Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery

Lourijsen, Evelijn; Avdeeva, Klementina; Gan, Kit Liang; Pundir, Vishal; Fokkens, Wytske J.

doi:10.1002/14651858.cd012843.pub2

Cited by 9 publications

(8 citation statements)

References 55 publications

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“…However, a study involving 88 adult CRS patients who underwent FESS revealed that preoperative coagulation screening tests such as PT, international normalized ratio (INR), and APTT were not effective in predicting intraoperative bleeding ( 29 ). Nevertheless, other studies have indicated that the use of anticoagulants, either locally or systemically, can help to reduce bleeding associated with FESS ( 30–32 ). Coincidentally, our investigation has revealed that even when PT and PTA were within the normal range, their elevation was significantly associated with POV during FESS.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram for predicting poor operative visibility during FESS in Chinese adult patients with CRS

Sun,

Liang,

Yang

et al. 2024

Front. Med.

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ObjectiveThe purpose of this study is to develop and evaluate a nomogram that is capable of predicting poor operative visibility during functional endoscopic sinus surgery.MethodTo identify potential risk factors, patients with chronic rhinosinusitis who underwent functional endoscopic sinus surgery (FESS) between January 2019 and December 2022 were selected from our hospital’s electronic medical record system. Data on general patient information, clinical manifestations, clotting-related test indices, Lund-Machay score of sinuses CT scanning, Lund-kennedy score of nasal endoscopies, anesthesia methods, intraoperative blood pressure and heart rate, and Boezaart bleeding score were collected. Minimum absolute convergence and selection operator (LASSO) regression, as well as multivariate logistic regression, were used to determine the risk factors. A nomogram was developed in order to predict poor operating visibility during FESS, and its performance was evaluated utilizing both the training and verification datasets via various measures including receiver operating characteristic (ROC) curve analysis, area under the curve (AUC), Hosmer-Lemeshow goodness-of-fit test, calibration curve, and decision curve analysis.ResultsOf the 369 patients who met the inclusion criteria, 88 of them exhibited POV during FESS. By deploying LASSO and multivariate logistic regression analyses, six risk factors were identified and used to construct a nomogram for predicting POV during FESS. These factors include prothrombin time (PT), prothrombin activity (PTA), Lund-Mackay score (LMS), Lund-Kennedy score (LKS), anesthetic method, and intraoperative hypertension. The AUC of the training set was found to be 0.820 while that of the verification set was 0.852. The Hosmer-Lemeshow goodness-of-fit test and calibration curve analysis revealed good consistency between predicted and actual probabilities. Also, the decision curve demonstrated that the nomogram had a high degree of clinical usefulness and net benefit.ConclusionThe constructed nomogram has a strong ability to predict the poor intraoperative field in patients with chronic rhinosinusitis, which can help preoperative judgment of high-risk patients and provide evidence for perioperative management and preoperative plan formulation.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram for predicting poor operative visibility during FESS in Chinese adult patients with CRS

Sun,

Liang,

Yang

et al. 2024

Front. Med.

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“…This is based on the hypothesis that 3.9% of patients require intervention (administration of packed red blood cells or surgical, radiological or endoscopic intervention) due to postoperative haemorrhage 11 14–17 19. Based on previous studies and our published trial, we expect a decrease in postoperative intervention for haemorrhage to 1.4% (a decrease of 2.5%) in patients who receive TXA peroperatively 10 20…”

Section: Methods and Analysismentioning

confidence: 99%

“…In order to be eligible to participate, a subject must meet the following inclusion criteria: primary bariatric procedure, good knowledge of the Dutch or English language and written informed consent. Subjects with any of the following criteria will be excluded: pregnancy, iatrogenic bleeding during surgery (with the exception of bleeding originating from the staple line), a medical history of bleeding disorders, Wegener’s disease, sarcoidosis, spontaneous major acute bleeding, VTE (defined as pulmonary embolism or deep vein thrombosis), disseminated intravascular coagulation or any other coagulopathies, epilepsy, colour vision disorders, use of anticoagulant medication and heart failure or other conditions necessitating fluid restrictions 20…”

Section: Methods and Analysismentioning

confidence: 99%

Peroperative administration of tranexamic acid in Roux-en-Y and one-anastomosis gastric bypass to reduce haemorrhage in patients with morbid obesity: protocol for randomised controlled trial (PATRY trial)

