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tranexamic acid in cardiac surgery

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https://www.readbyqxmd.com/read/27913736/additional-effects-of-topical-tranexamic-acid-in-on-pump-cardiac-surgery
#1
Noppon Taksaudom, Sophon Siwachat, Apichat Tantraworasin
OBJECTIVE: Postoperative bleeding after cardiac surgery is commonly associated with hyperfibrinolysis. This study was designed to evaluate the efficacy of topical tranexamic acid in addition to intravenous tranexamic acid in reducing bleeding in cardiac surgery cases. METHODS: From July 1, 2014 to September 30, 2015, 82 patients who underwent elective on-pump cardiac surgery were randomized into a tranexamic acid group and a placebo group. In the tranexamic acid group, 1 g of tranexamic acid dissolved in 100 mL of normal saline solution was poured into the pericardium during sternal closure; the placebo group had 100 mL of saline only...
December 2, 2016: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/27871586/comparative-effectiveness-of-epsilon-aminocaproic-acid-and-tranexamic-acid-on-postoperative-bleeding-following-cardiac-surgery-during-a-national-medication-shortage
#2
Kevin P Blaine, Christopher Press, Ken Lau, Jan Sliwa, Vidya K Rao, Charles Hill
STUDY OBJECTIVE: The aim of this study was to compare the effectiveness of epsilon-aminocaproic acid (εACA) and tranexamic acid (TXA) in contemporary clinical practice during a national medication shortage. DESIGN: A retrospective cohort study. SETTING: The study was performed in all consecutive cardiac surgery patients (n=128) admitted to the cardiac-surgical intensive care unit after surgery at a single academic center immediately before and during a national medication shortage...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27774838/tranexamic-acid-in-patients-undergoing-coronary-artery-surgery
#3
Paul S Myles, Julian A Smith, Andrew Forbes, Brendan Silbert, Mohandas Jayarajah, Thomas Painter, D James Cooper, Silvana Marasco, John McNeil, Jean S Bussières, Shay McGuinness, Kelly Byrne, Matthew T V Chan, Giovanni Landoni, Sophie Wallace
Background Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. Methods In a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo coronary-artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here...
October 23, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27607599/temporal-changes-in-clot-lysis-and-clot-stability-following-tranexamic-acid-in-cardiac-surgery
#4
Mariann Tang, Per Wierup, Catherine J Rea, Jrgen Ingerslev, Vibeke E Hjortdal, Benny Srensen
Cardiac surgery induces a multifactorial coagulopathy. Regular use of tranexamic acid (TXA) is becoming standard of care. Clinical challenges include selecting optimal dosing regimen and balancing the benefit versus risk of additional dosing with antifibrinolytics. The objective was to evaluate the effect of TXA by assessing kinetic properties of plasma clot formation, clot stability, and clot fibrinolysis. The study was a prospective case follow-up of 28 patients undergoing cardiac surgery (mean age 63.9 years, 29% women)...
September 2, 2016: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/27388281/tranexamic-acid-decreases-the-magnitude-of-platelet-dysfunction-in-aspirin-free-patients-undergoing-cardiac-surgery-with-cardiopulmonary-bypass-a-pilot-study
#5
Caroline Van Aelbrouck, Sebastian Jorquera-Vasquez, Ingrid Beukinga, Olivier Pradier, Brigitte Ickx, Luc Barvais, Luc Van Obbergh, David Faraoni
This study sought to compare the effect of tranexamic acid (TXA) administration on cardiopulmonary bypass-induced platelet dysfunction in patients who received preoperative aspirin or not. We performed a prospective, randomized, double-blind pilot study, including patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Patients without aspirin interruption were enrolled in the 'group ASPIRIN' (n = 18) and those who had never been treated with aspirin were included in the 'group NO ASPIRIN' (n = 10)...
