Tranexamic acid for reducing mortality in emergency and urgent surgery

Perel, Pablo; Ker, Katharine; Uribe, Carlos Hernándo Morales; Roberts, Ian

doi:10.1002/14651858.cd010245

Cited by 48 publications

(73 citation statements)

References 9 publications

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“…A Cochrane review showed that TXA significantly reduces blood transfusion in patients undergoing emergency or urgent non-obstetrical surgery. 18 TXA is safe in pregnancy, being FDA category B. It is therefore unsurprising that there is interest in its role in the prevention of postpartum hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive IV tranexamic acid versus topical tranexamic acid application of the placental bed for prevention of postpartum hemorrhage in women with placenta previa: a randomized controlled trial

Shady

Sallam

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Placenta previa one of the famous etiology of excessive blood loss during and after cesarean section. The objective of this study was to determine the effect of prophylactic adjunctive IV versus topical tranexamic acid (TA) on calculated and measured blood loss during and after caesarean section due to placenta previa compared with standard IV oxytocin alone.Methods: In this double-blind randomized controlled trial, 120 women were undergoing caesarean delivery for placenta previa (PP) were randomly allocated to receive 10 IU oxytocin IV after placental delivery, or receive 1 gm tranexamic acid IV just before skin incision plus 10 IU oxytocin IV after placental delivery or received 10 IU oxytocin IV after placental delivery plus 2 gm topical tranexamic acid applied on placental bed. The main outcome was to measure blood loss during and 4-hour post caesarean delivery.Results: 120 women were enrolled (n = 40 in each group). Both groups of women received IV tranexamic acid (Group II) and topical tranexamic acid (Group III) showed great reduction in intraoperative and 4 hours post-operative blood loss compared with (Group I) which received 10 IU oxytocin only (P = 0.0001, 0.0001, 0.0001, 0.0001), so the overall estimated blood loss in group II and III showed highly reduction compared with group I (P = 0.0001, 0.0001).Conclusions: Prophylactic adjunctive TA topical application on the placental bed or iv administration reduces blood loss during and after caesarean delivery in women with a placenta previa. novel application of topical tranexamic acid on the placental bed is effective in reduce intraoperative and postoperative bleeding in comparison with IV route with elimination of theoretical risk of thrombi embolism complication with IV rout.

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Section: Discussionmentioning

confidence: 99%

Adjunctive IV tranexamic acid versus topical tranexamic acid application of the placental bed for prevention of postpartum hemorrhage in women with placenta previa: a randomized controlled trial

Shady

Sallam

2017

Int J Reprod Contracept Obstet Gynecol

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“…45 Nonetheless, because available clinical trials as a whole 10 include a small number of TXA-treated patients, some doubt persists regarding the safety of TXA. [46][47][48] The European Society of Anaesthesiology guidelines 39 recommend TXA administration in total hip and knee arthroplasty and in spine surgery. However, these recommendations are accompanied by the sug-15 gestion to individually evaluate the risk-benefits of the treatment in women, patients with a history of VTE, and individuals older than 60 yr.…”

mentioning

confidence: 99%

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

Colomina

Koo

Basora

et al. 2017

British Journal of Anaesthesia

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Abstract15 Background. Perioperative tranexamic AQ5 acid (TXA) use can reduce bleeding and transfusion requirements in several types of surgery, but level I evidence proving its effectiveness in major spine surgery is lacking. This study was designed to investigate the hypothesis that TXA reduces perioperative blood loss and transfusion requirements in patients undergoing major spine procedures. Methods. We conducted a multicentre, prospective, randomized double-blind clinical trial, comparing TXA with placebo in 20 posterior instrumented spine surgery. Efficacy was determined based on the total number of blood units transfused and the perioperative blood loss. Other variables such as the characteristics of surgery, length of hospital stay, and complications were also analysed. Results. Ninety-five patients undergoing posterior instrumented spine surgery (fusion of >3 segments) were enrolled and randomized: 44 received TXA (TXA group) and 51 received placebo (controls). The groups were comparable for duration of 25 surgery, number of levels fused, and length of hospitalization. Transfusion was not required in 48% of subjects receiving TXA compared with 33% of controls (P ¼ 0.05). Mean number of blood units transfused was 0.85 in the TXA group and 1.42 with placebo (P ¼ 0.06). TXA resulted in a significant decrease in intraoperative bleeding (P ¼ 0.01) and total bleeding (P ¼ 0.01) relative to placebo. The incidence of adverse events was similar in the two groups. Conclusions. TXA did not significantly reduce transfusion requirements, but significantly reduced perioperative blood loss 30 in adults undergoing major spinal surgery.Clinical trial registration. NCT01136590.

