Dual-route tranexamic acid to reduce blood loss in coronary artery bypass graft surgery: a randomized controlled trial

Prokopchuk‐Gauk, Oksana; Rosin, Mark W.; Mycyk, Taras; Lim, Hyun J.; Brose, Kelsey

doi:10.1007/s12630-016-0684-0

Cited by 2 publications

(2 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Neither ivTXA 11 nor ivTXA 33 groups differed significantly from mice who received no interventions, which suggests that TXA may need to be concentrated within wounds to reduce blood loss in this model. Recent studies of TXA in cardiac surgery support this notion by demonstrating small, but significantly decreased post operative blood loss with systemically administered TXA, and further reduction of blood loss when combined with topical TXA . However, bleeds in mice are not directly translatable to trauma in humans, because mouse vessels, hemorrhage volumes, bleed times, and extent of fibrinolysis are much smaller.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies of TXA in cardiac surgery support this notion by demonstrating small, but significantly decreased post operative blood loss with systemically administered TXA, 33 and further reduction of blood loss when combined with topical TXA. 34 to 112 mg/kg TXA in pigs and 24 to 80 mg/kg TXA in humans, when normalizing by body surface area. Since this human equivalent dose is usually well tolerated and similar to clinical doses, this acute toxicity of the spTXA formulation is likely caused by high osmolarity of the injected solution and not by its TXA content, since high osmolarity alone is known to cause local toxicity, pain, and tissue damage and since TXA has a long history of safe clinical use.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Topical tranexamic acid inhibits fibrinolysis more effectively when formulated with self‐propelling particles

Baylis

Lee

John

et al. 2019

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Background Endogenous fibrinolytic activation contributes to coagulopathy and mortality after trauma. Administering tranexamic acid (TXA), an antifibrinolytic agent, is one strategy to reduce bleeding; however, it must be given soon after injury to be effective and minimize adverse effects. Administering TXA topically to a wound site would decrease the time to treatment and could enable both local and systemic delivery if a suitable formulation existed to deliver the drug deep into wounds adequately. Objectives To determine whether self‐propelling particles could increase the efficacy of TXA. Methods Using previously developed self‐propelling particles, which consist of calcium carbonate and generate CO2 gas, TXA was formulated to disperse in blood and wounds. The antifibrinolytic properties were assessed in vitro and in a murine tail bleeding assay. Self‐propelled TXA was also tested in a swine model of junctional hemorrhage consisting of femoral arteriotomy without compression. Results Self‐propelled TXA was more effective than non‐propelled formulations in stabilizing clots from lysis in vitro and reducing blood loss in mice. It was well tolerated when administered subcutaneously in mice up to 300 to 1000 mg/kg. When it was incorporated in gauze, four of six pigs treated after a femoral arteriotomy and without compression survived, and systemic concentrations of TXA reached approximately 6 mg/L within the first hour. Conclusions A formulation of TXA that disperses the drug in blood and wounds was effective in several models. It may have several advantages, including supporting local clot stabilization, reducing blood loss from wounds, and providing systemic delivery of TXA. This approach could both improve and simplify prehospital trauma care for penetrating injury.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Topical tranexamic acid inhibits fibrinolysis more effectively when formulated with self‐propelling particles

Baylis

Lee

John

et al. 2019

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty

Wang

Zhao

et al. 2018

Medicine

View full text Add to dashboard Cite

Background:Blood management after arthroplasties has become a serious problem. The objective is to perform a meta-analysis to compare the efficacy and safety between oral tranexamic acid (TXA) and intravenous TXA for blood management in total knee and hip arthroplasty.Methods:We systematically searched randomized controlled trials (RCTs) from Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Google scholar. Eligibility criteria: Patients: adult patients with end-stage joint osteoarthritis, rheumatoid arthritis, and osteonecrosis of the femoral head, who prepared for TJA; Interventions: The experiential group received the intravenous form of TXA; Comparisons: Oral form of TXA; Outcomes: Total blood loss, hemoglobin reduction, transfusion requirements, duration of hospitalization, and thrombotic complications including deep vein thrombosis (DVT) and pulmonary embolism (PE); Study design: Randomized control trials (RCTs) and non-RCT. Meta-analysis results were collected and analyzed by the software STATA 11.0. After testing for heterogeneity between studies, data were aggregated for random-effects models when necessary.Results:Four RCTs and 2 non-RCTs were included in the meta-analysis. The present meta-analysis revealed that there were no significant differences regarding total blood loss (WMD = −25.013, 95% CI: −51.002 to 0.977, P = .059), postoperative hemoglobin decline (WMD = −0.090, 95% CI: −0.205 to 0.024, P = .122), or transfusion rate (RD = −0.039, 95% CI: −0.080 to 0.002, P = .062) between the 2 groups.Conclusion:Oral TXA shows comparable efficacy to that of the intravenous forms after total knee and hip arthroplasty. Due to the limited quality of evidence currently available, higher quality RCTs is necessary.

show abstract

Dual-route tranexamic acid to reduce blood loss in coronary artery bypass graft surgery: a randomized controlled trial

Cited by 2 publications

References 4 publications

Topical tranexamic acid inhibits fibrinolysis more effectively when formulated with self‐propelling particles

Topical tranexamic acid inhibits fibrinolysis more effectively when formulated with self‐propelling particles

The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty

Contact Info

Product

Resources

About