Results 1 to 3 of 3

Thread: Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery

  1. #1
    Managing Editor Jan B. Wade's Avatar
    Join Date
    Apr 1996
    Location
    Bellingham, Washington, United States
    Posts
    1,592

    Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery

    Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study


    http://www.biomedcentral.com/content...2482-11-29.pdf -


    Abstract

    Background: Degenerative spinal stenosis and instability requiring multilevel spine surgery has been associated with large blood losses. Factors that affect perioperative blood loss include time of surgery, surgical procedure, patient height, combined anterior/posterior approaches, number of levels fused, blood salvage techniques, and the use of anti-fibrinolytic medications. This study was done to evaluate the efficacy of tranexamic acid in reducing blood loss in spine surgery.

    Methods: This retrospective case control study includes 97 patients who had to undergo surgery because of degenerative lumbar spinal stenosis and instability. All operations included spinal decompression, interbody fusion and posterior instrumentation (4-5 segments). Forty-six patients received 1 g tranexamic acid intravenous, preoperative and six hours and twelve hours postoperative; 51 patients without tranexamic acid administration were evaluated as a control group. Based on the records, the intra- and postoperative blood losses were measured by evaluating
    the drainage and cell saver systems 6, 12 and 24 hours post operation. Additionally, hemoglobin concentration and platelet concentration were reviewed. Furthermore, the number of red cell transfusions given and complications associated with tranexamic acid were assessed.

    Results: The postoperative hemoglobin concentration demonstrated a statistically significant difference with a p value of 0.0130 showing superiority for tranexamic acid use (tranexamic acid group: 11.08 g/dl, SD: 1.68; control group: 10.29 g/dl, SD: 1.39). The intraoperative cell saver volume and drainage volume after 24 h demonstrated a significant difference as well, which indicates a less blood loss in the tranexamic acid group than the control group. The postoperative drainage volume at12 hours showed no significant differences; nor did the plateletconcentration Allogenic blood transfusion (two red cell units) was needed for eight patients in the tranexamic acid group and nine in the control group because of postoperative anemia. Complications associated with the administration of tranexamic acid, e.g. renal failure, deep vein thrombosis or pulmonary embolism did not occur.

    Conclusions: This study suggests a less blood loss when administering tranexamic acid in posterior lumbar spine surgery as demonstrated by the higher postoperative hemoglobin concentration and the less blood loss. But given the relatively small volume of blood loss in the patients of this study it is underpowered to show a difference in transfusion rates.
    Mr. Jan B. Wade
    Admin
    Email

    Click here for the Best Questions and Answers regarding Transfusion Alternatives and Patient Blood Management.




  2. New Feature! NoBlood Answers!

    • ASK questions regarding Transfusion Alternatives and Patient Blood Management.
    • SHARE your facts, opinions and personal experience.
    • DISCOVER the best answers chosen by Healthcare Professionals and the Public.
    • RANK the best answers.

    Click here to see the Best Answers to Top Questions.

  3. #2
    Registered User
    Join Date
    Jun 2007
    Posts
    4
    European Journal of Obstetrics & Gynecology and Reproductive Biology


    Article in Press
    Reducing blood loss at abdominal myomectomy with preoperative use of dinoprostone intravaginal suppository: a randomized placebo-controlled pilot study



    Department of Obstetrics & Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
    Received 22 January 2012; received in revised form 7 July 2012; accepted 13 September 2012. published online 10 October 2012.
    Uncorrected Proof



    Abstract

    Objective

    To determine the effect of a single preoperative intravaginal prostaglandin E2 (PGE2; dinoprostone) suppository on reducing intraoperative blood loss and the need for subsequent blood transfusion at abdominal myomectomy for symptomatic leiomyomas.
    Study design

    In a prospective randomized double-blind placebo-controlled pilot study, 108 women who had abdominal myomectomy for symptomatic leiomyomas were enrolled. Patients were randomly assigned to receive a single dose of intravaginal 20mg dinoprostone (n=54) or placebo (n=54) 60min before the operation. The primary outcome was the operative blood loss. The secondary outcomes were the need for blood transfusion, change in hemoglobin (Hb) level 24h after operation, and the prevalence of side effects.
    Results

    Blood loss and transfusion rate were significantly greater in the group without PGE2 suppository (group B) than in the group with PGE2 (group A): they were respectively 485.7±361.3mL vs 364.1±279.4mL (P=.02; relative risk [RR] 0.95; 95% confidence interval [CI], 0.63–1.45) and 18.5% vs 3.7% (P=.04; RR 1.32; 95% CI, 3.7–18.5). Group B had a significant decrease in Hb level 24h after operation compared with group A (P<.05). There was no difference in the patient demographics, intraoperative characteristics, postoperative stay, complications, and the side effects between the two groups.
    Conclusion

    A single pre-operative dose of dinoprostone administered intravaginally could be a safe and reliable method to help decrease blood loss during abdominal myomectomy. Further larger prospective studies are required to support this conclusion.