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“…A number of Cochrane systematic reviews conducted in a variety of surgical settings had reported the efficacy of prophylactic perioperative administration of TXA in reducing blood loss and the need for blood transfusion. [6][7][8][9][10] TXA has already been demonstrated to reduce uterine blood loss in non-surgical aspect. Various studies had revealed that TXA resulted in a significant reduction of menstrual blood loss in menorrhagic women while not increasing the risk of thrombosis and had been used successfully to treat menorrhagia associated with a number of coagulopathies.…”

mentioning

confidence: 99%

“…26 There has been consistent results about the significant role of TXA in blood conservation in various settings, from trauma to cardiac, neurological, orthopedic, craniofacial, obstetric and gynaecological surgery. [6][7][8]27 Ker et al in their systematic review of randomized clinical trials on the effect of TXA on surgical blood loss had revealed that TXA reduces the probability of blood transfusion by 38%. 16 With growing evidence about the positive effects of TXA on perioperative bleeding and transfusion rate, this randomized, double-blinded, placebo-controlled study was conducted with the objective of determining whether a single prophylactic dose of TXA given intravenously can reduce perioperative blood loss and also the need for blood transfusion in patients undergoing abdominal hysterectomy.…”

mentioning

confidence: 99%

“…Numerous clinical trials have not reported any evidence for an increased risk of thromboembolic events with TXA in various clinical situations, including trauma and surgery. 8,15,16 Recent evidence from the CRASH-2 trial of TXA in bleeding trauma patients showed a statistically significant reduction in mortality with no increase in thromboembolic effects and indeed, there was a statistically significant reduction in the risk of myocardial infarction. 17 In this study, the incidence of minor adverse effects like nausea, vomiting and diarrhoea were low and was comparable between both the groups.…”

mentioning

confidence: 99%

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Effect of prophylactic tranexamic acid on blood conservation in Indian women undergoing abdominal hysterectomy

Arthi

Jalakandan

Gunaseelan

2018

Int J Reprod Contracept Obstet Gynecol

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Background: The prevalence of anemia in India is so high that majority of women presenting for hysterectomy are already with borderline hemoglobin status and the perioperative blood loss puts them at risk of death and prolongs recovery. Antifibrinolytic agents, mainly Tranexamic acid (TXA) have been demonstrated to reduce blood loss and transfusion requirements in various surgeries. The present study was done to assess the efficacy of TXA in effectively reducing intraoperative blood loss and the need for transfusion in Indian population undergoing abdominal hysterectomy for benign indications.Methods: This randomized, double-blind, placebo-controlled study was conducted on hundred patients undergoing abdominal hysterectomy. Group T (n = 50)- received TXA 15 mg/kg in 100 ml Normal saline and Group N (n = 50)-received the same volume of Normal saline infused over 15 minutes. Estimated blood loss need for blood transfusion, duration of surgery, postoperative hemoglobin and incidence of adverse events were noted.Results: There was statistically significant reduction in mean blood loss in group T when compared to group N (360 ml versus 540 ml). Accordingly, there was significant difference in the number of patients requiring blood transfusion (12% versus 42%) and also the postoperative hemoglobin levels. The group T patients had a significantly shorter operating time (127.86 versus 148.64 minutes). None of the patients developed any major adverse events.Conclusions: The prophylactic TXA safely and effectively reduces the blood loss and transfusion requirements in Indian patients undergoing abdominal hysterectomy for benign indications.

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Tranexamic acid for reducing mortality in emergency and urgent surgery

Abstract: Tranexamic acid for reducing mortality in emergency and urgent surgery.

Cited by 48 publications

References 9 publications

Adjunctive IV tranexamic acid versus topical tranexamic acid application of the placental bed for prevention of postpartum hemorrhage in women with placenta previa: a randomized controlled trial

Adjunctive IV tranexamic acid versus topical tranexamic acid application of the placental bed for prevention of postpartum hemorrhage in women with placenta previa: a randomized controlled trial

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

Effect of prophylactic tranexamic acid on blood conservation in Indian women undergoing abdominal hysterectomy

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