Tranexamic acid administration and pulmonary embolism in combat casualties with orthopaedic injuries

Hoyt, Benjamin W.; Baird, M.; Schobel, Seth; Robertson, H. Thomas; Sanka, Ravi; Potter, Benjamin K.; Bradley, Matthew John; Oh, John S.; Elster, Eric A.

doi:10.1097/oi9.0000000000000143

Cited by 7 publications

(10 citation statements)

References 45 publications

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“…Consensus on the optimal application of TXA has yet to be developed in academia. Though most scholars proved the availability of TXA for systemic administration, there is a high risk for intravenous injections in elderly patients with comorbid underlying diseases, and there is also a risk of postoperative DVT in patients [ 23 ]. It has been found that the application of TXA in intra-articular cavity injection can further enhance the hemostatic effect because intra-articular TXA targets active bleeding sites and increases the stability of the fibrin clot, thereby avoiding blood loss from the tissue surface [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Application of Different Doses of Tranexamic Acid Plus Traditional Chinese Medicine in Hip Arthroplasty in Patients with Diabetes and Its Influence on Intraoperative Blood Loss and Postoperative Drainage

Yang

Luo

Zhang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To evaluate the efficacy of different doses of tranexamic acid plus traditional Chinese medicine (TCM) in hip arthroplasty in diabetic patients and the effect on intraoperative hemorrhage and postoperative drainage. Methods. One hundred patients admitted to our hospital from January 2019 to September 2021 were randomly divided into group B (n = 50) and group A (n = 50), and tranexamic acid was injected intravenously at a dose of 10 mg/kg and 20 mg/kg 30 min before skin incision, and then tranexamic acid 1.0 g was injected into the joint cavity through the drainage after incision closure, followed by 3 h of drainage clamping. The amount of blood loss, coagulation index, postoperative drainage, and incidence of venous thromboembolism (VTE) were compared between the groups. Results. Group A had significantly less total blood loss, dominant blood loss, and hidden blood loss than group B ( P < 0.05 ). No significant difference in postoperative coagulation indexes and postoperative drainage flow was found between the two groups ( P > 0.05 ). Serological examination results demonstrated no statistical difference in D-dimer (D-D) levels between the two groups. The absence of VTE in both groups was determined by imaging. Conclusion. Tranexamic acid is effective in reducing intraoperative hemorrhage in diabetic patients undergoing hip arthroplasty. The dose of 20 mg/kg outperforms 10 mg/kg in terms of clinical efficacy with a favorable safety profile, which can be applied according to the patient’s actual condition.

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Section: Discussionmentioning

confidence: 99%

Application of Different Doses of Tranexamic Acid Plus Traditional Chinese Medicine in Hip Arthroplasty in Patients with Diabetes and Its Influence on Intraoperative Blood Loss and Postoperative Drainage

Yang

Luo

Zhang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…The unaffected brinolytic process inspired an assumption that anti brinolytic agents should not be provided as the rst-line treatment of hypothermia coagulopathy in major thoracic surgeries. Constituent transfusion may be more e cacious [19] and more secure in correcting the cross-links of the coagulation cascade, considering the thrombotic risks carried by anti brinolytic treatments [20].…”

Section: Discussionmentioning

confidence: 99%

Temperature Effect on Coagulation Function in Mild Hypothermic Patients Undergoing Thoracic Surgeries: Thromboelastography (TEG) versus Standard Tests

