with-topical-administration-of-tranexamic-acid-in-primary-total-hip-arthroplasty-a-randomized-controlled-trial
#6
Yi Zeng, Hai-Bo Si, Bin Shen, Jing Yang, Zong-Ke Zhou, Peng-de Kang, Fu-Xing Pei
OBJECTIVE: Although there are still some controversies, large previous studies have confirmed that intravenous (i.v.) tranexamic acid (TXA) can effectively reduce blood loss and transfusions in total hip arthroplasty (THA) without increasing the risk of deep venous thrombosis. However, few studies have investigated the combination of i.v. and topical application of TXA in primary THA. The purpose of our current study is to examine whether i.v. combined with topical administration of TXA decreases postoperative blood loss and transfusion rates after THA...
January 17, 2017: Orthopaedic Surgery
https://www.readbyqxmd.com/read/28090594/effects-of-tranexamic-acid-on-platelet-function-and-thrombin-generation-etaplat-woman-trial-sub-study
#7
Kastriot Dallaku, Haleema Shakur, Ian Roberts, Phil Edwards, Danielle Beaumont, Maria Delius, Braun Siegmund, Orion Gliozheni, Ilir Tasha, Saimir Cenameri, Ulrich Mansmann
Background. Postpartum haemorrhage (PPH) is a leading cause of maternal death. Tranexamic acid (TXA) has the potential to reduce bleeding and a large randomized placebo controlled trial of its effect in women with PPH (The WOMAN trial) is underway. TXA might also affect coagulation factors and platelets.  Objectives. To examine the effect of TXA on thrombin generation, platelet function, fibrinogen, D-dimer and coagulation factors in women with PPH.  Methods. We will conduct a sub-study within the WOMAN trial...
December 15, 2016: Wellcome Open Res
https://www.readbyqxmd.com/read/28089468/obtain-a-outcome-benefits-of-tranexamic-acid-in-hip-arthroplasty-a%C3%A2-randomized-double-blinded-controlled-trial
#8
Andrew Fraval, Peter Effeney, Lena Fiddelaers, Belinda Smith, Ben Towell, Phong Tran
BACKGROUND: We examined whether the blood conserving effect of tranexamic acid (TXA) in total hip arthroplasty using the direct anterior approach, translates to an effect on functional outcomes in the perioperative period. METHODS: We conducted a single-center, randomized, double-blinded, placebo-controlled trial. One hundred one patients were randomized to receive either TXA or an equivalent volume of normal saline. The primary outcome measure was thigh swelling...
December 8, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28079258/combined-effect-of-therapeutic-strategies-for-bleeding-injury-on-early-survival-transfusion-needs-and-correction-of-coagulopathy
#9
K Balvers, S van Dieren, K Baksaas-Aasen, C Gaarder, K Brohi, S Eaglestone, S Stanworth, P I Johansson, S R Ostrowski, J Stensballe, M Maegele, J C Goslings, N P Juffermans
BACKGROUND: The combined effects of balanced transfusion ratios and use of procoagulant and antifibrinolytic therapies on trauma-induced exsanguination are not known. The aim of this study was to investigate the combined effect of transfusion ratios, tranexamic acid and products containing fibrinogen on the outcome of injured patients with bleeding. METHODS: A prospective multicentre observational study was performed in six level 1 trauma centres. Injured patients who received at least 4 units of red blood cells (RBCs) were analysed and divided into groups receiving a low (less than 1 : 1) or high (1 or more : 1) ratio of plasma or platelets to RBCs, and in receipt or not of tranexamic acid or fibrinogen products (fibrinogen concentrates or cryoprecipitate)...
January 12, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28076488/use-of-tranexamic-acid-in-trauma-patients-an-analysis-of-cost-effectiveness-for-use-in-brazil
#10
Marcelo A Pinto, Jair G da Silva, Aljamir D Chedid, Marcio F Chedid
Introduction: Use of tranexamic acid (TXA) in trauma has been the subject of growing interest by researchers and health professionals. However, there are still several open questions regarding its use. In some aspects medical literature is controversial. The points of disagreement among experts include questions such as: Which patients should receive TXA in trauma? Should treatment be performed in the pre-hospital environment? Is there any need for laboratory parameters before starting TXA treatment? What is the drug safety profile? The main issue on which there is still no basis in literature is: What is the indication for treatment within massive transfusion protocols? Objective: Answer the questions proposed based on critical evaluation of the evidence gathered so far and carry out a study of cost-effectiveness of TXA use in trauma adapted to the Brazilian reality...