July 6, 2016: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/27330150/effectiveness-of-pericardial-lavage-with-or-without-tranexamic-acid-in-cardiac-surgery-patients-receiving-intravenous-tranexamic-acid-a-randomized-controlled-trial
#6
Dorien M Kimenai, Bastiaan M Gerritse, Cees Lucas, Peter M Rosseel, Mohamed Bentala, Paul van Hattum, Nardo J M van der Meer, Thierry V Scohy
OBJECTIVES: Pericardial lavage with saline, with or without tranexamic acid (TA), is still not evidence-based within current clinical practice as a part of a blood conservation strategy in cardiac surgery patients receiving intravenous TA administration. The objective was to determine whether intravenous TA combined with pericardial lavage with saline, with or without TA, reduces blood loss by 25% after cardiac surgery measured in the first 12 h postoperatively. METHODS: In this single-centre, randomized controlled, multiple-armed, parallel study, individual patients were randomly assigned to receive either topical administration of 2 g TA diluted in 200 ml of saline (TA group), 200 ml of saline (placebo group) or no topical administration at all (control group)...
June 21, 2016: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/27117753/desmopressin-after-cardiac-surgery-in-bleeding-patients-a-multicenter-randomized-trial
#7
E Bignami, M Cattaneo, G Crescenzi, M Ranucci, F Guarracino, C Cariello, R Baldassarri, G Isgrò, E Baryshnikova, G Fano, A Franco, C Gerli, M Crivellari, A Zangrillo, G Landoni
BACKGROUND: Previous studies showed that desmopressin decreases post-operative blood loss in patients undergoing cardiac surgery. These studies were small and never studied the effect of desmopressin in patients with active bleeding. Objective of the study was to determine whether desmopressin reduces red blood cells transfusion requirements in patients with active bleeding after cardiac surgery who had been pre-treated with tranexamic acid. METHODS: This multicenter, randomized, double-blind, placebo-controlled, parallel-group study randomized elective patients with bleeding after cardiac surgery despite pre-treatment with tranexamic acid, to receive placebo (saline solution) or a single administration of desmopressin (0...
August 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27112920/major-transfusions-remain-frequent-despite-the-generalized-use-of-tranexamic-acid-an-audit-of-3322-patients-undergoing-cardiac-surgery
#8
Louis-Mathieu Stevens, Nicolas Noiseux, Ignacio Prieto, Jean-François Hardy
BACKGROUND: Aprotinin has been reapproved for use in Europe and in Canada. We sought to determine if its reintroduction was still pertinent given the widespread administration of tranexamic acid, another antifibrinolytic shown to reduce bleeding and transfusions. STUDY DESIGN AND METHODS: After institutional review board approval, we examined the cardiac surgery database (2012-2015; 3322 patients). Major transfusion was defined as 4 or more red blood cell units...
July 2016: Transfusion
https://www.readbyqxmd.com/read/26933848/stopping-vs-continuing-aspirin-before-coronary-artery-surgery
#9
RANDOMIZED CONTROLLED TRIAL
Paul S Myles, Julian A Smith, Andrew Forbes, Brendan Silbert, Mohandas Jayarajah, Thomas Painter, D James Cooper, Silvana Marasco, John McNeil, Jean S Bussières, Sophie Wallace
BACKGROUND: Most patients with coronary artery disease receive aspirin for primary or secondary prevention of myocardial infarction, stroke, and death. Aspirin poses a risk of bleeding in patients undergoing surgery, but it is unclear whether aspirin should be stopped before coronary artery surgery. METHODS: We used a 2-by-2 factorial trial design to randomly assign patients who were scheduled to undergo coronary artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo...
February 25, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/26796915/hemostatic-alterations-during-coronary-artery-bypass-grafting
#10
Chantal L I Gielen, Anneke Brand, Waander L van Heerde, Theo Stijnen, Robert J M Klautz, Jeroen Eikenboom
INTRODUCTION: The origination of blood loss after cardiac surgery is not fully explained, but is related to operation trauma and use of cardiopulmonary bypass (CPB). However, the extent of their contribution is incompletely known and might differ between distinct operation procedures. MATERIALS AND METHODS: Three groups of CABG procedures were studied: 1) off-pump coronary artery bypass surgery (OPCAB, n=11) without CPB, 2) CABG with use of CPB (CABG, n=11) and 3) CABG with use of CPB combined with aortic valve replacement (AVR, n=11)...
