The Efficacy and Safety of Tranexamic Acid in Cranio-Maxillofacial and Plastic Surgery

Murphy, Gardner; Glass, Graeme E.; Jain, Abhilash

doi:10.1097/scs.0000000000002250

Cited by 65 publications

(50 citation statements)

References 45 publications

(52 reference statements)

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“…Considering all surgical procedures, tranexamic acid has been shown to reduce blood loss by approximately one‐third. It has been shown specifically to reduce blood loss, and the rate of allogeneic blood transfusions after coronary artery surgery, spinal surgery, orthopaedic fracture surgery, prostate surgery, caesarean section or hysterectomy and plastic surgery procedures.…”

Section: Surgical Strategiesmentioning

confidence: 99%

Strategies to minimize intraoperative blood loss during major surgery

Shah

Palmer

Klein

2020

British Journal of Surgery

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Background Reducing operative blood loss improves patient outcomes and reduces healthcare costs. The aim of this article was to review current surgical, anaesthetic and haemostatic intraoperative blood conservation strategies. Methods This narrative review was based on a literature search of relevant databases up to 31 July 2019 for publications relevant to reducing blood loss in the surgical patient. Results Interventions can begin early in the preoperative phase through identification of patients at high risk of bleeding. Directly acting anticoagulants can be stopped 48 h before most surgery in the presence of normal renal function. Aspirin can be continued for most procedures. Intraoperative cell salvage is recommended when anticipated blood loss is greater than 500 ml and this can be continued after surgery in certain situations. Tranexamic acid is safe, cheap and effective, and routine administration is recommended when anticipated blood loss is high. However, the optimal dose, timing and route of administration remain unclear. The use of topical agents, tourniquet and drains remains at the discretion of the surgeon. Anaesthetic techniques include correct patient positioning, avoidance of hypothermia and regional anaesthesia. Permissive hypotension may be beneficial in selected patients. Promising haemostatic strategies include use of pharmacological agents such as desmopressin, prothrombin complex concentrate and fibrinogen concentrate, and use of viscoelastic haemostatic assays. Conclusion Reducing perioperative blood loss requires a multimodal and multidisciplinary approach. Although high‐quality evidence exists in certain areas, the overall evidence base for reducing intraoperative blood loss remains limited.

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Section: Surgical Strategiesmentioning

confidence: 99%

Strategies to minimize intraoperative blood loss during major surgery

Shah

Palmer

Klein

2020

British Journal of Surgery

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“…Minimally invasive techniques are attractive, particularly in young infants (< 6 months), as alternatives involve a long bicoronal scar, prolonged hospitalization, substantial blood loss and with a high chance of requiring allogenic transfusion requirements. (2)(3)(4)(5) The first SAC was reported by Lauritzen et al (6) The principle of SAC is to use the viscoelastic properties of the immature skull to widen the vault and reduce cranial length.…”

Section: Introductionmentioning

confidence: 99%

Spring Assisted Cranioplasty for the Correction of Non-Syndromic Scaphocephaly: A Quantitative Analysis of 100 consecutive cases

Rodgers

Glass

Tahim

et al. 2016

British Journal of Oral and Maxillofacial Surgery

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Background Spring-assisted cranioplasty has been proposed as an alternative to total calvarial remodelling for sagittal craniosynostosis. Advantages include its minimally invasive nature, reduced morbidity and hospital stay. Potential drawbacks include the need for a second procedure for removal and the lack of published long-term follow-up. We present a single institution experience of 100 consecutive cases using a novel spring design. Methods All patients treated at our institution between April 2010 and September 2014 were evaluated retrospectively. Patients with isolated non-syndromic sagittal craniosynostosis were included. Data were collected for operative time, anaesthetic time, hospital stay, transfusion requirement and complications in addition to cephalic index pre-operatively and at one day, three weeks and six months post-operatively. Results One hundred patients were included. Mean cephalic index was 68 pre-operatively, 71 at day 1 and 72 at 3 weeks and 6 months post-operatively. Nine patients required transfusion. Two patients developed a CSF leak requiring intervention. One patient required early removal of springs due to infection. One patient had a wound dehiscence over the spring and 1 patient sustained a venous infarct with hemiplegia. Five patients required further calvarial remodelling surgery. Conclusion Our modified spring design and protocol represents an effective strategy in the management of single-suture sagittal craniosynostosis with reduced total operative time and blood loss when compared to alternative treatment strategies. In patients referred within the first 6 months of birth this technique has become our procedure of choice. In a minority of cases especially in the older age groups further remodelling surgery is required

