Can topical administration of tranexamic acid be a good adjuvant to the intravenous route for decreasing postoperative seizure incidence? A double blinded randomized study

Taman, Hani I.; Amer, Ghada F; Amer, S.

doi:10.4103/1687-7934.153936

Cited by 3 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The range of mediastinal drainage following IP TxA in our study was similar to that reported in these studies (350‐700 vs 303‐730 mL, respectively) . In two other reports, the addition of topical application to IV TxA vs IV TxA alone did not add benefit in reducing postoperative 24‐hour blood loss compared with IV drug alone but significantly less products were used or significantly less seizures were observed with IV TxA plus topical TxA due to the lower dose of IV TxA used.…”

Section: Discussionsupporting

confidence: 87%

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

et al. 2019

View full text Add to dashboard Cite

Background Cardiac surgery patients are at high risk for postoperative bleeding. Intravenous (IV) tranexamic acid (TxA) is a commonly used antifibrinolytic drug, but is associated with postoperative seizures. We conducted this pilot randomized controlled trial (RCT) to determine the feasibility of a larger trial that will be designed to investigate the impact of TxA administration route, intrapericardial (IP) vs IV, on postoperative bleeding and seizures. Methods In this single‐center, double‐blinded, pilot RCT we enrolled adult patients undergoing nonemergent on‐pump cardiac operations through a median sternotomy. Participants were randomized to IP or IV TxA groups. The primary outcomes were cumulative chest tube drainage, transfusion requirements, and incidence of postoperative seizures. Results A total of 97 participants were randomized to the intervention and control groups. Baseline characteristics were similar in both groups. Most participants underwent a CABG and/or aortic valve replacement. There was no statistical difference. The IP TxA group was found to have a tendency for less chest tube drainage in comparison to the IV TxA group, 500.5 (370.0‐700.0) and 540.0 (420.0‐700.0) mL, respectively, which was not statistically significant (P = 0.2854). Fewer participants in the IP TxA group with cardiac tamponade and/or required a reoperation for bleeding and fewer packed red blood cell transfusions. None of the IP TxA group developed seizure vs one from the IV TxA group. Conclusion This is the first known pilot RCT to investigate the role of TxA route of administration in open cardiac surgery. Intrapericardial TxA shows promising results with decreased bleeding, transfusion requirements, reoperations, and postoperative seizures. A larger RCT is needed to confirm these results and lead to a change in practice.

show abstract

Section: Discussionsupporting

confidence: 87%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…28 The second trial compared adding topical 2 g TXA acid in 500 mL of normal saline to a reduced intravenous dose (30 mg/kg) versus full intravenous dose (50 mg/kg) of the drug. 29 No significant difference in 24-hour postoperative blood loss was observed in both studies and both studies were not included in the meta-analysis.…”

Section: Methodsmentioning

confidence: 96%

“…In addition, we identified two randomized trials comparing the addition of topical application to intravenous TXA acid versus the intravenous drug alone. 28,29 The first trial compared adding topical 2.5 g TXA in 250 mL of normal saline to full intravenous dose of the drug versus full intravenous dose 250 mL of normal saline. 28 The second trial compared adding topical 2 g TXA acid in 500 mL of normal saline to a reduced intravenous dose (30 mg/kg) versus full intravenous dose (50 mg/kg) of the drug.…”

Section: Methodsmentioning

confidence: 99%

Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis

Habbab

Semelhago

Lamy

2019

Thorac cardiovasc Surg

View full text Add to dashboard Cite

Background This meta-analysis was conducted to investigate the evidence for the efficacy and safety of intrapericardial tranexamic acid (TXA) in cardiac surgery. Methods We searched MEDLINE from 2000 to 2017 for randomized controlled trials that compared intrapericardial TXA to placebo. We performed a meta-analysis for the eligible trials that focused on chest tube drainage measured during the first 24 hours after surgery as a primary outcome. We also examined the secondary outcome measures of these trials such as the incidence of transfusion requirements following surgery and the evidence for any increase in complication rates. Results A total of seven randomized controlled trials (six on-pump and one off-pump) comparing topical application of TXA to placebo in 692 patients were eligible for the blood loss outcome data. These trials randomized 372 patients to receive TXA and 320 patients as controls. The use of intrapericardial TXA was associated with a considerable reduction in 24-hour blood loss in all seven studies and a weighted mean difference of −343.56 mL (95% confidence interval: −316.41, −370.72) significantly differed from zero (p = 0.005) with a heterogeneity of I 2 = 0%. The incidence of packed RBC transfusion in TXA patients was significantly lower in one study and was not significant but with trend in favor of TXA in five out of the six studies in which it was reported. In one trial, TXA was not detected in any patient and in another the studied groups were similar in postoperative complications, such as graft patency, myocardial infarction, cerebral infarction, atrial fibrillation, seizures, and infections. Conclusions Findings from this meta-analysis suggest that intrapericardial use of TXA in patients undergoing cardiac surgery can decrease postoperative bleeding without increasing the risk of postoperative seizures. Future large randomized, double-blind, controlled clinical trials are needed to confirm these promising findings.

show abstract

“…However, In a comparison with Taman et al, [30] study that evaluate topical administration of TxA if can be a good adjuvant to the I.V route for decreasing postoperative seizure incidence?, both studies show that the addition of topical application to IV TxA vs IV TxA alone did not add benefit in reducing postoperative 24h blood loss compared with IV drug alone but significantly less products were used, or significantly less seizures were observed with IV TxA plus topical TxA as in Taman HI, Amer GF, Amera SA study due to the lower dose of IV TxA used.…”

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

View full text Add to dashboard Cite

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.

show abstract

Can topical administration of tranexamic acid be a good adjuvant to the intravenous route for decreasing postoperative seizure incidence? A double blinded randomized study

Cited by 3 publications

References 0 publications

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

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

Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis

Effect of Topical Tranexamic Acid on Postoperative Bleeding in Cardiac Surgery

Contact Info

Product

Resources

About