The effect of different dosage regimens of tranexamic acid on blood loss in bimaxillary osteotomy: a randomized, double-blind, placebo-controlled study

Apipan, Benjamas; Rummasak, Duangdee; Narainthonsaenee, T

doi:10.1016/j.ijom.2017.10.007

Cited by 30 publications

(21 citation statements)

References 26 publications

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“…In order to reduce the total loss of blood, drugs with anti brinolytic properties may be used (e.g., aprotinin, tranexamic acid and epsilon-aminocaproic acid) (49). Among these compounds, tranexamic acid (TXA) is a synthetic lysine analogue commonly used in many types of surgery thanks to its ability to inhibit brinolysis and clot degradation (50). Large randomized clinical trials and meta-analyses have consistently con rmed that the intravenous administration of TXA could effectively and safely reduce perioperative blood loss and transfusion, albeit it is not risk-free (51,52).…”

Section: Discussionmentioning

confidence: 99%

Comparison of a Fast Track Protocol and Standard Care After Hip Arthroplasty in the Reduction of the Length of Stay and The Early Weight-Bearing Resumption: Study Protocol for a Randomized Controlled Trial

Rocchi

Stagni

Govoni

et al. 2020

Preprint

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BackgroundTo date, the hip arthroplasty is one of the most commonly performed surgical procedures, with a growing worldwide demand. In recent decades, major progress made in terms of surgical technique, biomechanics and tribology knowledge have contributed to improve the medical and functional management of the patient. This study aims to assess if the application of a fast track protocol, consisting of a pre-operative educational intervention, adequate post-operative pain control and intensive rehabilitation intervention, reduces length of stay (LOS) and allows the early functional recovery compared to normal clinical practice for patients undergoing hip arthroplasty.MethodsThe study population consists of 90 patients with primary arthrosis of the hip with an anterior indication of hip arthroplasty. The exclusion criteria are older than 70 years, a contraindication to performing spinal anaesthesia and bone mass index (BMI) greater than 32. Participants, 45 for each group, are randomly allocated to one of two arms: fast track clinical pathway or standard care protocol. During allocation, baseline parameters such as Harris Hip Score (HHS) and Western Ontario and McMaster Universities index (WOMAC) are collected. On the third postoperative day, the functional autonomy for each patient is assessed by the Iowa Level of Assistance (ILOA) scale and it is expected the discharge for patients in the fast track group (primary outcome). On the other hand, standard care patient discharge is expected after 5-7 days after surgery. During follow-up fixed at 6 weeks, 3, 6 and 12 months, HHS and WOMAC scores are collected for each patient (secondary outcomes).DiscussionAlthough total hip replacement has become a widespread standardized procedure, at the author’s knowledge, only few randomized controlled trial were performed to evaluate the effectiveness of fast track pathway vs. standard care procedure in the reduction of the LOS after hip arthroplasty. It is expected that our results collected by the application of minimally invasive surgical interventions with concomitant management of perioperative pain and bleeding, and early functional rehabilitation will contribute to enrich the understanding of clinical and organizational aspects linked to fast track arthroplasty. Trial registrationClinicalTrials.gov, NCT03875976, registered on 15 March 2019 – ‘Retrospectively registered’, https://clinicaltrials.gov/ct2/show/NCT03875976

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Section: Discussionmentioning

confidence: 99%

Comparison of a Fast Track Protocol and Standard Care After Hip Arthroplasty in the Reduction of the Length of Stay and The Early Weight-Bearing Resumption: Study Protocol for a Randomized Controlled Trial

Rocchi

Stagni

Govoni

et al. 2020

Preprint

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“…Blood loss was calculated from the difference between the fluid in the suction canisters and the irrigation fluid used plus the amount of blood in the surgical gauze estimated by weight [ 25 ] ; operation time (OT) refers to the duration from incision to the last suture.…”