    Elsevier



    Quote Originally Posted by Jan B. Wade View Post
    Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study


    http://www.biomedcentral.com/content...2482-11-29.pdf -


    Abstract

    Background: Degenerative spinal stenosis and instability requiring multilevel spine surgery has been associated with large blood losses. Factors that affect perioperative blood loss include time of surgery, surgical procedure, patient height, combined anterior/posterior approaches, number of levels fused, blood salvage techniques, and the use of anti-fibrinolytic medications. This study was done to evaluate the efficacy of tranexamic acid in reducing blood loss in spine surgery.

    Methods: This retrospective case control study includes 97 patients who had to undergo surgery because of degenerative lumbar spinal stenosis and instability. All operations included spinal decompression, interbody fusion and posterior instrumentation (4-5 segments). Forty-six patients received 1 g tranexamic acid intravenous, preoperative and six hours and twelve hours postoperative; 51 patients without tranexamic acid administration were evaluated as a control group. Based on the records, the intra- and postoperative blood losses were measured by evaluating
    the drainage and cell saver systems 6, 12 and 24 hours post operation. Additionally, hemoglobin concentration and platelet concentration were reviewed. Furthermore, the number of red cell transfusions given and complications associated with tranexamic acid were assessed.

    Results: The postoperative hemoglobin concentration demonstrated a statistically significant difference with a p value of 0.0130 showing superiority for tranexamic acid use (tranexamic acid group: 11.08 g/dl, SD: 1.68; control group: 10.29 g/dl, SD: 1.39). The intraoperative cell saver volume and drainage volume after 24 h demonstrated a significant difference as well, which indicates a less blood loss in the tranexamic acid group than the control group. The postoperative drainage volume at12 hours showed no significant differences; nor did the plateletconcentration Allogenic blood transfusion (two red cell units) was needed for eight patients in the tranexamic acid group and nine in the control group because of postoperative anemia. Complications associated with the administration of tranexamic acid, e.g. renal failure, deep vein thrombosis or pulmonary embolism did not occur.

    Conclusions: This study suggests a less blood loss when administering tranexamic acid in posterior lumbar spine surgery as demonstrated by the higher postoperative hemoglobin concentration and the less blood loss. But given the relatively small volume of blood loss in the patients of this study it is underpowered to show a difference in transfusion rates.

  4. #3
    Registered User
    Join Date
    Jun 2007
    Posts
    4

    Tranexamic acid reduced hip replacement transfusions ~80%; & wikipedia info

    http://www.ncbi.nlm.nih.gov/pubmed/23045310Orv Hetil. 2012 Oct 14;153(41):1607-12. doi: 10.1556/OH.2012.29455.
    [Pharmacological reduction of bleeding during hip endoprosthetic replacement].
    [Article in Hungarian]
    de Jonge T.
    Source
    Vas Megyei Markusovszky Kórház, Egyetemi Oktatókórház Nonprofit Zrt. Ortopédiai Sebészeti Osztály Szombathely Markusovszky L. u. 5. 9700.
    Abstract
    Introduction: Endoprosthetic replacement of the large joints is accompanied by major bleeding. During the last few years several authors reported the perioperative administration of tranexamic acid and its beneficial effect on reducing the blood loss. Objectives: In the present study, the author studied the effect of intravenously administered tranexamic acid in patients undergoing primary total hip arthroplasty in order to examine whether this treatment could reduce postoperative blood loss, the amount of transfused packed red cells, and the cost of the blood saving and/or transfusion.
    Methods: The author compared retrospectively the data of
    104 patients undergoing primary total hip arthroplasty between April, 2010 and December, 2011.
    54 patients were administered tranexamic acid (Group 1) and
    50 patients were treated without tranexamic acid (Group 2). The amount of postoperative bleeding, haemoglobin, hematocrit, red blood cell count, and the number of units of the transfused packed red cells were recorded. Cost effectiveness of treatment with tranexamic acid was calculated. Results: Postoperative blood loss in Group 1 was 732 ml (210-1280 ml), and in Group 2 1092 ml (420-2640 ml).

    Ten of the 54 patients in Group 1 had to be transfused, and the all-over need was 20 units of packed red cells.

    49 of the 50 patients in Group 2 received 98 units of allogenic blood.