April 2016: Thrombosis Research
https://www.readbyqxmd.com/read/26620803/a-systematic-review-and-meta-analysis-of-the-use-of-antifibrinolytic-agents-in-total-hip-arthroplasty
#11
REVIEW
Fei Huang, Yunfeng Wu, Zongsheng Yin, Guangwen Ma, Jun Chang
BACKGROUND: Antifibrinolytic agents such as tranexamic acid (TXA), epsilon aminocaproic acid (EACA), and aprotinin are widely used to reduce bleeding and the need for transfusion in cardiac, orthopaedic, and hepatic surgery. We aimed to assess the efficacy and safety of antifibrinolytic agents in total hip arthroplasty (THA). METHODS: A systematic literature search was performed using MEDLINE, PubMed, EMBASE, and Cochrane databases, as well as the reference lists of relevant articles...
November 2015: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
https://www.readbyqxmd.com/read/26569753/92-tranexamic-acid-and-post-operative-seizures-in-patients-who-underwent-cardiac-surgery
#12
Chan Justin, Angela Jerath, Humara Poonawala, Marcin Wasowicz
No abstract text is available yet for this article.
December 2015: Critical Care Medicine
https://www.readbyqxmd.com/read/26523960/left-ventricle-thrombus-after-tranexamic-acid-for-spine-surgery-in-an-hiv-positive-patient
#13
Neal Stuart Gerstein, Janet Kathryn Brierley, Matthew Douglas Culling
BACKGROUND CONTEXT: Our case highlights the underappreciated thrombotic risks of tranexamic acid (TXA) use in non-cardiac surgery and emphasizes the need to elucidate these risks with appropriate clinical trials. PURPOSE: The use of TXA in non-cardiac surgery has significantly expanded in the past 5 years, especially after the 2010 publication of the CRASH-2 Trial. We submit a case with the intent to highlight the thrombotic risk of TXA use during non-cardiac surgery and discuss the need for careful risk stratification before the use of TXA in this context...
February 2016: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/26348901/giant-somatosensory-evoked-potentials-coincident-with-epileptiform-discharges-in-acutely-comatose-patients
#14
David A Houlden, Mark I Boulos, Brian J Murray, Loretta Norton, G Bryan Young
BACKGROUND: The amplitude of the cortically generated somatosensory evoked potential (SSEP) is used to predict outcome in comatose patients. The relationship between epileptiform discharges and SSEP amplitude has not been elucidated in those patients. METHODS: Bilateral median nerve SSEP and electroencephalograph (EEG) studies were performed in a comatose patient (patient 1) 1 day after cardiac surgery and repeated 4 days later. He had tranexamic acid administered before and during surgery...
September 2015: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/26346761/aminocaproic-acid-administration-is-associated-with-reduced-perioperative-blood-loss-and-transfusion-in-pediatric-craniofacial-surgery
#15
G Hsu, J A Taylor, J E Fiadjoe, A M Vincent, E Y Pruitt, S P Bartlett, P A Stricker
BACKGROUND: Severe blood loss is a common complication of craniofacial reconstruction surgery. The antifibrinolytic ε-aminocaproic acid (EACA) reduces transfusion requirements in children undergoing cardiac surgery and in older children undergoing spine surgery. Tranexamic acid (TXA), another antifibrinolytic with a similar mechanism of action, has been shown to reduce blood loss and transfusion requirements in children undergoing craniofacial surgery. However, TXA has been associated with an increase in post-operative seizures and is more expensive than EACA...
