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tranexamic acid in cardiac surgery

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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
#1
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...
April 15, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28691229/desmopressin-use-for-minimising-perioperative-blood-transfusion
#2
REVIEW
Michael J Desborough, Kathryn Oakland, Charlotte Brierley, Sean Bennett, Carolyn Doree, Marialena Trivella, Sally Hopewell, Simon J Stanworth, Lise J Estcourt
BACKGROUND: Blood transfusion is administered during many types of surgery, but its efficacy and safety are increasingly questioned. Evaluation of the efficacy of agents, such as desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood loss is needed. OBJECTIVES: To examine the evidence for the efficacy of DDAVP in reducing perioperative blood loss and the need for red cell transfusion in people who do not have inherited bleeding disorders...
July 10, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28602219/tranexamic-acid-leads-to-paradoxical-coagulation-changes-during-cardiac-surgery-a-pilot-rotational-thromboelastometry-study
#3
Rajiv Sharma, Hayley L Letson, Samuel Smith, Geoffrey P Dobson
BACKGROUND: Tranexamic acid (TXA) is increasingly used during major surgery with the goal to reduce excessive bleeding, transfusion requirements, and reexploration. Our aim was to examine the effect of TXA on coagulation at different times during cardiac surgery using rotational thromboelastometry. MATERIALS AND METHODS: Nineteen adult males (EuroSCORE 4-5) were recruited consecutively for first-time cardiopulmonary bypass (CPB) surgery. Ten patients received TXA at anesthesia and nine received no TXA...
May 8, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28552944/intraoperative-tranexamic-acid-is-associated-with-postoperative-stroke-in-patients-undergoing-cardiac-surgery
#4
Zhen-Feng Zhou, Feng-Jiang Zhang, Yang-Fan Huo, Yun-Xian Yu, Li-Na Yu, Kai Sun, Li-Hong Sun, Xiu-Fang Xing, Min Yan
BACKGROUND: Stroke is a devastating and potentially preventable complication of cardiac surgery. Tranexamic acid (TXA) is a commonly antifibrinolytic agent in cardiac surgeries with cardiopulmonary bypass (CPB), however, there is concern that it might increase incidence of stroke after cardiac surgery. In this retrospective study, we investigated whether TXA usage could increase postoperative stroke in cardiac surgery. METHODS: A retrospective study was conducted from January 1, 2010, to December 31, 2015, in 2,016 patients undergoing cardiac surgery, 664 patients received intravenous TXA infusion and 1,352 patients did not receive any antifibrinolytic agent...
2017: PloS One
https://www.readbyqxmd.com/read/28366297/aprotinin-as-an-alternative-to-tranexamic-acid-in-cardiac-surgery-is-this-where-we-started-from
#5
EDITORIAL
Anne Godier, Beverley J Hunt
No abstract text is available yet for this article.
April 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28263046/seizures-associated-with-tranexamic-acid-for-cardiac-surgery-a-meta-analysis-of-randomized-and-non-randomized-studies
#6
Hisato Takagi, Tomo Ando, Takuya Umemoto
INTRODUCTION: The aim of this meta-analysis was to assess whether tranexamic acid (TXA) therapy for adult cardiac surgery is associated with an increase in the risk of seizures, and we performed a meta-analysis of randomized controlled trials (RCTs) and non-randomized observational studies. EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through December 2016 using PubMed and OVID. Eligible studies were RCTs and non-randomized observational studies on TXA versus control (no TXA, placebo, or active control such as low-dose TXA, aprotinin, and epsilon aminocaproic acid) enrolling adult patients undergoing cardiac surgery and reporting the postoperative incidence of seizures as an outcome...
August 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28245519/pharmacokinetics-of-tranexamic-acid-in-neonates-and-infants-undergoing-cardiac-surgery
#7
Ralph Gertler, Michael Gruber, Stanislas Grassin-Delyle, Saïk Urien, Klaus Martin, Peter Tassani-Prell, Siegmund Braun, Simon Burg, Gunther Wiesner
AIM: Tranexamic acid (TXA) continues to be one of the antifibrinolytics of choice during paediatric cardiac surgery. However, in infants less than 1 year of age, the optimal dosing based on pharmacokinetic (PK) considerations is still under discussion. METHODS: Forty-three children less than 1 year of age were enrolled, of whom 37 required the use of cardiopulmonary bypass (CPB) and six were operated on without CPB. Administration of 50 mg kg(-1) TXA intravenously at the induction of anaesthesia was followed by 50 mg kg(-1) into the CPB prime in the CPB group...