    Thromboembolic complication was not observed in connection with the use of tranexamic acid. The reduction of blood loss with the application of tranexamic acid and the transfused packed red cells cost in average 5,180 HUF per patient in Group 1 and 15,850 HUF in Group 2. Conclusions: Intravenous administration of tranexamic acid reduces effectively the transfusion rate and the blood loss in the postoperative period in patients undergoing primary total hip arthroplasty. More than 1.5 million HUF and 240 units of packed red cells could be yearly saved with the introduction of this simple, safe and cheap method of drug administered blood conservation. Orv. Hetil., 2012, 153, 1607-1612.
    PMID: 23045310 [PubMed - in process]


    Tranexamic acid - Wikipedia, the free encyclopedia
    Tranexamic acid (commonly marketed in tablet form as Lysteda and in IV form as Cyklokapron in the U.S. and Australia and as Transamin,Transcam in Asia, and Espercil in South America. Also marketed as TRAXYL (Nuvista Pharma) in Bangladesh, Cyclo-F and Femstrual in UK.) is a synthetic derivative of the amino acid lysine. It is used to treat or prevent excessive blood loss during surgery and in various other medical conditions. It is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin, by binding to specific sites of both plasminogen and plasmin, a molecule responsible for the degradation of fibrin. Fibrin is a protein that forms the framework of blood clots. It has roughly eight times the antifibrinolytic activity of an older analogue, ε-aminocaproic acid.

    Tranexamic acid is frequently used in surgeries with high risk of blood loss such as cardiac, liver, vascular and large orthopedic procedures. Its oral form is now being evaluated for use in outpatient conditions involving heavy bleeding.
    [edit]Trauma
    Tranexamic acid has been found to decrease the risk of death in people who have significant bleeding due to trauma.[1] However, it may actually increase the risk of death due to bleeding if administered more than 3 hours after the injury.[2]
    [edit]Heart surgery
    Tranexamic acid is commonly used in cardiac surgery, both with and without cardiopulmonary bypass. It replaces aprotinin.
    [edit]Orthopedic surgery
    Tranexamic acid is used in orthopedic surgery to reduce bloodloss. It is of proven value in clearing the field of surgery and reducing pre- and postoperative blood loss. Drain and number of transfusions are reduced. However, the hidden blood loss is not reduced. Still, it is becoming an important tool in the anaesthetist's arsenal. It is commonly used in joint replacement surgery.
    [edit]Menstrual bleeding
    Used as firstline nonhormonal treatment of dysfunctional uterine bleeding, and heavy bleeding associated with uterine fibroids. A recent study showed patients treated with tranexamic acid are more likely to develop thrombosis and necrosis in their fibroids, and may result in pain and fever. Moreover, the histological appearance of the necrosis in women treated by tranexamic acid is no different from the spontaneous incidence of thrombosis. The U.S. Food and Drug Administration (FDA) approved tranexamic acid oral tablets (brand name Lysteda) for treatment of heavy menstrual bleeding on 13 November 2009.
    In March 2011 the status of Tranexamic acid for treatment of heavy menstrual bleeding (menorrhagia) was changed in the UK, from PoM (Prescription only Medicines) to P (Pharmacy Medicines)[3] and became available over the counter in UK pharmacies under the brand names of Cyclo-F and Femstrual, initially exclusively for Boots pharmacy, which has sparked some discussion about availability.[4] (In parts of Europe - like for example Sweden - it had then been available OTC for over a decade.)
    [edit]Dentistry
    Tranexamic acid is used in dentistry in the form of a 5% mouth rinse after extractions or surgery in patients with prolonged bleeding time, e.g. from acquired or inherited disorders.
    [edit]Other uses
    In obstetrics, tranexamic acid is used after delivery to reduce bleeding, often with syntocinon/oxytocin and fundal massage. A major trial is in progress worldwide to establish the efficacy of the drug to arrest postpartum haemorrhage (PPH). Since the drug can be administered orally, it has great potential to reduce maternal mortality rates in developing countries where primary healthcare is often unavailable.
    In cardiac surgery, e.g. coronary artery bypass surgery, it is used to prevent excessive blood loss.
    In hemophilia - Tranexamic acid is also useful in the treatment of bleeding as a second line treatment after factor VIII in patients (e.g. tooth extraction).
    In hereditary angioedema[5]
    [edit]Society and culture
    TXA has been included in the WHO list of essential medicines.[6] TXA is inexpensive and treatment would be considered highly cost effective in high, middle and low income countries.[7]
    [edit]References

Similar Threads

  1. The Effect of Tranexamic Acid on Reducing Blood Loss in Cementless Total Hip...
    By lekozza in forum News and Hot Topics such as Hepatitis C, SARS and AIDS
    Replies: 0
    Last Post: 12-29-2009, 07:02 PM

Tags for this Thread

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •