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dose of tranexamic acid in cardiac surgery

Hisato Takagi, Tomo Ando, Takuya Umemoto
BACKGROUND: We focused whether tranexamic acid (TXA) therapy for adult cardiac surgery is associated with an increase in the risk of seizures and performed a meta-analysis of randomized controlled trials (RCTs) and non-randomized observational studies. METHODS: MEDLINE and EMBASE were searched through December 2016 using PubMed and OVID. Eligible studies were RCTs and non-randomized observational studies of 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...
March 6, 2017: Journal of Cardiovascular Surgery
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...
February 28, 2017: British Journal of Clinical Pharmacology
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
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
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
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
Navid Madershahian, Maximilian Scherner, Roman Pfister, Tanja Rudolph, Antje C Deppe, Ingo Slottosch, Elmar Kuhn, Yeong-Hoon Choi, Thorsten Wahlers
OBJECTIVES: Antifibrinolytics are widely used in cardiac surgery to save blood perioperatively. In the present study we evaluated the hemostatic effects of tranexamic acid (TXA) to decrease bleeding tendency and transfusion requirements in high-risk patients following transapical aortic valve implantation (TA-AVI). METHODS: A retrospective analysis was performed on aortic stenosis patients undergoing TA-AVI with or without intraoperative TXA administration to determine postoperative blood loss and transfusion requirements...
2015: Journal of Cardiothoracic Surgery
William Ng, Angela Jerath, Marcin Wąsowicz
Blood loss and subsequent transfusions are associated with major morbidity and mortality. The use of antifibrinolytics can reduce blood loss in cardiac surgery, trauma, orthopedic surgery, liver surgery and solid organ transplantation, obstetrics and gynecology, neurosurgery and non-surgical diseases. The evidence of their efficacy has been mounting for years. Tranexamic acid (TXA), a synthetic lysine-analogue antifibrinolytic, was first patented in 1957 and its use has been increasing in contrast to aprotinin, a serine protease inhibitor antifibrinolytic...
2015: Anaesthesiology Intensive Therapy
Qi Joy Yang, Angela Jerath, Robert R Bies, Marcin Wąsowicz, K Sandy Pang
Tranexamic acid (TXA), an effective anti-fibrinolytic agent that is cleared by glomerular filtration, is used widely for cardiopulmonary bypass (CPB) surgery. However, an effective dosing regimen has not been fully developed in patients with renal impairment. The aims of this study were to characterize the inter-patient variability associated with pharmacokinetic parameters and to recommend a new dosing adjustment based on the BART dosing regimen for CPB patients with chronic renal dysfunction (CRD). Recently published data on CPB patients with normal renal function (n = 15) were re-examined with a two-compartment model using the ADAPT5 and NONMEMVII to identify covariates that explain inter-patient variability and to ascertain whether sampling strategies might affect parameter estimation...
July 2015: Biopharmaceutics & Drug Disposition
Ahmad Imtiaz, Mujahid-ul-Islam, Islam Ansa, Shah Azmat Ali
BACKGROUND: Cardiac surgery is associated with excessive bleeding that is as a result of coagulopathy caused by cardiopulmonary bypass. We evaluated the effect of two different modalities for administering similar doses of tranexamic acid on bleeding following primary elective coronary artery bypass grafting (CABG). METHODS: In the randomized control trial. 137 patients scheduled for CABG were randomized to two groups applying different modalities of tranexamic acid administration (bolus injection of 30 mg/kg vs...
July 2014: Journal of Ayub Medical College, Abbottabad: JAMC
Mark C Wesley, Luis M Pereira, Laurie A Scharp, Sitaram M Emani, Francis X McGowan, James A DiNardo
BACKGROUND: Tranexamic acid (TXA) is one of the most commonly used antifibrinolytic medications in children undergoing repair of congenital heart defects. However, a pharmacokinetics analysis of TXA has never been performed in neonates or young children undergoing complex cardiac surgeries using cardiopulmonary bypass, hypothermia, circulatory arrest, and ultrafiltration. A comprehensive pharmacokinetics study was performed in this patient population. METHODS: Fifty-five patients ranging from 2 days through 4 yr old were categorized into three groups: children less than 2 months old, infants 2 months to 1 yr old, and children greater than 1 yr old and weighing up to 20 kg...
April 2015: Anesthesiology
Lilian Tengborn, Margareta Blombäck, Erik Berntorp
Experience with tranexamic acid, an indirect fibrinolytic inhibitor, started as soon as it was released from Shosuke Okamoto's lab in the early 1960s. It was first prescribed to females with heavy menstrual blood loss and to patients with hereditary bleeding disorders. Soon the indications were widened to elective surgery because of its blood saving effects. Contraindications are few, most important is ongoing venous or arterial thrombosis and allergy to tranexamic acid, and the doses has to be reduced in renal insufficiency...
February 2015: Thrombosis Research
Jingming Xie, Lawrence G Lenke, Tao Li, Yongyu Si, Zhi Zhao, Yingsong Wang, Ying Zhang, Jie Xiao
BACKGROUND CONTEXT: With a significant increase in the number and complexity of spinal deformity corrective surgeries, blood loss, often requiring massive intraoperative transfusions, becomes a major limiting factor during surgery. This scenario is particularly during posterior vertebral column resection (PVCR), where extensive intraoperative blood loss may pose a major risk to the patient, preventing smooth execution of the procedure. Tranexamic Acid (TXA) has been used in cardiac and orthopedic surgeries, including major spinal surgeries, to reduce blood loss and transfusion requirements for decades...
April 1, 2015: Spine Journal: Official Journal of the North American Spine Society
D Royston
There is a considerable difference between the mechanism of action of the lysine analogues, tranexamic acid and epsilon-aminocaproic acid, and the serine protease inhibitor aprotinin. Aprotinin acts to inactivate free plasmin, but with little effect on bound plasmin, whereas the lysine analogues are designed to prevent excessive plasmin formation by fitting into plasminogen's lysine-binding site to prevent the binding of plasminogen to fibrin. Aprotinin is associated with a reduction in bleeding and transfusion requirements following major surgery, and has a dose-response profile, compared with no dose-response effect in the one study investigating tranexamic acid in cardiac surgical patients...
January 2015: Anaesthesia
Teneille E Gofton, Michael W A Chu, Loretta Norton, Stephanie A Fox, Lindsay Chase, John M Murkin, G Bryan Young
INTRODUCTION: Recently, there have been several retrospective reports suggesting an increased frequency in seizures after cardiopulmonary bypass, associated with increased patient morbidity. We sought to prospectively investigate the incidence of electrographic seizures without clear convulsive clinical correlates and subsequent neurologic injury following cardiac surgery. METHODS: This single-center, prospective, observational study used continuous subhairline electroencephalographic (cEEG) monitoring in the intensive care unit following routine cardiac surgery, ranging from coronary bypass surgery to complex aortic arch reconstruction...
October 2014: Neurocritical Care
Tomomi Hasegawa, Yoshihiro Oshima, Ayako Maruo, Hironori Matsuhisa, Akiko Tanaka, Rei Noda, Shinji Yokoyama, Kazutaka Iwasaki
OBJECTIVE: The aim of this study was to evaluate the clinical effects of intraoperative tranexamic acid administration in cardiac surgery without blood transfusion (bloodless cardiac surgery) in children. METHODS: Seventy-one consecutive patients weighing less than 20 kg, who underwent bloodless cardiac surgery for simple atrial or ventricular septal defects at Kobe Children's Hospital from January 2011 to June 2013, were enrolled in this retrospective study. Tranexamic acid was administered during surgery from January 2012 (TXA group; n = 31), whereas it was not administered before January 2012 (control group; n = 40)...
November 2014: Asian Cardiovascular & Thoracic Annals
V Sharma, R Katznelson, A Jerath, L Garrido-Olivares, J Carroll, V Rao, M Wasowicz, G Djaiani
Because of a lack of contemporary data regarding seizures after cardiac surgery, we undertook a retrospective analysis of prospectively collected data from 11 529 patients in whom cardiopulmonary bypass was used from January 2004 to December 2010. A convulsive seizure was defined as a transient episode of disturbed brain function characterised by abnormal involuntary motor movements. Multivariate regression analysis was performed to identify independent predictors of postoperative seizures. A total of 100 (0...
February 2014: Anaesthesia
Bakhtiari Rostam Esfandiari, Mohammad Moazeni Bistgani, Majid Kabiri
OBJECTIVE: This study investigated the effects of low-dose tranexamic acid on post-coronary artery bypass surgery bleeding. BACKGROUND: Diffuse microvascular bleeding is still a common problem after cardiac procedures. This study was designed to evaluate the hemostatic effects of low-dose tranexamic acid in on-pump coronary artery bypass graft surgery. METHODS: In this prospective randomized placebo-controlled study, 150 patients who were candidates for coronary artery bypass were enrolled and randomly assigned to 1 of 2 groups (tranexamic acid or placebo)...
December 2013: Asian Cardiovascular & Thoracic Annals
David Faraoni, Christophe Cacheux, Caroline Van Aelbrouck, Brigitte E Ickx, Luc Barvais, Jerrold H Levy
BACKGROUND: Tranexamic acid is used to decrease bleeding and transfusions during cardiac surgery. However, dosing based on pharmacokinetic data to optimally inhibit fibrinolysis is unknown. With increasing concerns regarding seizures associated with higher doses, lower dosing schemes may be important. OBJECTIVE: To determine the effect of two dosing schemes compared with placebo on fibrinolysis and clinical outcomes. DESIGN: A double-blind, randomised, controlled, pilot trial...
September 2014: European Journal of Anaesthesiology
Yingjie Du, Jiaying Xu, Guyan Wang, Jia Shi, Lijing Yang, Sheng Shi, Haisong Lu, Yuefu Wang, Bingyang Ji, Zhe Zheng
OBJECTIVE: Tranexamic acid (TA), a synthetic antifibrinolytic drug, has been shown to reduce postoperative bleeding and the need for allogeneic blood transfusion in cardiac surgery. However, the optimal dose regimen of TA is still under debate. The aim of this study was to evaluate whether a lower-dose TA regimen produced equivalent efficacy to its higher-dose counterpart in reducing postoperative bleeding and transfusion needs. DESIGN: A prospective, randomized, double-blind trial...
October 2014: Journal of Cardiothoracic and Vascular Anesthesia
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