August 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28221207/aprotinin-vs-tranexamic-acid-in-isolated-coronary-artery-bypass-surgery-a-multicentre-observational-study
#8
Elsa Deloge, Julien Amour, Sophie Provenchère, Bertrand Rozec, Bruno Scherrer, Alexandre Ouattara
BACKGROUND: Aprotinin appears to be more efficacious than lysine analogues to reduce bleeding and transfusion of blood products in high-transfusion-risk cardiac surgical patients. However, in isolated coronary artery bypass graft (CABG) surgery, the results from head-to-head trials remain less conclusive. OBJECTIVE: Our objective was to compare the efficacies and safety of aprotinin and tranexamic acid (TXA) in patients undergoing isolated on-pump CABG. DESIGN: A multicentre before-and-after study pooling individual data from published trials and unpublished data from three other databases...
May 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28125808/coagulation-management-in-jersey-calves-an-ex-vivo-study
#9
Sabine Gröning, Judith Maas, Svenja van Geul, Rolf Rossaint, Ulrich Steinseifer, Oliver Grottke
OBJECTIVE: Jersey calves are frequently used as an experimental animal model for in vivo testing of cardiac assist devices or orthopedic implants. In this ex vivo study, we analyzed the coagulation system of the Jersey calves and the potential of human-based coagulation management to circumvent perioperative bleeding complications during surgery. Experimental Procedure: Blood from 7 Jersey calves was subjected to standard laboratory tests and thromboelastometry analysis. An ex vivo model of dilutional coagulopathy was used to study the effects of fibrinogen or prothrombin complex concentrate supplementation...
2017: European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes
https://www.readbyqxmd.com/read/28118792/noteworthy-literature-published-in-2016-for-the-cardiothoracic-anesthesiologist
#10
Dirk J Varelmann, J Daniel Muehlschlegel
Clinical research and outcome studies dominated the publication spectrum for the cardiothoracic anesthesiologist in 2016. Echocardiography is an important tool in the armamentarium of the cardiothoracic anesthesiologist. Technology is advancing at a fast pace: A new method to quantify the regurgitant volume in mitral regurgitation has been described in an experimental model and been validated in humans. Interesting studies on key elements of our daily practice have been published: Does tranexamic acid decrease the transfusion requirements after cardiac surgery? Are patients with a postoperative cognitive deficit at risk for dementia 7...
March 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28068786/topical-and-low-dose-intravenous-tranexamic-acid-in-cyanotic-cardiac-surgery
#11
RANDOMIZED CONTROLLED TRIAL
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...
February 2017: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/27988092/safety-of-tranexamic-acid-in-pediatric-cardiac-surgery-a-nationwide-database-study
#12
Takuma Maeda, Yusuke Sasabuchi, Hiroki Matsui, Yoshihiko Ohnishi, Shigeki Miyata, Hideo Yasunaga
OBJECTIVES: The present study aimed to examine the association between tranexamic acid (TXA) use and adverse effects (seizures, thromboembolism, and renal dysfunction) in a pediatric cardiac surgery population using a national inpatient database in Japan. The authors also assessed the association between TXA use and other clinical outcomes (length of hospital stay and in-hospital mortality). DESIGN: A nationwide, retrospective cohort study using propensity score analyses...
April 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27956673/prospective-observational-study-of-the-effect-of-dual-antiplatelet-therapy-with-tranexamic-acid-treatment-on-platelet-function-and-bleeding-after-cardiac-surgery
#13
J Amour, M Garnier, J Szymezak, Y Le Manach, D Helley, S Bertil, A Ouattara, B Riou, P Gaussem
BACKGROUND: The bleeding impact of dual antiplatelet therapy (DAPT), aspirin and clopidogrel, maintained until coronary artery bypass graft surgery (CABG), is still a matter of debate. The lack of preoperative antiplatelet activity measurement and heterogeneity of antifibrinolytic protocols in prior studies make the conclusions questionable. The aim of this prospective study was to determine, after preoperative antiplatelet activity measurement, if the maintenance of DAPT until CABG increases bleeding in patients treated with tranexamic acid (TA)...
December 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27940453/perioperative-management-of-the-bleeding-patient
#14
K Ghadimi, J H Levy, I J Welsby
Perioperative bleeding remains a major complication during and after surgery, resulting in increased morbidity and mortality. The principal causes of non-vascular sources of haemostatic perioperative bleeding are a preexisting undetected bleeding disorder, the nature of the operation itself, or acquired coagulation abnormalities secondary to haemorrhage, haemodilution, or haemostatic factor consumption. In the bleeding patient, standard therapeutic approaches include allogeneic blood product administration, concomitant pharmacologic agents, and increasing application of purified and recombinant haemostatic factors...
December 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27913736/additional-effects-of-topical-tranexamic-acid-in-on-pump-cardiac-surgery
#15
RANDOMIZED CONTROLLED TRIAL
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...
January 2017: 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
#16
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
#17
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, 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...
January 12, 2017: 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
#18
Mariann Tang, Per Wierup, Catherine J Rea, Jørgen Ingerslev, Vibeke E Hjortdal, Benny Sørensen
: 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)...
June 2017: 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
#19
RANDOMIZED CONTROLLED TRIAL
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)...
December 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
#20
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)...
December 2016: European Journal of Cardio-thoracic Surgery
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