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Vance G Nielsen, Paul M Ford
Aminocaproic acid (EACA) availability has recently been decreased whereas tranexamic acid (TXA) is still available as an antifibrinolytic agent to decrease blood loss associated with procedures involving cardiopulmonary bypass (CPB) by inhibiting plasmin mediated platelet activation. Given that the clinical inclination is to substitute TXA for EACA, we sought to compare the antifibrinolytic efficacy of the two agents using the clinically accepted molar ratio of EACA:TXA (7.9:1) that prevents platelet activation in a viscoelastic based system under a variety of conditions in human plasma; 25-50% therapeutic concentration (EACA 32...
June 20, 2018: Journal of Thrombosis and Thrombolysis
Andrea L Grant, Hayley L Letson, Jodie L Morris, Peter McEwen, Kaushik Hazratwala, Matthew Wilkinson, Geoffrey P Dobson
BACKGROUND: Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce excessive bleeding and transfusion requirements. Our aim was to examine if TXA was required in all osteoarthritis patients undergoing TKA surgery, and its possible effects on systemic inflammation and coagulation properties. METHODS: Twenty-three patients (Oxford Score 22-29) were recruited consecutively; 12 patients received TXA before (IV, 1.2 g/90 kg) and immediately after surgery (intra-articular, 1...
June 18, 2018: Journal of Orthopaedic Surgery and Research
Gillian Houghton, Carol Kingdon, Michelle Dower, Haleema Shakur-Still, Zarko Alfirevic
OBJECTIVE: The WOMAN Trial was the first in the UK to use the option of waiver of informed consent at the time of an obstetric emergency. This qualitative study aimed to investigate participants' views of the acceptability of the recruitment methods used. DESIGN: Qualitative study using in-depth interviews with women who did and did not give consent at the time of their recruitment to the WOMAN Trial. SETTING: Highest UK recruitment site for the WOMAN Trial (129/569)...
June 17, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
Gregory R Stettler, Ernest E Moore, Geoffrey R Nunns, Jim Chandler, Erik Peltz, Christopher C Silliman, Anirban Banerjee, Angela Sauaia
BACKGROUND: Goal-directed hemostatic resuscitation based on thrombelastography has a survival benefit compared to conventional coagulation assays. While thrombelastography transfusion thresholds for patients at risk for massive transfusion (MT) have been defined, similar cutoffs do not exist for the other commonly used viscoelastic assay, rotational thromboelastometry (ROTEM). The purpose of this study was to develop ROTEM blood product thresholds in patients at risk for MT. METHODS: ROTEM was assessed in trauma activation patients admitted from 2010 to 2016 (n = 222)...
August 2018: Journal of Surgical Research
Moslem Shakeri, Firooz Salehpour, Ghaffar Shokouhi, Kamkar Aeinfar, Javad Aghazadeh, Farhad Mirzaei, Seyed Ahmad Naseri Alavi
STUDY DESIGN: A randomized double-blind placebo controlled study. PURPOSE: In the present study, we aimed to assess the efficacy of tranexamic acid (TXA) in reducing blood loss after laminectomy and posterolateral fusion of the spine. OVERVIEW OF LITERATURE: Blood loss is the most significant complication involved with surgery, especially in spinal surgery. Multilevel laminectomy and laminectomy with instrumentation (pedicle screws and rods) are complex spine surgeries and are considered as medium-risk procedures for bleeding...
June 2018: Asian Spine Journal
J L Saes, S E M Schols, W L van Heerde, M R Nijziel
Hyperfibrinolytic bleeding can be caused by a deficiency of one of the inhibitors of fibrinolysis (plasminogen activator inhibitor type 1 (PAI-1) or α2-antiplasmin (α2-AP), or an excess of one of the activators of fibrinolysis: tissue type plasminogen activator or urokinase type plasminogen activator. This review focuses on the clinical implications of these disorders. The bleeding phenotype of fibrinolytic disorders is characterized by delayed bleeding after trauma, surgery and dental procedures. Bleeding in areas of high fibrinolytic activity is also common, such as menorrhagia and epistaxis...
May 30, 2018: Journal of Thrombosis and Haemostasis: JTH
Sumaya Huque, Ian Roberts, Bukola Fawole, Rizwana Chaudhri, Sabaratnam Arulkumaran, Haleema Shakur-Still
BACKGROUND: Peripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas. METHODS: We used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage...
May 29, 2018: BMC Pregnancy and Childbirth
M J R Desborough, C A T Hildyard, S J Stanworth
No abstract text is available yet for this article.
May 24, 2018: Journal of Thrombosis and Haemostasis: JTH
Irene de Miguel, Josune Orbe, Juan A Sánchez-Arias, José A Rodríguez, Agustina Salicio, Obdulia Rabal, Miriam Belzunce, Elena Sáez, Musheng Xu, Wei Wu, Haizhong Tan, Hongyu Ma, José A Páramo, Julen Oyarzabal
In an effort to find novel chemical series as antifibrinolytic agents, we explore α-phenylsulfonyl-α-spiropiperidines bearing different zinc-binding groups (ZBGs) to target those metalloproteinases involved in the fibrinolytic process: MMP3 and MMP10. Surprisingly, all these new chemical series were inactive against these metalloproteinases; however, several new molecules retained the antifibrinolytic activity in a phenotypic functional assay using thromboelastometry and human whole blood. Further optimization led to compound 38 as a potent antifibrinolytic agent in vivo, three times more efficacious than the current standard-of-care (tranexamic acid, TXA) at 300 times lower dose...
May 10, 2018: ACS Medicinal Chemistry Letters
Nicoleta Stoicea, Kenneth Moran, Abdel-Rasoul Mahmoud, Andrew Glassman, Thomas Ellis, John Ryan, Jeffrey Granger, Nicholas Joseph, Nathan Salon, Wiebke Ackermann, Barbara Rogers, Weston Niermeyer, Sergio D Bergese
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic agent that has shown promise in reducing blood loss during total hip arthroplasty (THA). Several studies have reported side effects of high-dose TXA administration, including myocardial infarction (MI), thromboembolic events, and seizures. These possible side effects have prevented the widespread adoption of TXA in the surgical community. METHODS: We conducted a retrospective chart review of 564 primary and revision THAs performed at a single academic center...
May 2018: Medicine (Baltimore)
Stav Brown, Amy Yao, Peter J Taub
BACKGROUND: Prevention of blood loss is a chief consideration in plastic and reconstructive surgery. The antifibrinolytic drugs tranexamic acid and ε-aminocaproic acid have emerged as promising agents to reduce both perioperative blood loss and transfusion requirements. However, published reports in the plastic surgery literature are lacking. The authors sought to summarize the current knowledge of the use of antifibrinolytics in plastic surgery by reviewing the existing literature for clinical outcomes and recommendations...
June 2018: Plastic and Reconstructive Surgery
Athena Kritharis, Hanny Al-Samkari, David J Kuter
Hereditary Hemorrhagic Telangiectasia, also known as Osler-Weber-Rendu syndrome, is an autosomal dominant disorder that causes abnormal blood vessel formation. The diagnosis of hereditary hemorrhagic telangiectasia is clinical, based on the Curacao criteria. Genetic mutations that have been identified include ENG, ACVRL1/ALK1, and MADH4/SMAD4, among others. Patients with hereditary hemorrhagic telangiectasia may have telangiectasias and arteriovenous malformations in various organs and suffer from many complications including bleeding, anemia, iron deficiency, and high output heart failure...
May 24, 2018: Haematologica
Sophie Testa, Walter Ageno, Emilia Antonucci, Rossella Morandini, Jan Beyer-Westendorf, Maurizio Paciaroni, Marc Righini, Piera Sivera, Peter Verhamme, Vittorio Pengo, Daniela Poli, Gualtiero Palareti
The management of major bleeding in patients treated with direct oral anticoagulants (DOACs) is still not well established. START-Events, a branch of the START registry (Survey on anTicoagulated pAtients RegisTer) (NCT02219984), aims to describe the actual management of bleeding or recurrent thrombotic events in routine clinical practice. We here present the results of the management of bleeding patients. The START-Event registry is a prospective, observational, multicenter, international study. Baseline characteristics (demographic, clinical, risk factors) of patients, laboratory data at admission and during follow-up, site of bleeding, therapeutic strategies, and outcomes at the time of hospital discharge and after 6 months were recorded on a web-based case report form...
