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https://www.readbyqxmd.com/read/28993489/civilian-and-military-doctors-knowledge-of-tranexamic-acid-txa-use-in-major-trauma-a-comparison-study
#1
Jonathan Blair Thomas Herron, R French, A D Gilliam
INTRODUCTION: Tranexamic acid (TXA) administration within the recommended time of 3 hours has been demonstrated to improve outcomes following trauma. The aim of this study was to identify potential knowledge gaps in the administration of TXA in order to target further educational training in those doctors responsible for the management of acute trauma. METHODS: 104 military and 852 civilian doctors were invited to complete a four-item web-based questionnaire pertaining to the indications, dose, side effects and evidence base for TXA administration in trauma...
October 9, 2017: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/28987273/tranexamic-acid-impairs-hippocampal-synaptic-transmission-mediated-by-gamma-aminobutyric-acid-receptor-type-a
#2
Hedwig Irl, Stephan Kratzer, Stefan Schwerin, Eberhard Kochs, Manfred Blobner, Gerhard Schneider, Gerhard Rammes, Rainer Haseneder
High-dose application of tranexamic acid (TXA), a widely used antifibrinolytic drug, can cause seizures in patients undergoing surgery. Mechanistically, seizures are considered to arise from an imbalance between inhibitory and excitatory synaptic transmission, whose main transmitters are gamma-aminobutyric acid (GABA) and glutamate. In the present study, we investigated the effects of TXA on neuronal excitability and synaptic transmission in the hippocampus, a structure that plays a pivotal role in human epilepsy...
October 5, 2017: European Journal of Pharmacology
https://www.readbyqxmd.com/read/28980475/comparison-of-oral-and-intravenous-tranexamic-acid-for-prevention-of-perioperative-blood-loss-in-total-knee-and-total-hip-arthroplasty
#3
Mary Alice Gortemoller, Bryan Allen, Rochelle Forsyth, Kimberly Theiss, Kristal Cunningham, Calvin Tucker
BACKGROUND: Tranexamic acid (TA) is an antifibrinolytic agent that prevents perioperative blood loss in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). This benefit has been established with the intravenous (IV) dosage form, but there is limited evidence evaluating oral TA in this setting. OBJECTIVE: To compare the effect of oral versus IV TA on perioperative blood loss in those undergoing TKA or THA. METHODS: In this single-centered retrospective chart review, participants at least 18 years of age who received IV or oral TA from a single surgeon who performed their THA or TKA were included...
October 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28976426/blood-conservation-using-tranexamic-acid-is-not-superior-to-epsilon-aminocaproic-acid-after-total-knee-arthroplasty
#4
RANDOMIZED CONTROLLED TRIAL
Clifford Kent Boese, Leslie Centeno, Ryan W Walters
BACKGROUND: Epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) are synthetic amino acid derivatives that interfere with fibrinolysis, promoting hemostasis by pharmacological means. Although both drugs have been shown to decrease blood loss with a minimal risk of thromboembolic adverse events following cardiac and vascular surgery, we are aware of only 1 published trial that directly compared the antifibrinolytic effects of EACA with those of TXA after total knee arthroplasty (TKA)...
October 4, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28972200/fibrinogen-modified-sodium-alginate-as-a-scaffold-material-for-skin-tissue-engineering
#5
Elena V Solovieva, Alexander Yu Fedotov, Vasily E Mamonov, Vladimir S Komlev, Andrey A Panteleyev
In search for a new pro-angiogenic scaffold material suitable for skin bioengineering and grafting therapy, we have fabricated a number of composite sodium alginate (AG) - fibrinogen (FG) sponge scaffolds using the freeze-drying approach. Thrombin was added to drive FG/fibrin conversion, while ε-aminocapronic acid (εAc) was used as antifibrinolytic component. The slow rates of scaffold biodegradation were achieved by using Ca2+ and Mg2+ cations as cross-linking agents. The novel thrombin-modified AG-FG scaffolds with highly interconnected porous structure were evaluated using scanning electron microscopy, tensile testing and pycnometric analysis...
October 3, 2017: Biomedical Materials
https://www.readbyqxmd.com/read/28940923/blood-conservation-in-cardiac-surgery
#6
REVIEW
G Blaudszun, A Butchart, A A Klein
This article aims at reviewing the currently available evidence about blood conservation strategies in cardiac surgery. Pre-operative anaemia and perioperative allogeneic blood transfusions are associated with worse outcomes after surgery. In addition, transfusions are a scarce and costly resource. As cardiac surgery accounts for a significant proportion of all blood products transfused, efforts should be made to decrease the risk of perioperative transfusion. Pre-operative strategies focus on the detection and treatment of anaemia...
September 21, 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/28939033/epsilon-aminocaproic-acid-to-reduce-blood-loss-and-transfusion-after-total-hip-and-total-knee-arthroplasty
#7
Juliann C Hobbs, Ian J Welsby, Cynthia L Green, Ishwori B Dhakal, Samuel S Wellman
BACKGROUND: Total hip and knee arthroplasty (THA and TKA) are associated with significant blood loss and some patients require postoperative blood transfusion. While tranexamic acid has been studied extensively among this population, we tested the hypothesis that epsilon aminocaproic acid (EACA) can reduce blood loss and transfusion after joint arthroplasty. METHODS: In April 2014, our Veterans Affairs Medical Center introduced a protocol to administer EACA during THA and TKA...
