Hemostatic effects of tranexamic acid and desmopressin during cardiac surgery.

Horrow, Jan C.; Riper, Daniel F. Van; Strong, Michael D.; Brodsky, I; Parmet, Jonathan L.

doi:10.1161/01.cir.84.5.2063

Cited by 171 publications

(107 citation statements)

References 43 publications

Supporting

Mentioning

102

Contrasting

Unclassified

Order By: Relevance

“…Long-term follow-up data on these patients was not available, however, the remote thromboembolism secondary to intraoperative single dose of tranexamic acid seems unlikely as it has a short halflife (14) . This observation is in accordance with other controlled studies; including several randomised studies in patients undergoing cardiac surgery (43)(44)(45)(46) . Furthermore, no thromboembolic episode was reported in a retrospective analysis of 256 pregnant women with bleeding disorders who were on tranexamic acid (47) .…”

Section: Surgical Field Qualitysupporting

confidence: 92%

Role of tranexamic acid in endoscopic sinus surgery - A systematic review and meta-analysis

Pundir¹,

Pundir²,

Georgalas

et al. 2013

Rhin

View full text Add to dashboard Cite

SummaryBackground: The role of tranexamic acid in patients undergoing endoscopic sinus surgery (ESS) is not clearly defined. The aim of our study is to systematically review the existing evidence on the role of tranexamic acid in patients undergoing ESS.Methodology: Systematic search of MEDLINE (1950MEDLINE ( -2013, EMBASE (1980EMBASE ( -2013, metaRegister, Cochrane Library and ISI conference proceedings was carried out. Results:Five randomised controlled trials with 192 patients receiving tranexamic acid and 196 controls were included. Metaanalysis demonstrated that mean estimated blood loss was significantly lower, and surgical field quality was significantly better in tranexamic acid group. There was no significant difference in mean operative time between the two groups. No significant adverse effects were noted in either of the groups. Conclusion:Intra-operative use of local and systemic tranexamic acid in ESS, results in significantly reduced estimated blood loss and improved surgical field quality. There is no statistically significant difference seen in operative time and incidence of side effects. Well-conducted larger RCTs using validated objective outcome measures and reporting on minor and major complications are required.

show abstract

Section: Surgical Field Qualitysupporting

confidence: 92%

Role of tranexamic acid in endoscopic sinus surgery - A systematic review and meta-analysis

Pundir¹,

Pundir²,

Georgalas

et al. 2013

Rhin

View full text Add to dashboard Cite

show abstract

“…Moreover, a few direct comparison studies [56,57] and a metaanalysis [58] on blood-saving agents in cardiac surgery have shown that other nontransfusional hemostatic agents such as aprotinin, tranexamic acid, and e-aminocaproic acid are more effective than DDAVP. There are few clinical trials evaluating the prophylactic use of DDAVP in noncardiac surgery.…”

Section: Desmopressin In Patients Without Preexisting Bleeding Disordersmentioning

confidence: 99%

The use of desmopressin as a hemostatic agent: A concise review

Franchini

2007

American J Hematol

123

View full text Add to dashboard Cite

Desmopressin, a synthetic derivative of the antidiuretic hormone vasopressin, is the treatment of choice for most patients with von Willebrand disease and mild hemophilia A. Moreover, the compound has been shown to be useful in a variety of inherited and acquired hemorrhagic conditions, including some congenital platelet function defects, chronic liver disease, uremia, and hemostatic defects induced by the therapeutic use of antithrombotic drugs such as aspirin and ticlopidine. Finally, desmopressin has been used as a blood saving agent in patients undergoing operations characterized by large blood loss and transfusion requirements, but studies suggest that this is not as effective as other methods. This review briefly summarizes the current clinical indications on the use of desmopressin as a hemostatic agent. Am. J. Hematol., 2007. © 2007 Wiley‐Liss, Inc.

show abstract

“…Subsequent trials have failed to show a reduction in blood loss following DDAVP administration. Horrow et al were able to show that co-administration of TXA was necessary in a small group of patients to reduce blood loss, which the authors attributed to concomitant tissue plasminogen activator release [63].…”

Section: Desmopressinmentioning

confidence: 99%

Haemostatic management of cardiac surgical haemorrhage

2014

View full text Add to dashboard Cite

SummaryAlmost 30 000 cardiopulmonary bypass operations are performed in the UK every year, consuming a considerable portion of the UK blood supply. Each year, in cardiac surgery, 90% of blood products are used by only 10% of patients, and over the past 25 years, much innovation and research has gone into improving peri-operative diagnosis and therapy for these patients. Visco-elastic tests performed at the bedside, with modifications to allow direct quantification of fibrinogen levels, are probably the biggest advancement. There is no clear advantage of thromboelastometry over thromboelastography, and the published literature remains scarce. Visco-elastic testing has recently been coupled with the systematic replacement of clotting factors by means of factor concentrates, with objective improvement in terms of blood loss, red blood cell usage and surgical re-exploration. The National Institute for Health and Care Excellence has reviewed the available evidence and recommended visco-elastic tests as cost effective in cardiac surgery. Factor concentrates, however, carry significant risks, particularly unnecessary donor exposures, potential selective over-correction of partial deficiencies and the possibility that the postoperative risk of venous thromboembolism is increased; as yet there are no data on risk-benefit analysis. There are a number of promising drugs used in topical haemostasis, but the requirement to apply these before major bleeding is manifest limits their use considerably. Hyperfibrinolysis is less important than in the past due to the wide spread adoption of antifibrinolytic agents and close intra-operative monitoring of heparin effect.

show abstract

Hemostatic effects of tranexamic acid and desmopressin during cardiac surgery.

Abstract: Desmopressin exerts no hemostatic effect, with or without prior administration of antifibrinolytic drug. Prophylactic tranexamic acid alone appears economical and safe in decreasing blood loss and transfusion requirement after cardiac surgery.

Cited by 171 publications

References 43 publications

Role of tranexamic acid in endoscopic sinus surgery - A systematic review and meta-analysis

Role of tranexamic acid in endoscopic sinus surgery - A systematic review and meta-analysis

The use of desmopressin as a hemostatic agent: A concise review

Haemostatic management of cardiac surgical haemorrhage

Contact Info

Product

Resources

About