February 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/26317817/early-tranexamic-acid-administration-a-protective-effect-on-gut-barrier-function-following-ischemia-reperfusion-injury
#16
Mark E Diebel, Lawrence N Diebel, Charles W Manke, David M Liberati, John R Whittaker
BACKGROUND: The mucus barrier is a critical component of the gut barrier and may be disrupted by pancreatic enzymes following trauma/hemorrhagic shock (T/HS). Luminal strategies against pancreatic enzyme activation or contact with the intestine are protective of the mucus layer and gut barrier integrity following T/HS. There is increasing evidence the use of tranexamic acid (TA) attenuates inflammatory responses in cardiac surgery and is readily absorbed from the gut. We therefore postulated that systemic administration of TA would attenuate mucus degradation and gut barrier failure following T/HS...
December 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26258658/effective-tranexamic-acid-concentration-for-95-inhibition-of-tissue-type-plasminogen-activator-induced-hyperfibrinolysis-in-children-with-congenital-heart-disease-a-prospective-controlled-in-vitro-study
#17
Laurence Rozen, David Faraoni, Cristel Sanchez Torres, Ariane Willems, Denis C F Noubouossie, Dragos Barglazan, Philippe Van der Linden, Anne Demulder
BACKGROUND: Although recent studies have assessed tranexamic acid (TXA) pharmacokinetics in different subgroups, the effective concentration of TXA required to completely inhibit fibrinolysis remains to be determined. OBJECTIVE: An in-vitro determination of the effective TXA concentration needed for 95% inhibition (EC95) of tissue-type plasminogen activator (t-PA) activated fibrinolysis, using an experimental model designed for thromboelastometry (ROTEM). DESIGN: A prospective interventional study...
December 2015: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/26121803/-the-use-of-thromboelastometry-and-tranexamic-acid-reduces-blood-loss-and-transfusion-requirements-in-cardiac-surgery-under-cardiopulmonary-bypass
#18
Junko Ichikawa, Mitsuharu Kodaka, Tomoko Kitahara, Nobuhiko Sato, Keiko Nishiyama, Kiyoharu Nakano, Makiko Komori
BACKGROUND: We evaluated whether using thromboelastometry and tranexamic acid influenced blood loss and transfusion requirements in cardiac surgery requiring cardiopulmonary bypass. METHODS: We perfomed a retrospective analysis examining perioperative coagulation results, and the transfusion requirements of concentrated red cells (CRCs), fresh frozen plasma (FFP) and platelet administration between 12 months before and 10 months after thromboelastometry and tranexamic acid had been introduced in our institution...
February 2015: Masui. the Japanese Journal of Anesthesiology
https://www.readbyqxmd.com/read/26083991/fibrinogen-reduction-and-coagulation-in-cardiac-surgery-an-investigational-study
#19
Chantal L I Gielen, Jos Grimbergen, Robert J M Klautz, Jaap Koopman, Paul H A Quax
Fibrinogen as precursor of fibrin plays an essential role in clot formation. There are three main mechanisms associated with a reduction in fibrinogen concentration during cardiac surgery: hemodilution, consumption, and degradation. Moreover, early fibrinogen degradation products (FgDPs) can interfere with normal fibrin formation of intact fibrinogen. The aim of this study was to determine the relative contributions of hemodilution, consumption, and degradation to fibrinogen loss in cardiac surgery and to evaluate the effects fibrinogen degradation products on blood clot formation in vitro...
September 2015: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/26015509/what-dose-of-tranexamic-acid-is-most-effective-and-safe-for-adult-patients-undergoing-cardiac-surgery
#20
Sam Hodgson, Joseph T Larvin, Charles Dearman
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: what dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery? Altogether 586 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Current evidence shows clinical benefit of using high-dose tranexamic acid (>80 mg/kg total dose) as opposed to low-dose tranexamic acid (<50 mg/kg total dose) in cardiac surgery with cardiopulmonary bypass...
September 2015: Interactive Cardiovascular and Thoracic Surgery
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