't Hart,

Noordman,

Palsgraaf-Huisbrink

et al. 2024

BMJ Open

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IntroductionBy implementation of Enhanced Recovery After Bariatric Surgery protocols and day-care surgery, early discharge poses a challenge if excessive bleeding occurs after bariatric surgery. Tranexamic acid (TXA) has demonstrated efficacy in other surgical fields and in bariatric pilot studies. This trial aims to assess the efficacy of peroperative administration of TXA in reducing haemorrhage in patients undergoing gastric bypass surgery.Method and analysisThis is a multicentre, phase III, double-blind randomised controlled trial in six high-volume bariatric centres in the Netherlands. A total of 1524 eligible patients, aged 18 years or older, undergoing primary gastric bypass surgery (either Roux-en-Y gastric bypass or one-anastomosis gastric bypass) will be randomised between TXA and placebo (1:1, variable block, stratified for centre, day-care/overnight stay and type of surgery) after obtaining informed consent (2.5% less haemorrhage, power 80%, 2-sided-α 0.05 and 10% dropout). Exclusion criteria are pregnancy, amedical history of acute bleeding (without cause), venous thrombotic events (VTEs), epilepsy, anticoagulant use and iatrogenic bleeding during surgery (aside from staple line). The primary outcome is postoperative haemorrhage requiring intervention within 30 days postoperatively. Secondary outcome measures are staple line reinforcement, blood loss, duration of surgery, postoperative haemoglobin, vital parameters, minor and major complications, side effects of TXA (nausea, hypotension and VTE), length of hospital stay and directly made costs.Ethics and disseminationWritten informed consent will be obtained from all participants. The protocol has been approved by the Medical Research Ethics Committees United, Nieuwegein, on 7 February 2023 (registration number: R22.102). Results will be disseminated through peer-reviewed publications and conferences.Trial registration numberNCT05464394

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“…Among the drugs used to reduce the risk of bleeding, we have tranexamic acid (trans-4-amino-methyl-cyclohexane carboxylic acid), which reduces blood loss during surgery, improves the quality and safety of the surgical field [5]; This synthetic antifibrinolytic agent inhibits plasminogen to plasmin coverage on the fibrin surface, causing clot stabilization [6]. Its antifibrinolytic effect is reached between two and three hours after oral administration and immediately after intravenous administration, it has a halflife of approximately two hours [5] with bioavailability of 46% in oral intake. The most common adverse events are nausea, diarrhea, and abdominal colic.…”

Section: Introductionmentioning

confidence: 99%

“…The most common adverse events are nausea, diarrhea, and abdominal colic. The side effects of its systematic use: thromboembolic events and seizures are rare and infrequent [5] and can cause color vision disorder; when administered intravenously, tranexamic acid is used at a dose of 10mg/kg, slow administration (1ml/min) is recommended to avoid significant hypotension.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2024

OJOR

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Introduction: Tonsillectomy is the most widely performed procedure worldwide, with complications like bleeding which is divided into primary that occurs within 24 hours and secondary at any point more than 24 hours after surgery. Among the drugs used to reduce the risk of bleeding, we have tranexamic acid; its use topical has not been described for early or late tonsil bleeding. Materials and Methods:The medical records with diagnosis of post-tonsillectomy hemorrhage that have been treated with topical tranexamic acid at the Carlos Andrade Marin Specialties Hospital and the Private Hospital of the city of Quito in the period 2018-2022 were analyzed. The study population was six adult patients.Results: Topical tranexamic acid was administered; it was evident that with the first instillation the bleeding was controlled in the 83.3%, oral tolerance began from 12 hours after the scheme started; a patient failed and need emergency surgery. Conclusion:Administration of topical tranexamic acid was successful in controlling post-tonsillectomy hemorrhage.

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Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery

Cited by 9 publications

References 55 publications

Development and validation of a nomogram for predicting poor operative visibility during FESS in Chinese adult patients with CRS

Development and validation of a nomogram for predicting poor operative visibility during FESS in Chinese adult patients with CRS

Peroperative administration of tranexamic acid in Roux-en-Y and one-anastomosis gastric bypass to reduce haemorrhage in patients with morbid obesity: protocol for randomised controlled trial (PATRY trial)

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