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https://www.readbyqxmd.com/read/27907937/tranexamic-acid-for-trauma-resuscitation-in-the-united-states-of-america
#1
Mark Walsh, Scott Thomas, Ernest Moore, Hunter Moore, Andres Piscoya, Daniel Hake, Michael Son, Tim Pohlman, Julie Wegner, John Bryant, Alberto Grassetto, Patrick Davis, Nathan Nielsen, Anton Crepinsek, Jacob T Shreve, Francis Castellino
The utilization of tranexamic acid (TXA) for the management of bleeding trauma patients has been a subject of much debate on both sides of the Atlantic and in Australia. As a result of the large randomized controlled study called the Clinical Randomization of an Antifibrinolytic in Severe Hemorrhage (CRASH-2), there was an initial enthusiasm for the use of TXA to treat bleeding patients. However, the adoption of TXA in the United States was delayed by concerns of "knowledge and evidence gaps" of the CRASH-2 study and because of a lack of mechanistic rationale that would explain the survival benefit noted in the study...
December 1, 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27896241/local-administration-of-tranexamic-acid-during-prostatectomy-surgery-effects-on-reducing-the-amount-of-bleeding
#2
Pejman Pourfakhr, Elham Gatavi, Shahram Gooran, Farhad Etezadi, Mohamad Reza Khajavi, Reza Pourroustaei, Reza Shariat Moharari, Atabak Najafi
BACKGROUND: One of the issues in prostatectomy surgery is bleeding. Although tranexamic acid (TRA) is an antifibrinolytic agent for reducing bleeding, controversies surround its use. OBJECTIVES: In this study, the effect of local administration of TRA on reducing bleeding during prostatectomy surgery was evaluated. METHODS: A total of 186 patients who underwent prostatectomy surgery were assessed in this clinical trial study. Patients were divided randomly into two groups...
November 2016: Nephro-urology Monthly
https://www.readbyqxmd.com/read/27885960/high-dose-tranexamic-acid-reduces-intraoperative-and-postoperative-blood-loss-in-posterior-lumbar-interbody-fusion
#3
Junichi Kushioka, Tomoya Yamashita, Shinya Okuda, Takafumi Maeno, Tomiya Matsumoto, Ryoji Yamasaki, Motoki Iwasaki
OBJECTIVE Tranexamic acid (TXA), a synthetic antifibrinolytic drug, has been reported to reduce blood loss in orthopedic surgery, but there have been few reports of its use in spine surgery. Previous studies included limitations in terms of different TXA dose regimens, different levels and numbers of fused segments, and different surgical techniques. Therefore, the authors decided to strictly limit TXA dose regimens, surgical techniques, and fused segments in this study. There have been no reports of using TXA for prevention of intraoperative and postoperative blood loss in posterior lumbar interbody fusion (PLIF)...
November 25, 2016: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27871571/spine-tumor-resection-among-patients-who-refuse-blood-product-transfusion-a-retrospective-case-series
#4
Alexandra E Kisilevsky, Liam Stobart, Kristine Roland, Alana M Flexman
STUDY OBJECTIVE: To describe the perioperative blood conservation strategies and postoperative outcomes in patients who undergo complex spinal surgery for tumor resection and who also refuse blood product transfusion. DESIGN: A retrospective case series. SETTING: A single-center, tertiary care and academic teaching hospital in Canada. PATIENTS: All adult patients undergoing elective major spine tumor resection and refusing blood product transfusion who were referred to our institutional Blood Utilization Program between June 1, 2004, and May 9, 2014...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27869629/coagulation-profile-of-patients-with-adolescent-idiopathic-scoliosis-undergoing-posterior-spinal-fusion
#5
Patrick Bosch, Tanya S Kenkre, Joanne A Londino, Antonio Cassara, Charles Yang, Jonathan H Waters
BACKGROUND: Blood loss and transfusion requirements during posterior spinal fusion for adolescent idiopathic scoliosis remain a concern. The mechanism of bleeding in these patients is poorly characterized. Thromboelastography is a comprehensive test of a patient's coagulation system commonly used in cardiac surgical procedures. It has not been well studied for use in patients with adolescent idiopathic scoliosis. METHODS: A prospective, observational study of the coagulation profile of patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion is presented...
October 19, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27852408/-study-on-the-difference-of-blood-coagulation-function-in-patients-with-traumatic-brain-injury-in-plain-and-plateau-area
#6
J Sun, Y Tian, R C Jiang, X L Dong, Y Wang, W B Wu, K X Wu, J N Zhang
Objective: In this study, we tested platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), and other indicators of coagulation function, and revealed their difference in patients with traumatic brain injury (TBI) between plain and plateau area. Base on the results, we may provide research basis for the therapy of TBI associated coagulopathy in different areas. Methods: 151 TBI patients from Tianjin Medical University General Hospital, and 74 from People's Hospital of Tibet Autonomous Region in the period from Dec 2013 to Dec 2015 were enrolled...