November 2016: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
https://www.readbyqxmd.com/read/28072709/tranexamic-acid-reduces-perioperative-blood-loss-of-posterior-lumbar-surgery-for-stenosis-or-spondylolisthesis-a-randomized-trial
#11
Houyin Shi, Yunsheng Ou, Dianming Jiang, Zhengxue Quan, Zenghui Zhao, Yong Zhu
BACKGROUND: A prospective, randomized, double-blind, placebo-controlled study was performed. The routine usage of TA in spinal surgery is controversial. Only a few studies have focused on patients undergoing posterior lumbar surgery for stenosis or spondylolisthesis, although a large clinical cohort exists in the population. This study aimed to evaluate the effect and safety of TA in reducing perioperative blood loss in posterior lumbar surgery for stenosis or spondylolisthesis. METHODS: 100 eligible patients out of 126 were randomized to receive either a bolus dose of 30 mg/kg TA i...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28072700/is-prophylactic-tranexamic-acid-administration-effective-and-safe-for-postpartum-hemorrhage-prevention-a-systematic-review-and-meta-analysis
#12
Chunbo Li, Yuping Gong, Lingling Dong, Bingying Xie, Zhiyuan Dai
BACKGROUND: To assess the efficacy and safety of tranexamic acid (TA) in reducing blood loss and lowering transfusion needs for patients undergoing caesarean section (CS) or vaginal delivery (VD). METHODS: An electronic literature search of PubMed, EMBASE, OVID, Cochrane library, Scopus, Central, and Clinical trials.gov was performed to identify studies that evaluating the usage of TA in CS or VD. The methodological quality of included trials was assessed and data extraction was performed...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28070235/bevacizumab-and-gastrointestinal-bleeding-in-hereditary-hemorrhagic-telangiectasia
#13
George Ou, Cherry Galorport, Robert Enns
We report a case of severe, refractory gastrointestinal (GI) bleeding in a patient with hereditary hemorrhagic telangiectasia (HHT) whose massive transfusion dependence was lifted shortly after treatment with bevacizumab, an anti-vascular endothelial growth factor. The patient's bleeding had been refractory to repeated endoscopic interventions, tranexamic acid, and tamoxifen. However, following treatment with bevacizumab at 5 mg/kg every other week, nearly 300 units of packed red blood cell transfusions were avoided in one year's time...
December 27, 2016: World Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28068786/topical-and-low-dose-intravenous-tranexamic-acid-in-cyanotic-cardiac-surgery
#14
Jigar Patel, Mrugesh Prajapati, Hardik Patel, Hemang Gandhi, Shilpa Deodhar, Himani Pandya
Background Coagulopathy is a major problem in surgery for cyanotic congenital heart disease. Tranexamic acid has been used both topically and systemically and plays a vital role in pediatric cardiac surgery by reducing blood loss and blood product requirement. We aimed to determine the anti-fibrinolytic effectiveness of low-dose systemic or topical tranexamic acid or a combination of both. Methods Seventy-five patients were divided in 3 groups of 25. Group A patients were given tranexamic acid 20 mg kg(-1) intravenously after sternotomy and 20 mg kg(-1) after heparin reversal...
January 1, 2017: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/28061495/effectiveness-and-safety-of-tranexamic-acid-in-spinal-deformity-surgery
#15
Ho Yong Choi, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim
OBJECTIVE: Spinal deformity surgery has the potential risk of massive blood loss. To reduce surgical bleeding, the use of tranexamic acid (TXA) became popular in spinal surgery, recently. The purpose of this study was to determine the effectiveness of intra-operative TXA use to reduce surgical bleeding and transfusion requirements in spinal deformity surgery. METHODS: A total of 132 consecutive patients undergoing multi-level posterior spinal segmental instrumented fusion (≥5 levels) were analyzed retrospectively...