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“…Similarly, use of TA in lowering blood loss and need for transfusion has been documented in various published studies pertaining to Obstetrics/Gynecology, Orthopedics, Head and Neck and Cardiac surgery (27,28,29,30).…”

Section: Discussionmentioning

confidence: 92%

Preventing Excessive Blood Loss During Percutaneous Nephrolithotomy by Using Tranexamic Acid: A Double Blinded Prospective Randomized Controlled Trial

Siddiq¹,

Khalid²,

Mithani³

et al. 2017

jus

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Objective: Percutaneous nephrolithotomy (PCNL) is most frequently performed procedure for renal stones 2 cm and larger. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive and safe drug like tranexamic acid (TA) would ultimately turn out to be cornerstone for establishing future guidelines. Aim of this study is to evaluate whether TA is efficacious in preventing blood loss during PCNL. Materials and Methods: Ethical review board approval taken. Sample size calculation yielded 240 patients, comprising 120 in each group. Group A receiving TA and group B receiving placebo. Age, gender, body mass index (BMI), stone size, volume and location, preoperative blood count, creatinine, urine analysis, coagulation profile and necessary radiological investigations done. Randomization through lottery method. Both patient and investigator were blinded. Hemoglobin (Hb) and hematocrit (Hct) levels done at 24 hours postoperatively and fall in values recorded. Results: Both groups were equal in characteristics like age, gender, BMI, stone size, volume and location (p>0.05). Operative variables like calyx punctured, position of puncture and operative time were also found to be similar in both groups. Median change in Hb in placebo group was 1.6 interquartile range (IQR) 4, while in TA group was 1.3 (IQR 7.8) (p=0.001). Similarly, median change in Hct level in placebo group was 3.6 (IQR 11.8) and in TA group was 2.4 (IQR 13) (p<0.001). Sixteen patients were transfused after surgery; 12 (75%) belonged to placebo group while 4 (25%) belonged to TA group (p=0.038). Hospital stay was not significantly different in both groups (p=0.177) with median of 4.0 and IQR of 0 in both groups. Conclusion: TA during PCNL reduces blood loss and minimizes blood transfusion rate.Amaç: Perkütan nefrolitotomi (PNL), 2 cm ve daha büyük böbrek taşları için en sık uygulanan prosedürdür. Perioperatif kanama en yaygın komplikasyon olup, istenmeyen sonuçların öngörülen önemli faktörüdür. Traneksamik asit (TA) gibi ucuz ve güvenli ilaçlarla önleme, nihayetinde gelecek kılavuz ilkeleri oluşturmak için temel taş haline dönüşebilir. Bu çalışmanın amacı, TA'nın PNL sırasında kan kaybını önlemede etkili olup olmadığını değerlendirmektir. Abstract Öz What's known on the subject? and What does the study add?Percutaneous nephrolithotomy is most frequently performed procedure for renal stones measuring 2 cm. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive safe drug like Tranexamic acid would ultimately turn out to be cornerstone for establishing future guidelines. Currently there is only one study published internationally highlighting this notion. Therefore this study will be beneficial for researchers in shaping the current practices.

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The Efficacy and Safety of Tranexamic Acid in Cranio-Maxillofacial and Plastic Surgery

Cited by 65 publications

References 45 publications

Strategies to minimize intraoperative blood loss during major surgery

Strategies to minimize intraoperative blood loss during major surgery

Spring Assisted Cranioplasty for the Correction of Non-Syndromic Scaphocephaly: A Quantitative Analysis of 100 consecutive cases

Preventing Excessive Blood Loss During Percutaneous Nephrolithotomy by Using Tranexamic Acid: A Double Blinded Prospective Randomized Controlled Trial

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