October 25, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27837327/topical-versus-intravenous-tranexamic-acid-in-total-knee-arthroplasty-a-meta-analysis-of-randomized-controlled-trials
#7
Shangquan Wang, Xinxia Gao, Yan An
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic drug used widely to prevent bleeding in total knee arthroplasty (TKA). However, there is no consensus regarding the administration routes of TXA. This meta-analysis aimed to investigate the efficacy of topical (intra-articular) versus intravenous TXA in reducing blood loss and transfusion rate in patients who underwent TKA. METHOD: We conducted a Pubmed, EMBASE, Cochrane Library, and Web of Science search for randomized controlled trials (RCTs) comparing topical versus intravenous TXA in TKA...
November 11, 2016: International Orthopaedics
https://www.readbyqxmd.com/read/27811561/haemostatic-resuscitation-in-trauma-the-next-generation
#8
Jakob Stensballe, Sisse R Ostrowski, Pär I Johansson
PURPOSE OF REVIEW: To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma. RECENT FINDINGS: Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated with the lethal triad, and consumptive coagulopathy...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27806184/antifibrinolytic-therapy-to-reduce-haemoptysis-from-any-cause
#9
REVIEW
Gabriela Prutsky, Juan Pablo Domecq, Carlos A Salazar, Roberto Accinelli
BACKGROUND: Haemoptysis is a common pathology around the world, occurring with more frequency in low-income countries. It has different etiologies, many of which have infectious characteristics. Antifibrinolytic agents are commonly used to manage bleeding from different sources, but their usefulness in pulmonology is unclear. OBJECTIVES: To evaluate the effectiveness and safety of antifibrinolytic agents in reducing the volume and duration of haemoptysis in adult and paediatric patients...
November 2, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27803823/massive-bleeding-as-the-first-clinical-manifestation-of-metastatic-prostate-cancer-due-to-disseminated-intravascular-coagulation-with-enhanced-fibrinolysis
#10
Mónica Palma Anselmo, Gustavo Nobre de Jesus, João Madeira Lopes, Rui M M Victorino, João Meneses Santos
Disseminated intravascular coagulation (DIC) is the most frequent coagulation disorder associated with metastatic prostate adenocarcinoma. However, DIC with enhanced fibrinolysis as an initial presentation of prostate cancer is extremely rare. The appropriate treatment to control bleeding in these situations is challenging, controversial, and based on isolated case reports in the literature. A 66-year-old male presented at the emergency department with acute severe spontaneous ecchymoses localized to the limbs, laterocervical hematoma, and hemothorax...
2016: Case Reports in Hematology
https://www.readbyqxmd.com/read/27798034/rationale-and-design-of-platelet-transfusions-in-haematopoietic-stem-cell-transplantation-the-path-pilot-study
#11
Jason Tay, David Allan, Sara Beattie, Christopher Bredeson, Dean Fergusson, Dawn Maze, Mitchell Sabloff, Kednapa Thavorn, Alan Tinmouth
INTRODUCTION: In patients with transient thrombocytopenia being treated with high-dose chemotherapy followed by stem cell rescue-haematopoietic stem cell transplantation (HSCT), prophylactic transfusions are standard therapy to prevent bleeding. However, a recent multicentre trial suggests that prophylactic platelet transfusions in HSCT may not be necessary. Additionally, the potential overuse of platelet products places a burden on a scarce healthcare resource. Moreover, the benefit of prophylactic platelet transfusions to prevent clinically relevant haemorrhage is debatable...
October 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27797450/s2-subsite-variations-between-human-and-mouse-enzymes-plasmin-factor-xia-kallikrein-elucidate-inhibition-differences-by-tfpi-2-domain1-wildtype-leu17arg-mutant-and-aprotinin
#12
K Vadivel, Y Kumar, G I Ogueli, S M Ponnuraj, P Wongkongkathep, J A Loo, M S Bajaj, S P Bajaj
BACKGROUND: Using TFPI-2 Kunitz domain1 (KD1), we obtained a bifunctional antifibrinolytic molecule (KD1L17R -KT ) with C-terminal lysine (kringle domain binding) and P2'-residue arginine (improved specificity towards plasmin). KD1L17R -KT strongly inhibited human plasmin (hPm), with no inhibition of human kallikrein (hKLK) or factor XIa (hXIa). Furthermore, KD1L17R -KT reduced blood loss comparable to aprotinin in a mouse liver-laceration model of organ hemorrhage. However, effectiveness of these antifibrinolytic agents in a model of hemorrhage mimicking extremity trauma and their inhibition efficiencies for mouse enzymes (mPm, mKLK or mXIa) remain to be determined...
