Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion

Henry, David; Carless, Paul A; Moxey, Annette; O’Connell, Dianne; Stokes, Barrie; Fergusson, Dean; Ker, Katharine

doi:10.1002/14651858.cd001886.pub3

Cited by 289 publications

(148 citation statements)

References 254 publications

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“…Preventive application of fibrinolytic inhibitors (aprotinin, lysine analogues) in cardiac surgery has been used to reduce postoperative blood loss and transfusion requirements since the 1980s [1,2]. In 2007 due to the results published by Karkouti et al [3], Mangano et al [4] and Fergusson et al [5] aprotinin has been suspended from the pharmaceutical market.…”

Section: Introductionmentioning

confidence: 99%

Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study

Spegar

Vanek

Snircova

et al. 2011

J Thromb Thrombolysis

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The study was performed to examine a possible augmentation of systemic administration of tranexamic acid by the additional topical application during heart valve surgery in the post-aprotinin era. One-hundred patients were enrolled in the study and all the patients were given tranexamic acid intravenously. The participants were randomized into two groups (A, n = 49; B, n = 51), and before commencing the sternal suturing, the study solution (group A: 250 ml of normal saline + tranexamic acid 2.5 g, placebo group B: 250 ml of normal saline) was poured into the pericardial cavity. The cumulative blood loss (geometric means [95% confidence intervals]) 4 h after the surgery was 86.1 [56.1, 132.2] ml in group A, and 135.4 [94.3, 194.4] in group B, test for equality of geometric means P = 0.107, test for equality of variances P = 0.059. Eight hours after the surgery, the blood loss was 199.4 [153.4, 259.2] ml in group A, 261.7 [205.1, 334.0] ml in group B, P = 0.130 and P = 0.050, respectively. Twenty-four hours postoperatively the blood loss was 504.2 [436.0, 583.0] ml in group A, 569.7 [476.0, 681.7] ml in group B, P = 0.293 and P = 0.014, respectively. The proportion of patients transfused postoperatively by fresh frozen plasma differed significantly between the two study groups (group A: n = 21, group B: n = 36, P = 0.008). Our hypothesis is supported by a significant difference in the inter-group variance of blood loss and the proportion of patients requiring fresh frozen plasma; however evident differences in mean postoperative blood loss were not statistically significant.

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Section: Introductionmentioning

confidence: 99%

Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study

Spegar

Vanek

Snircova

et al. 2011

J Thromb Thrombolysis

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“…Unlike aprotinin, TXA is not associated with hypersensitivity reactions. Its use also reduces the cost [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…This was attributed to standardized DVT prophylaxis and excellent postoperative pain relief that resulted in early ambulation on the first postoperative day. It is pertinent to note that in various specialties such as orthopedic, oncological, and cardiovascular surgeries, use of TXA has been shown to as safe as the placebo [7,38,39]; however, fact remains that simultaneous bilateral knee arthroplasty is a risk factor and a larger study is required to confirm the safety of the routine use of intravenous administration of TXA and bilateral TKA.…”

Section: Discussionmentioning

confidence: 99%

“…TXA was administered as a bolus dose of 10 mg/kg, 10 min before the deflation of tourniquet on the first side, followed by a continued intravenous infusion of 10 mg/kg/h over the next 3 h. Equal volumes of the placebo were administered at the same rate and route. The dosage protocol suggested by Henry et al [7] was modified by the authors of this study.…”

Section: Methodsmentioning

confidence: 99%

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Tranexamic acid reduces blood loss in simultaneous bilateral total knee arthroplasty: a randomized control trial

Raviraj

Anand

Chakravarthy

et al. 2011

Eur J Orthop Surg Traumatol

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Total knee arthroplasty (TKA) is a common procedure, and bilateral TKA ensures cost efficiency. Bilateral TKA is associated with increased requirement of blood transfusion (BT). BT is associated with hazards, therefore be avoided. Tranexamic acid (TXA) has been suggested to reduce the BT, and the use of TXA in bilateral TKA appears sparse in literature. This study aimed at assessing the effect of TXA in such patients. This prospective randomized controlled trial evaluated the use of TXA in bilateral TKA. Pre-and postoperative hemoglobin (Hb) and packed cell volume (PCV), blood loss and BT, hospital stay, and the cost of TXA compared to blood transfusion were the measured variables. 175 patients (n = 88 TXA, n = 87 CTRL) completed the study. The patients in the control (CTRL) group on an average received 0.3 units and 0.07 in TXA group. The average blood loss in the TXA group was significantly less than the CTRL (P \ 0.0001). There was no significant difference in the perioperative complications, hospital stay in the two groups. The use of TXA reduces the postoperative blood loss. The allogenic BT requirement in patients undergoing bilateral TKA is significantly decreased. The routine use of this drug is cost-effective and reduces postoperative blood loss.

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“…Hinsichtlich einer Fibrinolysestörung ist die Gabe eines Antifibrinolytikums als Ergänzungstherapie empfehlenswert, um den Blutverlust zu minimieren [13]. Zwischen Aprotinin und den Lysinana loga konnten kaum Wirkungsunterschie de nachgewiesen werden.…”

Section: Korrektur Der Koagulopathieunclassified

Management von Blutungsdiathesen in der Intensivmedizin

Petros

2011

Med Klin

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Bleeding disorders are frequent in intensive care medicine, the most common form being acquired. Trauma, gastrointestinal bleeding, liver failure, hematologic malignancies, and adverse drug reactions play an important role. Moderate to severe hereditary bleeding disorders are usually known prior to the acute disease state, while mild hereditary forms may manifest for the first time in association with the acute stress condition. Generally, proper history taking and structured observation are decisive in order to conduct an appropriate diagnostic workup and initiate logical hemostatic management. One cannot always wait for laboratory results during continuous blood loss or conditions such as hypothermia and acidosis. In such cases, pathophysiological extrapolation of expected hemostatic disturbances is essential for timely hemostatic management.

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Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion

Cited by 289 publications

References 254 publications

Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study

Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study

Tranexamic acid reduces blood loss in simultaneous bilateral total knee arthroplasty: a randomized control trial

Management von Blutungsdiathesen in der Intensivmedizin

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