Prophylactic hemostatic drugs do not reduce hemorrhage: Thromboelastographic study during upper abdominal surgery

Abstract

Although a number of hemostatic drugs are currently used during surgery to reduce hemorrhage, their effects on bleeding are still controversial. Furthermore, few studies have been made on their prophylactic effects. The purpose of this study was to clarify the effects of hemostatic drugs on bleeding. Thirty adult patients undergoing upper abdominal surgery were randomly assigned to receive carbazochrome sodium sulfonate and tranexamic acid immediately after induction of anesthesia (group H,n=15) or no hemostatic drugs (group C,n=15). Common coagulation-tests [prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB)], thromboelastography [reaction time (R), coagulation time (K), maximum amplitude (MA), clot formation rate (α)], and determination of bleeding time were conducted before induction of anesthesia and just before the completion of surgery. PT, R, and K decreased significantly in both groups, while MA and α increased and FIB decreased significantly in group C. No significant difference in blood loss was observed between the groups. Our findings, therefore, suggest that these two hemostatic drugs do not have prophylactic effects on intraoperative bleeding. Further studies are, however, necessary before applying these results to all surgical patients.

The Effect of Intravenous Tranexamic Acid Before and During Spinal Surgery in Bleeding Volume During and After Surgical Operation

“…Recently, there is an increasing interest in using TA for reducing bleeding, especially after the publication of CRASH-2 [20], which is the largest published trauma trial up to now. Currently, the role of fibrinolysis in bleeding is being closely observed [14][15][16][17]21].…”

“…It blocks the lysine-binding sites of plasminogen, resulting in inhibition of plasminogen activation and fibrin binding to plasminogen, which impairs fibrinolysis [22]. TA can also directly inhibit plasmin activity, but higher doses are required to reduce plasmin formation [15][16][17].…”

“…TA is about ten times as potent as aminocaproic acid in vitro, and binds more strongly than aminocaproic acid to both the strong and weak receptor sites of the plasminogen in a ratio corresponding to the difference in potency between the compounds. TA is distributed throughout all body tissues and the plasma half-life is 120 minutes [15][16][17][23][24][25].…”

“…Besides, prophylac-tic transfusion of antifibrinolytic products, such as TA has been shown to improve hemostasis. However, the results are still controversial [12][13][14][15][16][17].…”

The Effect of Carbazochrome Sodium Sulfonate in Patients with Colonic Diverticular Bleeding: Propensity Score Matching Analyses Using a Nationwide Inpatient Database

“…Theoretically, CSS decreases capillary permeability and increases capillary resistance ( 4 ), which may decrease the hemorrhaging time. The hemostatic effect of CSS has been suggested since at least the 1960s ( 5 ), and CSS has been used to treat bleeding in the gastrointestinal and respiratory tracts or during obstetrical surgery ( 6 ), orthopedic surgery ( 7 ), and abdominal surgery ( 8 ).…”