August 24, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28938282/efficacy-and-safety-of-tranexamic-acid-in-orthopaedic-fracture-surgery-a-meta-analysis-and-systematic-literature-review
#8
Kamil M Amer, Saqib Rehman, Kamal Amer, Christopher Haydel
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic drug that has been shown to be effective in reducing blood loss and the need for transfusions after several orthopaedic surgeries. However, the effectiveness of TXA use in orthopaedic fracture surgeries still remains unclear. The purpose of this meta-analysis was to review existing literature with interest in the effectiveness and safety of TXA treatment in reducing total blood loss and transfusion rates for patients who underwent surgery for fracture repairs...
October 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28920517/bleeding-control-in-palliative-care-patients-with-the-help-of-tranexamic-acid
#9
Marcus J P Geist, Jens Kessler, Susanne Frankenhauser, Hubert J Bardenheuer
BACKGROUND: Persistent bleeding is a common reason for admitting patients with advanced cancer to a palliative care unit. Several reports show a successful therapeutic use of the antifibrinolytic agent tranexamic acid in palliative care patients having hemorrhages. However, it is not administered routinely in severe bleeding situations in palliative care, and general dosing recommendations are unclear. CASE PRESENTATION: We report on 3 patients who were treated with tranexamic acid due to symptomatic hemorrhage complicating different malignant processes...
January 1, 2017: Journal of Palliative Care
https://www.readbyqxmd.com/read/28918481/fibrinolysis-in-trauma-a-review
#10
REVIEW
M J Madurska, K A Sachse, J O Jansen, T E Rasmussen, J J Morrison
Fibrinolytic dysregulation is an important mechanism in traumatic coagulopathy. It is an incompletely understood process that consists of a spectrum ranging from excessive breakdown (hyperfibrinolysis) and the shutdown of fibrinolysis. Both hyperfibrinolysis and shutdown are associated with excess mortality and post-traumatic organ failure. The pathophysiology appears to relate to endothelial injury and hypoperfusion, with several molecular markers identified in playing a role. Although there are no universally accepted diagnostic tests, viscoelastic studies appear to offer the greatest potential for timely identification of patients presenting with fibrinolytic dysregulation...
September 16, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28904799/clinical-significance-of-measuring-plasminogen-activator-inhibitor-1-in-sepsis
#11
Toshiaki Iba, Jecko Thachil
BACKGROUND: Disseminated thrombotic process in the microcirculation is considered to be an important cause of multiple organ dysfunction in sepsis. The fundamental purpose of this prothrombotic change was believed to be in the host defense against microbial dissemination. In that process, antifibrinolytic property plays an important role. MAIN BODY: For the understanding of pathophysiology of sepsis, it is quite useful to grasp the alterations in coagulation/fibrinolytic parameters, i...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28902964/plasmatic-coagulation-and-fibrinolysis-in-healthy-and-otostrongylus-affected-northern-elephant-seals-mirounga-angustirostris
#12
Sarrah Kaye, Shawn Johnson, Carlos Rios, Daniel J Fletcher
BACKGROUND: Prepatent Otostrongylus arteritis results in hemorrhagic diathesis in free-ranging Northern elephant seals (Mirounga angustirostris) attributed to aberrant larval migration of the lungworm, Otostrongylus circumlitus. Clinical signs are often nonspecific, including lethargy, anorexia, and blepharospasm, but can progress to spontaneous frank hemorrhage and death within 72 hours of onset. Previously published case reports describe coagulopathy with prolonged PT and APTT, normal to elevated platelet counts, normal antithrombin concentrations, and low concentrations of fibrinogen degradation products...
September 13, 2017: Veterinary Clinical Pathology
https://www.readbyqxmd.com/read/28885402/tranexamic-acid-for-the-management-of-obstetric-hemorrhage
#13
Luis D Pacheco, Gary D V Hankins, Antonio F Saad, Maged M Costantine, Giuseppe Chiossi, George R Saade
Obstetric hemorrhage remains the most common cause of maternal mortality worldwide. It is believed that increased fibrinolytic activity, secondary to release and activation of endothelial tissue plasminogen activator, is involved in its pathogenesis. Tranexamic acid (TXA), an antifibrinolytic agent, has been shown to be beneficial in trauma patients if used within 3 hours of injury. A recent large randomized controlled trial showed that TXA given to hemorrhaging women within 3 hours after delivery was associated with decreased risk of death resulting from bleeding with no increase in thromboembolic complications...