Section: Methodsmentioning

confidence: 99%

Effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery

Du¹,

Zhang²,

Song³

et al. 2021

Medicine

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Background: In facial contour surgery, due to the narrow field of vision in the oral approach and the abundant blood supply to the maxillofacial area, hemostasis is not easy. The purpose of this study was to evaluate the hemostatic effect of soluble hemostatic gauze. Methods: We organized a prospective randomized study of 282 patients receiving facial contouring surgery (4 types of procedures in total) during 2016.1.1 to 2018.12.30. For each type of procedure, patients were randomly divided into study group (received hemostatic gauze) and control group (received sterile gauze). Two groups were compared for each type of procedure regarding 5 major perioperative variables: intraoperative blood loss, operation time, 24-hour postoperative drainage volume, total postoperative drainage volume, and postoperative drainage time. Correlation between variables was analyzed. Results: Compared with control group, the study group had higher amount of intraoperative blood loss in mandibular angle ostectomy (MAO) ( P < .01) and mandibular angle-body-chin curved ostectomy procedures ( P < .05), less total postoperative drainage volume in MAO ( P < .01) but not in malarplasty with MAO and partial masseter muscle resection along with MAO procedures. No significant difference was observed between respective study and control groups regarding operation time, 24-hour postoperative drainage volume, and postoperative drainage time in any of the 4 types of surgery. In all 4 types of procedures, a strongly positive correlation was observed between total drainage volume and 24-hour drainage volume in both the study and control groups ( r : 0.88–0.97, P < .01). Conclusion: The effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery is associated with the type of surgery, which can reduce the risk of postoperative bleeding in MAO. However, for surgery with relatively large amount of intraoperative and postoperative bleeding, the hemostatic gauze had a limited postoperative hemostasis efficacy, which needs further evaluation.

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“…Finally, 6 independent studies were included in the final meta-analysis. [9][10][11][12][13][14] The detailed steps of our literature search and the study selection are described in Figure 1.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

“…Side effects (nausea and/or vomiting) of using TXA was only referred in 1 study, with no statistical difference with placebo. 10…”

Section: Secondary End Pointsmentioning

confidence: 99%

“…However, these studies were of limited sample size, preventing a validation of certain outcomes unless meta-analysis is performed. 2,[9][10][11][12][13][14] On the other hand, currently published meta-analyses included all types of OS and neglected routes of TXA administration. 3,5,15 Accordingly, considering unique role of bimaxillary OS in the clinical settings, we conducted a meta-analysis of randomized controlled trials (RCTs) to comprehensively assess the role of TXA during bimaxillary OS.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery

2020

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Background: Tranexamic acid (TXA) has been widely used during craniofacial and orthognathic surgery (OS). However, results of the literature are inconsistent due to specific type of surgery and a small sample of studies. The purpose of this study was to evaluate the role of TXA in bimaxillary OS. Methods: We performed a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE to identify randomized controlled trials (RCTs) that compared effect of TXA on bimaxillary OS with placebo. Outcomes of interests included intraoperative blood loss, allogenic transfusion, operation time, and volume of irrigation fluid. Random effects models were chosen considering that heterogeneity between studies was anticipated, and I 2 statistics were used to test for the presence of heterogeneity. Results: Totally 6 RCTs were identified. Tranexamic acid resulted in significantly reduced intraoperative blood loss (weighted mean difference [WMD] = −264.82 mL; 95% CI: −380.60 to −149.04 mL) and decreased amounts of irrigation fluid (WMD = −229.23 mL; 95% CI: −399.63 to −58.83 mL). However, TXA had no remarkable impact on risk of allogenic blood transfusion (pooled risk ratio = 0.50; 95% CI: 0.20-1.23), operation time (WMD = −8.71 min; 95% CI: −20.98 to 3.57 min), and length of hospital stay (WMD = −0.24 day; 95% CI: −0.62 to 0.14 day). No TXA-associated severe adverse reactions or complications were observed. Conclusions: Currently available meta-analysis reveals that TXA is effective in decreasing intraoperative blood loss; however, it does not reduce the risk of allogenic blood transfusion in bimaxillary OS.

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The effect of different dosage regimens of tranexamic acid on blood loss in bimaxillary osteotomy: a randomized, double-blind, placebo-controlled study

Cited by 30 publications

References 26 publications

Comparison of a Fast Track Protocol and Standard Care After Hip Arthroplasty in the Reduction of the Length of Stay and The Early Weight-Bearing Resumption: Study Protocol for a Randomized Controlled Trial

Comparison of a Fast Track Protocol and Standard Care After Hip Arthroplasty in the Reduction of the Length of Stay and The Early Weight-Bearing Resumption: Study Protocol for a Randomized Controlled Trial

Effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery

Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery

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