October 31, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27797129/alternative-agents-to-prophylactic-platelet-transfusion-for-preventing-bleeding-in-people-with-thrombocytopenia-due-to-chronic-bone-marrow-failure-a-meta-analysis-and-systematic-review
#13
REVIEW
Michael Desborough, Andreas V Hadjinicolaou, Anna Chaimani, Marialena Trivella, Paresh Vyas, Carolyn Doree, Sally Hopewell, Simon J Stanworth, Lise J Estcourt
BACKGROUND: People with thrombocytopenia due to bone marrow failure are vulnerable to bleeding. Platelet transfusions have limited efficacy in this setting and alternative agents that could replace, or reduce platelet transfusion, and are effective at reducing bleeding are needed. OBJECTIVES: To compare the relative efficacy of different interventions for patients with thrombocytopenia due to chronic bone marrow failure and to derive a hierarchy of potential alternative treatments to platelet transfusions...
October 31, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27765582/major-liver-resection-systemic-fibrinolytic-activity-and-the-impact-of-tranexamic-acid
#14
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...
October 17, 2016: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/27751907/assessment-of-an-electronic-intervention-in-young-women-with-heavy-menstrual-bleeding
#15
J E Dietrich, D L Yee, X M Santos, J L Bercaw-Pratt, J Kurkowski, H Soni, Y J Lee-Kim, M D Shah, D Mahoney, L V Srivaths
BACKGROUND: Bleeding disorders (BD) occur in up to 50% of adolescents with heavy menstrual bleeding (HMB). This presents unique challenges to healthcare providers given the complexity of treating the condition and such complexity can result in difficulty with patients understanding basic information about their condition, limit communication with medical providers, and patient compliance. SPECIFIC AIMS: To use an electronic approach to enhance patient compliance with medications used to treat their HMB...
October 14, 2016: Journal of Pediatric and Adolescent Gynecology
https://www.readbyqxmd.com/read/27749296/massive-fulminant-thrombosis-during-liver-transplantation-in-a-patient-with-a-previously-unknown-antithrombin-pathway-mutation
#16
Dmitri Bezinover, Shigekazu Sugino, Yuka Imamura-Kawasawa, Matthew S Bell, Zakiyah Kadry, Piotr K Janicki
We describe a case of fulminant intraoperative thrombosis during deceased donor liver transplantation. Despite significant medical bleeding, the patient suddenly developed diffuse thrombosis in all chambers of the heart and pulmonary vasculature resulting in intraoperative death. The patient's postmortem genetic analysis demonstrated a deleterious missense mutation in a coagulation pathway gene, SERPINC1, which codes for antithrombin III. The level of antithrombin III was not available to directly prove the causality of thrombosis, but our findings suggest that this mutation, in combination with antifibrinolytic administration in a hypercoagulable cirrhotic patient, might have contributed to the development of this catastrophic thrombotic event...
December 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27749008/compaction-of-fibrin-clots-reveals-the-antifibrinolytic-effect-of-factor-xiii-comment
#17
V Gurewich
The interesting article on the antifibrinolytic effect of Factor XIII by Rijken et al [1] was predicated on the assumption that fibrinolysis is mediated only by tPA, since that is what was studied. However, there is evidence that this common assumption should be put into question. In a study published almost thirty years ago, we showed that whereas spontaneous lysis of platelet poor plasma clots was mediated by tPA, that of platelet-rich plasma clots, with which this article was concerned, could not be abolished by tPA antibody, but instead was abolished by the addition of uPA antibody...
October 17, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27748995/compaction-of-fibrin-clots-reveals-the-antifibrinolytic-effect-of-factor-xiii-reply
#18
D C Rijken, S Abdul, J J M C Malfliet, F W G Leebeek, S Uitte de Willige
We thank Dr. Gurewich [1] for his critical evaluation of the impact of our recently published article on factor XIII [2]. This article describes that mechanical compaction or platelet-mediated retraction of plasma clots is essential to fully reveal the antifibrinolytic effect of factor XIII on tPA-induced plasma clot lysis. Dr. Gurewich argues that we cannot assume that these results are applicable to endogenous fibrinolysis in vivo, because endogenous fibrinolysis does depend not only on tPA, but also on uPA...
October 17, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27744662/novel-therapeutic-strategies-in-the-management-of-non-variceal-upper-gastrointestinal-bleeding
#19
Ari Garber, Sunguk Jang
Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application...
September 2016: Clinical Endoscopy
https://www.readbyqxmd.com/read/27741100/topical-versus-systemic-tranexamic-acid-after-total-knee-and-hip-arthroplasty-a-meta-analysis-of-randomized-controlled-trials
#20
Yongcai Chen, Zhuo Chen, Shuo Cui, Zhiyang Li, Zhengjiang Yuan
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic drug widely used to reduce blood loss during joint replacements, including total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, there is no final consensus regarding the composition of an optimal administration of TXA regime between topical and systemic (intravenous). The purpose of our study was to compare the efficacy of topical and intravenous (IV) regimen of TXA during TKA and THA. METHODS: Five relevant electronic online databases, PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Chinese Biomedical Database were systematically searched in November 2015...
October 2016: Medicine (Baltimore)
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