October 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28874237/-drowning-induced-hyperfibrinolytic-disseminated-intravascular-coagulation
#14
Andreas Lund Hattesen, Henrik Karsten Berg, Lars Folkersen, Anne-Mette Hvas
This article summarizes the current knowledge of drowning-induced hyperfibrinolytic disseminated intravascular coagulation. Drowning induces respiratory failure with ensuing cardiac arrest, hypoxaemia and ischaemia. A coagulopathy is induced by ischaemia, acidosis and hypothermia, and clinically the patient develops uncontrolled bleeding due to hyperfibrinolysis. A rapid diagnostic approach is required to recognize this hyperfibrinolytic state, since initiation of treatment with antifibrinolytics and fibrinogen concentrate may bring this life-threatening condition to cessation...
August 28, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28803773/low-dose-versus-high-dose-tranexamic-acid-reduces-the-risk-of-nonischemic-seizures-after-cardiac-surgery-with-cardiopulmonary-bypass
#15
Pierre Couture, Jean-Sébastien Lebon, Éric Laliberté, Georges Desjardins, Marie-Ève Chamberland, Christian Ayoub, Antoine Rochon, Jennifer Cogan, André Denault, Alain Deschamps
OBJECTIVE: The incidence of postoperative nonischemic seizures associated with the use of tranexamic acid (TXA) and the possibility of prevention with a low-dose regimen of TXA were evaluated. DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PARTICIPANTS: A total of 12,195 patients who underwent cardiac surgical procedures under cardiopulmonary bypass (CPB) were evaluated. INTERVENTIONS: The files of every clinical seizure case diagnosed in the surgical intensive care unit between April 2006 and April 2014 were reviewed...
October 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28802375/post-tonsillectomy-hemorrhagic-outcomes-in-children-with-bleeding-disorders-at-a-single-institution
#16
Priyesh N Patel, Alexandra M Arambula, Allison P Wheeler, Edward B Penn
OBJECTIVE: To report on the post-tonsillectomy bleeding outcomes and factors associated with hemorrhage among children with pre- or post-operatively diagnosed bleeding disorders treated with an institutional protocol. METHODS: Retrospective cohort study of patients with hematologic disorders who underwent tonsillectomy between 2003 and 2016 and were treated with perioperative desmopressin or factor replacement and/or aminocaproic acid. Postoperative outcomes were compared to controls matched for age, sex, and indication for surgery...
September 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28793394/tranexamic-acid-induced-acute-renal-cortical-necrosis-in-post-endoscopic-papillectomy-bleeding
#17
Doo Hyun Ko, Tae Hyung Kim, Jong Wook Kim, Ja Joong Gu, Baek Hyun Yoon, Ji Hong Oh, Seung Goun Hong
Acute renal failure can be the result of acute renal cortical necrosis (RCN), which commonly occurs from complications occurring during pregnancy. RCN is rarely caused by medications, although tranexamic acid, which is used in patients with acute bleeding for its antifibrinolytic effects, reportedly causes acute RCN in rare cases. An 82-year-old woman experienced gastrointestinal bleeding after endoscopic papillectomy of an ampullary adenoma. The bleeding was controlled with tranexamic acid administration; however, 4 days later, her urine volume decreased and she developed pulmonary edema and dyspnea...
August 9, 2017: Clinical Endoscopy
https://www.readbyqxmd.com/read/28791655/current-and-emerging-options-for-the-management-of-inherited-von-willebrand-disease
#18
REVIEW
Jessica M Heijdra, Marjon H Cnossen, Frank W G Leebeek
Von Willebrand disease (VWD) is the most common inherited bleeding disorder with an estimated prevalence of ~1% and clinically relevant bleeding symptoms in approximately 1:10,000 individuals. VWD is caused by a deficiency and/or defect of von Willebrand factor (VWF). The most common symptoms are mucocutaneous bleeding, hematomas, and bleeding after trauma or surgery. For decades, treatment to prevent or treat bleeding has consisted of desmopressin in milder cases and of replacement therapy with plasma-derived concentrates containing VWF and Factor VIII (FVIII) in more severe cases...
August 8, 2017: Drugs
https://www.readbyqxmd.com/read/28780893/abnormal-uterine-bleeding-in-perimenopause
#19
S R Goldstein, M A Lumsden
Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office or primary-care setting. The wider availability of diagnostic tools has allowed prompt diagnosis and treatment of an increasing number of menstrual disorders in an office setting. This White Paper reviews the advantages and disadvantages of transvaginal ultrasound, blind endometrial sampling and diagnostic hysteroscopy. Once a proper diagnosis has been established, appropriate therapy may be embarked upon...
August 7, 2017: Climacteric: the Journal of the International Menopause Society
https://www.readbyqxmd.com/read/28756471/the-research-agenda-for-trauma-critical-care
#20
REVIEW
Karim Asehnoune, Zsolt Balogh, Giuseppe Citerio, Andre Cap, Timothy Billiar, Nino Stocchetti, Mitchell J Cohen, Paolo Pelosi, Nicola Curry, Christine Gaarder, Russell Gruen, John Holcomb, Beverley J Hunt, Nicole P Juffermans, Mark Maegele, Mark Midwinter, Frederick A Moore, Michael O'Dwyer, Jean-François Pittet, Herbert Schöchl, Martin Schreiber, Philip C Spinella, Simon Stanworth, Robert Winfield, Karim Brohi
In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice...
July 29, 2017: Intensive Care Medicine
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