Comparison of single versus double tranexamic acid dose regimens in reducing post-operative blood loss following intramedullary nailing of femoral fracture nonunions

Shodipo, Olaoluwa Moses; Jatto, Hamzah Ibrahim; Ramat, Ali Mohammed; Ibrahim, Shaphat Shuaibu; Ajiboye, Lukman Olalekan; Arojuraye, Soluideen Adebayo; James, John Adeniran; Toluse, Adetunji

doi:10.1007/s00264-021-05220-0

Cited by 6 publications

(4 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tranexamic acid use in traumatic hemorrhage has been the subject of intense research and debate for over a decade, in addition to nontrauma pharmacokinetic studies reporting investigations into different dosing strategies outside of traumatic hemorrhage and coagulopathy. 13,[27][28][29][30] In this study, we found no differences in mortality or adverse events between a single bolus and double bolus strategy when compared with the CRASH-2 trial dosing protocol (1 g bolus plus 1 g infusion). This finding is in agreement with previous studies that have found no significant difference in clinical outcomes for patients in which the (second) in-hospital dose of TXA is omitted.…”

Section: Discussionmentioning

confidence: 50%

“…While there were no differences in age between the three study groups, the bolus plus infusion group had more females (34%) versus single bolus (17%) versus double bolus (16%) ( p = 0.002; Table 1). Similarly, patients in this group had significantly higher median Injury Severity Score (ISS) [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] versus single bolus ISS versus double bolus ISS (25, 16-34; p = 0.001). Patients who received bolus plus infusion had significantly higher rates of blunt injury, while the double bolus group had a higher proportion of severe abdominal injuries (Table 1).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage

Gunn,

Stevenson,

Almuwallad

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

Introduction Tranexamic acid (TXA) is a life-saving treatment for traumatic hemorrhage, but the optimal dosing regimen remains unknown. Different doses and treatment strategies have been proposed, including single bolus, repeated bolus or bolus plus infusion. The aim of this study was to determine the effect of different TXA dosing strategies on clinical outcomes in bleeding trauma patients. Methods Secondary analysis of a perpetual cohort study from a UK Level 1 trauma center. Adult patients who activated the local major hemorrhage protocol and received TXA were included. The primary outcome was 28-day mortality. Secondary outcomes were 24-hour mortality, multiple organ dysfunction syndrome (MODS), venous thromboembolism (VTE) and ROTEM fibrinolysis. Results Over an 11-year period, 525 patients were included. Three dosing groups were identified: 1 g bolus only (n = 317), 1 g bolus +1 g infusion over 8 hours (n = 80), and 2 g bolus (n = 128). Demographics and admission physiology were similar, but there were differences in injury severity (median ISS: 25, 29 & 25); and admission systolic blood pressure (median SBP: 99, 108, 99 mmHg) across the 1 g, 1 g + 1 g and 2 g groups. 28-day mortality was 21% in each treatment group. The incidence of MODS was significantly higher in the bolus plus infusion group (84%) vs 1 g bolus (64%) and 2 g bolus (62%) group, p = 0.002, but on multivariable analysis was non-significant. VTE rates were similar in the 1 g bolus (4%), 2 g bolus (8%) and bolus plus infusion groups (7%). There was no difference in ROTEM Maximum Lysis at 24 hours: 5% in both the 1 g and 2 g bolus groups vs 4% in bolus plus infusion group. Conclusion Clinical outcomes and 24-hour fibrinolysis state were equivalent across three different dosing strategies of TXA. Single bolus administration is likely preferable to a bolus plus infusion regimen. Level of Evidence Level IV, Therapeutic/Care Management

show abstract

Section: Discussionmentioning

confidence: 50%

Section: Resultsmentioning

confidence: 99%

A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage

Gunn,

Stevenson,

Almuwallad

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Other papers that have a difficulty in finding a place are participation of vitamins or regimes in healing, education in preparation of patients for a specialized procedure such as joint replacement, and doctor's experience in introducing new procedures.We published many such controversial subjects related to orthopaedics and conjunctive tissue [1-3]. We published papers dealing with the use of specific molecules like tranexamic acid during surgery [4][5][6][7]. We published also papers related to the use of drugs or medications before or after surgery as well as regional anaesthetic blocks [8][9][10][11].…”

mentioning

confidence: 99%

“…We published many such controversial subjects related to orthopaedics and conjunctive tissue [1-3]. We published papers dealing with the use of specific molecules like tranexamic acid during surgery [4][5][6][7]. We published also papers related to the use of drugs or medications before or after surgery as well as regional anaesthetic blocks [8][9][10][11].…”

mentioning

confidence: 99%

About anesthesiology and surgery: analgesia, anaesthesia, and non-surgical papers published in journals of surgery

