Decreasing Postoperative Blood Loss by Topical vs. Intravenous Tranexamic Acid in Open Cardiac Surgery (DEPOSITION) study: Results of a pilot study

Habbab, Louay M.; Hussain, Sara; Power, Patricia; Bashir, Shaheena; Gao, Peggy; Semelhago, Lloyd; VanHelder, Tomas; Parry, Dominic; Chu, Victor; Lamy, André

doi:10.1111/jocs.14027

Cited by 13 publications

(6 citation statements)

References 26 publications

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“…The find-ings indicate that the topical application of TxA is at least as effective and as safe as IV TxA in cardiac surgery. In our study we use 2g of TxA and our findings are consistent with the primary out come in first 24h as Habbab et al, [28] study.…”

Section: Rostami Et Alsupporting

confidence: 88%

“…In a first pilot RCT study by Habbab et al, [28] investigate the role of TxA route of administration (IP vs IV) in cardiac surgery (CABG and/or aortic valve replacement), where the effects of applied topically were comparable with IV TxA with a tendency for decreased bleeding, transfusion requirements, reoperations, and postoperative seizures. A 97 adult patients undergoing nonemergent on-pump cardiac operations were enrolled and randomized to IP or IV TxA groups.…”

Section: Rostami Et Almentioning

confidence: 99%

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Effect of Topical Tranexamic Acid on Postoperative Bleeding in Cardiac Surgery

ISMAIL¹,

MIDANY

2022

The Medical Journal of Cairo University

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Background: One of the major cardiac surgery problems is post-operative bleeding which may lead to blood transfusion. Blood loss is due to many causes one of them is fibrinolysis. Many antifibrinolytic drugs have been used to decrease the post-operative bleeding for cardiac surgery including eaminocaproic acid, aprotinin and tranexamic acid. Tranexamic acids are synthetic derivatives of the amino acid lysine. It binds with the lysine on binding site of plasminogen and plasmin due to that the plasminogen dislodge from the surface of the fibrin so demoralizing the fibrinolysis process. Aim of Study:To study the effect of application of topical tranexamic acid in reducing the postoperative bleeding in patients undergoing cardiac surgery by median sternotomy. Patients and Methods: A Randomized Controlled ClinicalTrialwas carried out one 50 subjects was programmed for elective open cardiac surgery, enrolled by computer program and divided randomly in two group, group A (n=25) received TxA 2g in 100ml NSS in the pericardial cavity and mediastinum before the sternal closure While group B (n=25) 100ml of NSS alone. The drains will be monitored in the next 24 hours with calculation of blood loss. Blood products will be calculated when given for patient. Re exploration is done if there urgency. Results:The result of the study revealed statistically significant difference between TxA group and the placebo group regarding the postoperative blood loss and the need for packed RBC transfusion. This means the topical application of TxA decreasing the postoperative bleeding, blood transfusion and the need for reopration, but there was no statistically significant difference in plasma and platelet transfusions between the two groups. Conclusion:The use of topical TXA have a significant effect on the reduction of bleeding after Cardiac Surgery, also was able to decrease the blood transfusions. Moreover, show better results in reducing the return to the operating room due to bleeding.

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Section: Rostami Et Alsupporting

confidence: 88%

Section: Rostami Et Almentioning

confidence: 99%

Effect of Topical Tranexamic Acid on Postoperative Bleeding in Cardiac Surgery

ISMAIL¹,

MIDANY

2022

The Medical Journal of Cairo University

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“…TXA. There were tendencies towards reduced chest tube drainage and reduced RBC transfusion in the intrapericardial group, although statistical significance was not reached 334 . The above-mentioned meta-analysis performed to determine the optimal dosing and delivery method of TXA in elective heart surgery reported that topical TXA had no statistically significant impact on transfusion of allogeneic blood products 327 .…”

Section: Discussionmentioning

confidence: 98%

“…There were tendencies towards reduced chest tube drainage and reduced RBC transfusion in the intrapericardial group, although statistical significance was not reached. 334 The above-mentioned meta-analysis performed to determine the optimal dosing and delivery method of TXA in elective heart surgery reported that topical TXA had no statistically significant impact on transfusion of allogeneic blood products. 327 On the other hand, in a 2020 meta-analysis of topical (intrapericardial) TXA in cardiac surgery, topical TXA was associated with significantly reduced 24 h blood loss and no increase in the risk of postoperative seizures.…”

Section: Antifibrinolytic Therapy (Aprotinin E-aminocaproic Acid [Eac...mentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

145

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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“…The topical use of TXA has also been found to reduce perioperative blood loss in orthopedic replacement surgeries[ 24 25 26 ] and cardiac surgeries. [ 27 ] A recently published meta-analysis of 67 studies on topical TXA concluded with the recommendation that “further study of the topical application is required outside of the field of orthopedics.”[ 28 ] There was none in gynecology. Our study is a step in that direction.…”

Section: Discussionmentioning

confidence: 99%

Topical vs. intravenous administration of tranexamic acid to minimize blood loss in abdominal hysterectomy perioperatively: A randomized controlled study

Mitra¹,

Jain²,

Singh³

et al. 2022

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: Topical application of tranexamic acid (TXA) to bleeding wound surfaces is rapidly gaining recognition and currently a topic of further research in patients undergoing abdominal hysterectomy. The aim of the study was to compare the efficacy of topical vs. intravenous (i.v.) administration of TXA in reducing perioperative blood loss in patients undergoing abdominal hysterectomy. Material and Methods: A double-blinded parallel-group randomized controlled study was conducted in a tertiary teaching institute. Group 1 (n = 25) received 10 mg.kg -1 i.v. bolus of TXA after induction followed by infusion of 1 mg.kg -1 .h -1 of TXA, in 50 ml of normal saline (NS), till the completion of surgery and just before closure of peritoneum 100 ml of NS was applied topically over the raw surface. Group 2 (n = 25) received 50 ml of NS over 10 min after induction, followed by infusion of 50 ml of NS, till the completion of surgery and just before closure of peritoneum, 1.5 g of TXA mixed in 100 ml of NS was applied topically over the raw surface. The primary outcome was total perioperative blood loss (intraoperative plus 24 h postoperative). The secondary outcomes included change in hemoglobin concentration postoperatively at 12 h, 24 h; need for blood/blood product transfusion; amount of blood/blood product transfused and side effects of TXA. Results: Total perioperative blood loss was 312 ± 106.65 ml in group 1 and 325 ± 89.90 ml in group 2 (p = 0.659). It was found that the mean reduction in hemoglobin was 0.7 g.dl -1 and 0.54 g.dl -1 in group 1 and 0.67 g.dl -1 and 0.44 g.dl -1 in group 2 at 12 h and 24 h respectively, with no significant intergroup difference. Conclusion: Administration of TXA topically is as efficacious as TXA administered i.v. to minimize perioperative blood loss in patients undergoing abdominal hysterectomy.

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Decreasing Postoperative Blood Loss by Topical vs. Intravenous Tranexamic Acid in Open Cardiac Surgery (DEPOSITION) study: Results of a pilot study

Cited by 13 publications

References 26 publications

Effect of Topical Tranexamic Acid on Postoperative Bleeding in Cardiac Surgery

Effect of Topical Tranexamic Acid on Postoperative Bleeding in Cardiac Surgery

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Topical vs. intravenous administration of tranexamic acid to minimize blood loss in abdominal hysterectomy perioperatively: A randomized controlled study

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