January 1, 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/28041551/-haemostatic-resuscitation-in-bleeding-trauma-patients
#16
Jakob Stensballe, Pär I Johansson, Jacob Steinmetz
Trauma haemorrhage is a common reversible cause of death. Haemostatic resuscitation focuses on replacing the lost blood with transfusions equivalent to whole blood as early as possible. In Denmark, the optimal ratio for transfusions in massive bleeding is four packs of red blood cells, four packs of plasma and one pool of platelets (equal to ratio 1:1:1 in USA). Haemostatic resuscitation also includes a restricted use of crystalloids, early tranexamic acid, and a goal-directed transfusion therapy by using viscoelastic haemostatic assays to detect coagulopathy and the need for additional transfusions or pro-haemostatics...
December 26, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28035773/additional-intraarticular-tranexamic-acid-further-reduced-postoperative-blood-loss-compared-to-intravenous-and-topical-bathed-tranexamic-acid-in-total-hip-arthroplasty-a-retrospective-sequential-series-study
#17
Nariaki Nakura, Kazuo Hirakawa, Satoshi Takayanagi, Akira Saito, Koji Tsuji, Yasunobu Tamaki, Shunsuke Ochiai, Masahiko Mihara
BACKGROUND: Topical tranexamic acid (TXA) administration has been described to be effective in decreasing blood loss in total hip arthroplasty (THA). The aim of this retrospective study was to evaluate whether topical intraarticular TXA administration in addition to intravenous (IV) and topical bathed TXA further reduces blood loss in THA patients. STUDY DESIGN AND METHODS: Four-hundred patients were enrolled in this sequential series study with two different phases during four different time periods...
December 30, 2016: Transfusion
https://www.readbyqxmd.com/read/28033139/air-medical-administration-of-tranexamic-acid
#18
Brian Cornelius
Traumatic injury is a significant cause of morbidity and mortality in the United States. Massive hemorrhage is responsible for the vast majority of deaths. Evolution in trauma treatment has resulted in major improvements to emergency care. Tranexamic acid (TXA), an antifibrinolytic agent, is synthetically derived from amino acids. The CRASH-2 study demonstrated that the early administration of TXA results in significant decreases in morbidity and mortality. Experiences by coalition forces in Southwest Asia found a substantial increase in survival of trauma patients with early TXA administration...
January 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28031511/use-of-tranexamic-acid-in-dynamic-hip-screw-plate-fixation-for-trochanteric-fractures
#19
Ranjit Kumar Baruah, Pranab Jyoti Borah, Russel Haque
PURPOSE: To evaluate perioperative blood loss and blood transfusion requirement in patients who underwent dynamic hip screw plate fixation for a stable trochanteric fracture with or without preoperative intravenous tranexamic acid (TXA). METHODS: 49 men and 11 women (mean age, 56.5 years) who underwent open reduction and internal fixation with a dynamic hip screw plate for a stable trochanteric fracture by a single surgeon were equally randomised to receive either a single dose of intravenous TXA (15 mg/kg) 15 minutes prior to surgery or an equal volume of normal saline by slow infusion...
December 2016: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28026726/-intra-articular-application-of-tranexamic-acid-significantly-reduces-blood-loss-and-transfusion-requirement-in-primary-total-knee-arthroplasty
#20
J Lošťák, J Gallo, J Špička, K Langová
PURPOSE OF THE STUDY The aim of this prospective study was to investigate the effect of topical application of tranexamic acid (TXA, Exacyl) on the amount of post-operative blood loss, and blood transfusion requirement in patients undergoing primary total knee arthroplasty (TKA). Attention was paid to early complications potentially associated with TXA administration, such as haematoma, wound exudate, or knee swelling. In addition, the economic benefit of TXA treatment was also taken into account. MATERIAL AND METHODS The study included 238 patients (85 men and 153 women) who underwent primary total knee arthroplasty (TKA) at our department between January 2013 and November 2015...
2016: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
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