Scarlat

Mavrogenis

2021

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Subjects treated in a general orthopaedic publication are innumerable. Some themes could not be included in a very specialized journal or in a technical publication because they treat "borderline" subjects such as the biology of healing in tissues, patient-related outcomes in a specific procedure, or pain management. Other papers that have a difficulty in finding a place are participation of vitamins or regimes in healing, education in preparation of patients for a specialized procedure such as joint replacement, and doctor's experience in introducing new procedures.We published many such controversial subjects related to orthopaedics and conjunctive tissue [1-3]. We published papers dealing with the use of specific molecules like tranexamic acid during surgery [4][5][6][7]. We published also papers related to the use of drugs or medications before or after surgery as well as regional anaesthetic blocks [8][9][10][11]. However, the most read and cited borderline papers are dedicated to pain management and blood loss as well as the outcome studies in controversial subjects [12][13][14][15]. Some of the published papers were dedicated to analgesia and anaesthesia. For millennia, pain was a major subject for both patients and doctors and modern anaesthesia realized unbelievable progress in managing pre-operative and postoperative care as well as the realization of surgery "per se" [16,17]. No surgery without anaesthesia. The surgical team includes as pre-requisite the presence of a specialized anesthesiologist doctor or assistant. Difficult cases are managed correctly with pre-operative and post-operative protocols. Many patients are old, presenting comorbidities and chronic treatments such as anticoagulants or respiratory medication. Patients become more and more demanding and the cases become more complex and difficult. Is it reasonable to refuse

show abstract

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

Gibbs

Champaneria

Geneen

et al. 2023

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Background Pelvic, hip, and long bone fractures can result in significant bleeding at the time of injury, with further blood loss if they are treated with surgical fixation. People undergoing surgery are therefore at risk of requiring a blood transfusion and may be at risk of peri‐operative anaemia. Pharmacological interventions for blood conservation may reduce the risk of requiring an allogeneic blood transfusion and associated complications. Objectives To assess the effectiveness of different pharmacological interventions for reducing blood loss in definitive surgical fixation of the hip, pelvic, and long bones. Search methods We used a predefined search strategy to search CENTRAL, MEDLINE, PubMed, Embase, CINAHL, Transfusion Evidence Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from inception to 7 April 2022, without restrictions on language, year, or publication status. We handsearched reference lists of included trials to identify further relevant trials. We contacted authors of ongoing trials to acquire any unpublished data. Selection criteria We included randomised controlled trials (RCTs) of people who underwent trauma (non‐elective) surgery for definitive fixation of hip, pelvic, and long bone (pelvis, tibia, femur, humerus, radius, ulna and clavicle) fractures only. There were no restrictions on gender, ethnicity, or age. We excluded planned (elective) procedures (e.g. scheduled total hip arthroplasty), and studies published since 2010 that had not been prospectively registered. Eligible interventions included: antifibrinolytics (tranexamic acid, aprotinin, epsilon‐aminocaproic acid), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants, and non‐fibrin sealants. Data collection and analysis Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using GRADE. We did not perform a network meta‐analysis due to lack of data. Main results We included 13 RCTs (929 participants), published between 2005 and 2021. Three trials did not report any of our predefined outcomes and so were not included in quantitative analyses (all were tranexamic acid versus placebo). We identified three comparisons of interest: intravenous tranexamic acid versus placebo; topical tranexamic acid versus placebo; and recombinant factor VIIa versus placebo. We rated the certainty of evidence as very low to low across all outcomes. Comparison 1. Intravenous tranexamic acid versus placebo Intravenous tranexamic acid compared to placebo may reduce the risk of requiring an allogeneic blood transfusion up to 30 days (RR 0.48, 95% CI 0.34 to 0.69; 6 RCTs, 457 participants; low‐certainty evidence) and may result in little to no difference i...

show abstract

Comparison of single versus double tranexamic acid dose regimens in reducing post-operative blood loss following intramedullary nailing of femoral fracture nonunions

Cited by 6 publications

References 20 publications

A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage

A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage

About anesthesiology and surgery: analgesia, anaesthesia, and non-surgical papers published in journals of surgery

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

Contact Info

Product

Resources

About