Hui

Zhang²,

Lang

et al. 2022

Preprint

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Purpose Our previous research has revealed that mild hypothermia leads to excessive bleeding in thoracic surgeries, while the underlying mechanism stayed unrevealed by the standard coagulation tests. The research question in this study was: “How does mild hypothermia impair the hemostatic function in patients receiving thoracic surgeries?”. The purpose was to detect the disturbed coagulation processes by comparing the TEG parameters in patients receiving active vs. passive warming during thoracic surgeries. Methods Standard coagulation tests and thromboelastography (TEG) were adopted to compare the hemostatic functions in patients receiving active vs. passive warming during thoracic surgeries. Furthermore, blood samples from passive warming group were retested for TEG at actual core body temperatures. Results Sixty-four eligible patients were included in this study. TEG revealed that mild hypothermia significantly disturbed coagulation by decreasing MA (59.4 ± 4.5mm vs. 64.2 ± 5.7mm, p = 0.04) and α angle (70.4 ± 5.2° vs. 74.9 ± 4.4°, p = 0.05), and prolonging ACT(122.2 ± 19.3s vs. 117.3 ± 15.2s, p = 0.01) and K time(1.9 ± 1.0s vs. 1.3 ± 0.4min, p = 0.02). TEGs conducted under core body temperatures revealed more impaired coagulation than those incubated at 37℃. Furthermore, postoperative shivering and waking time were significantly increased in mild hypothermic patients. Conclusion Mild hypothermia significantly impaired coagulation function in patients receiving thoracic surgeries, which could be detected by TEGs other than the standard coagulation tests. Temperature-adjusted TEGs may provide a preferable method of hemostatic monitoring and transfusion guidance in thoracic surgeries, which warrants further clinical investigations.

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“…В руководстве ТССС рекомендуется вводить транексамовую кис лоту на догоспитальном этапе пострадавшим, нуждающимся в переливании крови, в дозе 2 г медленно внутривенно или внутрикостно как возможно раньше, но не позднее чем через 3 ч после травмы [43]. Между тем, послед ние исследования показали, что применение транексамовой кислоты при боевой травме с массивной кровопотерей и скелетными по вреждениями значимо повышает риск веноз ных тромбоэмболических осложнений [21,22]. Рекомендации ТССС в отношении транекса мовой кислоты редко соблюдались во время военных конфликтов в Ираке и Афганистане.…”

Section: результаты и их анализunclassified

Prehospital care according to the principles of Damage Control Resuscitation in the conditions of modern warfare (literature review)

Shapkin

Seliverstov

Stekolnikov

et al. 2023

Med.-biol. soc.-psihol. probl. bezop. črezvyčajnyh situac.

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Relevance. Bleeding and hemorrhagic shock are the leading cause of potentially preventable deaths in combat casualties. The concept of pre-hospital injury control Remote Damage Control Resuscitation is becoming an integral part of care in the wounded with shock in the field. The significance of prehospital care provision according to the principles of Damage Control Resuscitation is increasing in future “multidomain battlefield”.The objective is to consider the effectiveness and features of prehospital care provision according to the principles of DCR in armed conflicts of the last two decades (in Afghanistan, Iraq, Africa, the Middle East).Methodology. A search was made for scientific articles in the PubMed database and the Scientific Electronic Library (eLIBRARY.ru), published from 2017 to 2022.Results and Discussion. Prehospital care according to the principles of Damage Control Resuscitation includes temporary arrest of bleeding, infusion therapy as part of hemostatic resuscitation and permissive hypotension, adequate respiratory support, prevention and elimination of hypothermia, and prompt evacuation to the stage of surgical care. Effective means to stop bleeding in combat casualties are modern hemostatic tourniquets, pelvic bandage, hemostatic dressings with koalin and chitosan. Resuscitation endovascular balloon occlusion of the aorta is recognized as a promising method for stopping internal bleeding. The basis of hemostatic resuscitation on the battlefield is the earlier transfusion of blood or its components in combination with the introduction of tranexamic acid and calcium preparations. Group O (I) whole blood with low titer anti-A and anti-B antibodies, lyophilized plasma and fibrinogen concentrate offer logistical advantages for combat use.Conclusion. Pre-hospital care according to the principles of Damage Control Resuscitation is effective and can significantly reduce mortality among those injured in combat operations.

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Tranexamic acid administration and pulmonary embolism in combat casualties with orthopaedic injuries

Cited by 7 publications

References 45 publications

Application of Different Doses of Tranexamic Acid Plus Traditional Chinese Medicine in Hip Arthroplasty in Patients with Diabetes and Its Influence on Intraoperative Blood Loss and Postoperative Drainage

Application of Different Doses of Tranexamic Acid Plus Traditional Chinese Medicine in Hip Arthroplasty in Patients with Diabetes and Its Influence on Intraoperative Blood Loss and Postoperative Drainage

Temperature Effect on Coagulation Function in Mild Hypothermic Patients Undergoing Thoracic Surgeries: Thromboelastography (TEG) versus Standard Tests

Prehospital care according to the principles of Damage Control Resuscitation in the conditions of modern warfare (literature review)

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