Tranexamic Acid-associated Necrosis and Intralesional Thrombosis of Uterine Leiomyomas

Ip, Philip; Lam, Ka-Wai; Cheung, Ching‐Lung; Yeung, Matthew C.W.; Pun, Ting-Chung; Chan, Queeny K.Y.; Cheung, Annie N.Y.

doi:10.1097/pas.0b013e318032125e

Cited by 56 publications

(8 citation statements)

References 44 publications

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“…Although side effects have been reported in other large scale studies but none of them were serious enough to warrant disuse of the drug [25,26]. …”

Section: Discussionmentioning

confidence: 99%

Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

et al. 2011

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Background & PurposeAllogenic blood transfusion in elective orthopaedic surgery is best avoided owing to its associated risks. Total knee replacement often requires blood transfusion, more so when bilateral surgery is performed. Many strategies are currently being employed to reduce the amount of peri-operative allogenic transfusions. Anti-fibrinolytic compounds such as aminocaproic acid and tranexamic acid have been used systemically in perioperative settings with promising results. This study aimed to evaluate the effectiveness of tranexamic acid in reducing allogenic blood transfusion in total knee replacement surgery.MethodologyThis was a retrospective cohort study conducted on patients undergoing total knee replacement during the time period November 2005 to November 2008. Study population was 99 patients, of which 70 underwent unilateral and 29 bilateral knee replacement. Forty-seven patients with 62 (49.5%) knees (group-I) had received tranexamic acid (by surgeon preference) while the remaining fifty-two patients with 66 (51.5%) knees (group-II) had did not received any tranexamic acid either pre- or post-operatively.ResultsThe mean drop in the post-operative haemoglobin concentration in Group-II for unilateral and bilateral cases was 1.79 gm/dl and 2.21 gm/dl, with a mean post-operative drainage of 1828 ml (unilateral) and 2695 ml (bilateral). In comparison, the mean drop in the post-op haemoglobin in Group-I was 1.49 gm/dl (unilateral) and 1.94 gm/dl (bilateral), with a mean drainage of 826 ml (unilateral) and 1288 ml (bilateral) (p-value < 0.001).InterpretationTranexamic acid is effective in reducing post-operative drainage and requirement of blood transfusion after knee replacement.

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“…Although side effects have been reported in other large scale studies but none of them were serious enough to warrant disuse of the drug [25,26]. …”

Section: Discussionmentioning

confidence: 99%

Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

et al. 2011

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“…Clinical information, such as the patient's age, presenting symptoms, operative procedure, intraoperative findings, drug history 16,17 (in particular progestogen, gonadotropin hormone-releasing analog, and tranexamic acid), and follow-up data, were obtained from the hospital computerized clinical information system. The reasons for the frozen section request, frozen section diagnosis, and paraffin diagnosis were evaluated from the pathology reports.…”

Section: Clinical and Pathologic Datamentioning

confidence: 99%

Intraoperative Frozen Section Biopsy of Uterine Smooth Muscle Tumors

Lok¹,

Tse²,

Lee

et al. 2021

American Journal of Surgical Pathology

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Frozen sections of uterine smooth muscle tumors are infrequently required, and related diagnostic difficulties are seldom discussed. We analyzed the clinicopathologic features of 112 frozen sections of uterine smooth muscle tumors and determined the accuracy, reasons for deferrals, and causes of interpretational errors. Most patients (median age, 45 y) presented with pelvic mass symptoms (53%). The main reasons for a frozen section examination were an abnormal gross appearance including loss of the usual whorled pattern of leiomyoma (36 cases, 32.1%), and intraoperative discovery of an abnormal growth pattern and extrauterine extension of a uterine tumor (28 cases, 25%). There were 9 leiomyosarcomas and 103 leiomyomas, including 18 benign histologic variants. An accurate diagnosis of malignancy was achieved in all leiomyosarcomas, with the exception of a myxoid leiomyosarcoma. In 99 cases (88%), the frozen section diagnosis concurred with the permanent section diagnosis (false positives, 0.9%; false negatives, 0%). Misinterpretation of stromal hyalinization as tumor cell necrosis in a leiomyoma with amianthoid-like fibers was a major discrepancy. Two minor discrepancies did not lead to a change in management. The diagnosis was deferred in 10 cases (8.9%) because of stromal alterations, unusual cellular morphology, uncertain type of necrosis, and abnormal growth patterns. Thus, although various stromal and cellular alterations can cause diagnostic uncertainty, leading to deferrals, frozen section diagnosis of uterine smooth muscle tumors has a high accuracy rate. While a definitive frozen section diagnosis of malignancy may be made when there is unequivocal atypia, indisputable mitotic figures, and tumor cell necrosis, it is important to remember that nonmyogenic mesenchymal tumors may also mimic uterine smooth muscle tumors. In a frozen section setting, it would be sufficient to issue a diagnosis of “malignant mesenchymal tumor.” For tumors that do not meet the criteria for malignancy, issuing a frozen section diagnosis of “atypical mesenchymal tumor and defer the histologic subtyping to the permanent sections” is appropriate.

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“…Its efficacy in controlling UF-related bleeding is controversial[ 18 ] and it has also been related to a higher risk of fibroid necrosis and infarction (odds ratio [OR] = 3.6; 95% confidence intervals [CI] = 1.83-6.07). [ 19 ] Although there is a lack of high quality evidence, non-hormonal treatments are commonly used for symptomatic control during an acute UF-related uterine bleeding episode.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Pharmacological treatment of uterine fibroids

Moroni¹,

Vieira²,

Ferriani³

et al. 2014

Ann Med Health Sci Res

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Uterine fibroids (UF) are common, benign gynecologic tumors, affecting one in three to four women, with estimates of up to 80%, depending on the population studied. Their etiology is not well established, but it is under the influence of several risk factors, such as early menarche, nulliparity and family history. More than 50% of affected women are asymptomatic, but the lesions may be related to bothersome symptoms, such as abnormal uterine bleeding, pelvic pain and bloating or urinary symptoms. The treatment of UF is classically surgical; however, various medical options are available, providing symptom control while minimizing risks and complications. A large number of clinical trials have evaluated commonly used medical treatments and potentially effective new ones. Through a comprehensive literature search using PubMed, EMBASE, CENTRAL, Scopus and Google Scholar databases, through which we included 41 studies out of 7658 results, we thoroughly explored the different pharmacological options available for management of UF, their indications, advantages and disadvantages.

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Tranexamic Acid-associated Necrosis and Intralesional Thrombosis of Uterine Leiomyomas

Cited by 56 publications

References 44 publications

Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

Intraoperative Frozen Section Biopsy of Uterine Smooth Muscle Tumors

Pharmacological treatment of uterine fibroids

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