May 22, 2018: Internal and Emergency Medicine
Rikke Stagaard, Matthew J Flick, Barbara Bojko, Krzysztof Goryński, Paulina Z Goryńska, Carsten D Ley, Lisbeth H Olsen, Tom Knudsen
BACKGROUND: Fibrinolysis may exacerbate bleeding in haemophilia A (HA). Accordingly, antifibrinolytics have been used to help maintain haemostatic control. While antifibrinolytic drugs have been proven effective in the treatment of mucosal bleeds in the oral cavity, their efficacy in non-mucosal tissues remain an open question of significant clinical interest. OBJECTIVE: To determine whether inhibiting fibrinolysis improves the outcome in non-mucosal haemophilic tail vein transection (TVT) bleeding models, and to determine whether a standard ex vivo clotting/fibrinolysis assay can be used as a predictive surrogate for in vivo efficacy...
May 14, 2018: Journal of Thrombosis and Haemostasis: JTH
Massimo Franchini, Carlo Mengoli, Mario Cruciani, Valentino Bergamini, Francesca Presti, Giuseppe Marano, Simonetta Pupella, Stefania Vaglio, Francesca Masiello, Eva Veropalumbo, Vanessa Piccinini, Ilaria Pati, Giancarlo M Liumbruno
BACKGROUND: A number of clinical systematic review and meta-analysis have been published on the use of tranexamic in the obstetric setting. The aim of this meta-analysis was to evaluate the safety and effectiveness of tranexamic acid in reducing blood loss when given prior to caesarean delivery. MATERIALS AND METHODS: We searched the Cochrane Wounds Specialized Register, Cochrane Central, MEDLINE (through PUBMED), Embase, and SCOPUS electronic databases. We also searched clinical trials registries for ongoing and unpublished studies, and checked reference lists to identify additional studies...
April 3, 2018: Blood Transfusion, Trasfusione del Sangue
Dilek Gurlek Gokcebay, Vildan Culha, Nese Yarali, Namik Yasar Ozbek
: Type III von Willebrand's disease (vWD) is an inherited bleeding disorder, which is frequently associated with menorrhagia in women. Treatment options include antifibrinolytics, desmopressin, von Willebrand factor/factor VIII concentrates and in intractable bleeding circumstances recombinant factor VIIa (rFVIIa). We present an adolescent case with type III vWD who had a menorrhagia at menarche that was refractory to the standard treatment and ultimately was treated with rFVIIa successfully.
May 9, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Charles Cody White, Josef K Eichinger, Richard J Friedman
Blood loss management is critical to positive outcomes in patients undergoing total knee arthroplasty (TKA). Transfusions are associated with an increased risk of major and minor adverse events, length of hospitalization, and overall cost associated with surgery. Many techniques have been investigated and compared. Tranexamic acid (TXA), an antifibrinolytic drug widely known to reduce blood loss, may be a bridge to the goal of eliminating blood transfusions from TKA. Administration of TXA can be performed intravenously, topically at the knee joint, orally, or in combination...
May 4, 2018: Journal of Knee Surgery
Peipei Guo, Zike He, Yanhua Wang, Fuqiang Gao, Wei Sun, Wanshou Guo, Zirong Li, Liming Cheng
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic drug widely used as a blood-sparing technique in total knee arthroplasty (TKA), and it is usually administrated by intravenous or intraarticular injection. Recently, the oral form of TXA has been applied in TKA patients. However, there is no final consensus regarding the effectiveness and safety of oral TXA. The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy and safety of oral TXA versus control for blood loss after TKA...
May 2018: Medicine (Baltimore)
N Sigrist, L Olgiati, R S Jud Schefer
Tranexamic acid (TXA) is an antifibrinolytic drug that is used for uncontrolled bleeding of various origin. This retrospective study investigated the effect of tranexamic acid administration on bleeding tendency in dogs with surgically managed hemoperitoneum. Thirty dogs were treated with (TXA group) and 25 dogs without (CTR group) tranexamic acid prior to surgery. Various parameters (decrease in haematocrit, number of transfusions, shock index and changes in abdominal fluid accumulation) were used for characterization of bleeding tendency and compared between groups...
May 2018: Schweizer Archiv Für Tierheilkunde
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