Tranexamic acid for prophylaxis in haemophilia.

Ingram, G. I. C.; Inglish, P J; Bennett, A. E.

doi:10.1136/jcp.25.7.629

Cited by 8 publications

(4 citation statements)

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“…Several studies have reported reduction in perioperative blood loss and requirement for allogeneic blood transfusion with the use of tranexamic acid during joint arthroplasty and other major non‐emergency surgeries (Henry et al , 2011; Sukeik et al , 2011). A double blind study using tranexamic acid in 15 patients with severe haemophilia for 1 year did not reduce soft tissue, muscle or joint bleeds or the requirement for factor concentrates (Ingram et al , 1972b). However, a more recent study reported increased levels of TAFI in the synovial fluid in both inflammatory (rheumatoid arthritis) and degenerative (osteoarthritis) joint diseases as compared to healthy controls (So et al , 2003).…”

Section: Options For Early Diagnosis and Treatment Of Haemophilic Joimentioning

confidence: 99%

Exploration of the pathogenesis of haemophilic joint arthropathy: understanding implications for optimal clinical management

Acharya

2011

Br J Haematol

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SummaryHaemophilia is an inherited disorder of clotting factor deficiencies resulting in musculoskeletal bleeding, including haemarthroses, leading to orthopaedic complications. The pathogenesis of haemophilic joint arthropathy continues to be explored and there is evidence to suggest that iron, cytokines, and neo angiogenesis can initiate synovial and early cartilage damage resulting in molecular changes and the perpetuation of a chronic inflammatory state. This joint arthropathy has long term consequences for bone health resulting in chronic pain and quality of life issues in the individual with haemophilia. Haemarthroses can be prevented by the administration of clotting factor concentrates (prophylaxis). However, high costs and the need for venous access devices in younger children continue to complicate recommendations for universal prophylaxis. In patients who fail or refuse prophylaxis, procedures, such as synovectomy and arthroplasty, can provide relief from repeated haemarthroses. The optimal timing of these, however, is not well defined. Prevention of joint arthropathy needs to focus on prevention of haemarthroses through prophylaxis, identifying early joint disease through the optimal use of cost effective imaging modalities and the validation of serological markers of joint arthropathy. Screening for effects on bone health and optimal management of pain to improve quality of life are, likewise, important issues.

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Section: Options For Early Diagnosis and Treatment Of Haemophilic Joimentioning

confidence: 99%

Exploration of the pathogenesis of haemophilic joint arthropathy: understanding implications for optimal clinical management

Acharya

2011

Br J Haematol

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“…In 1968, Vermylen et al investigated the effect of tranexamic acid in essential menorrhagia by a double blind study [16]. Since then, the use of tranexamic acid as hemostatic in haemophilia [17], oral surgery [18], upper gastrointestinal haemorrhage [19], prostatic adenomectomy [20], hereditary angioneurotic edema [21], and cataract surgery [22] had been studied. In 1972, Hiippala introduced the concept of tranexamic acid reducing perioperative blood loss associated with total knee arthroplasty [23].…”

Section: Discussionmentioning

confidence: 99%

Comparing methods of tranexamic acid administration and blood reinfusion in reducing blood loss during total knee arthroplasty.

Yu¹,

Luan²,

Tian³

et al. 2018

hematology

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Background: Perioperative blood loss is associated with total knee arthroplasty (TKA). The tranexamic acid (TXA) is a plasminogen activator inhibitor widely used to prevent bleeding. The Stryker CBC II ConstaVac Blood Conservation System (CBC II, Stryker) can avoid homologous blood. The purpose of this study is to compare the efficacy of intravenous and topical regimen of TXA in primary TKA, and compare the efficacy of TXA and CBC II in primary TKA. Methods: The study included 202 patients accepted primary TKA from May 2010 to May 2015. The patients were divided into four groups: 53 patients were administered intravenously with 1000 mg TXA. 54 patients in an age and gender-matched group were topical administration with 1000mg of TXA in 100 cc of saline. 49 patients in an age and gender-matched control group undergo the treatment of blood reinfusion by CBC II. Control group included 46 patients did not take TXA and CBC II. Results: Post-operative 24 h total drainage volume were lowest, and the post-operative 24 h Hgb was highest in the group administered intravenously of TXA (p<0.05). The transfusion rate, amount of red blood cell suspension and frozen plasma were lowest in the administered intravenously of TXA group (p<0.05). Here was no thromboembolic event in four groups. Conclusions: Perioperative blood loss could be reduced by intravenous and topical regimen of TXA and CBC II after TKA. In addition, the application of TXA and CBC II is not associated with increased risk of thromboembolic complications.

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“…Further trials in the 1960s concluded that antifibrinolytic agents as prophylaxis did not have a statistically significant effect, although further trials in larger cohorts were indicated [18][19][20]. Since prophylaxis with specific clotting factors has become the standard of care, this aspect has not been further investigated; however, a combination of clotting factor and TXA is the standard of care for bleeding and for treatment around surgery in many haemophilia centres in Europe [21].…”

Section: Discussionmentioning

confidence: 99%

Anti-fibrinolytic agents in bleeding disorders – A clinical perspective

Hart

Badle

2016

The Journal of Haemophilia Practice

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Tranexamic acid (TXA) is a synthetic antifibrinolytic drug used widely used to control bleeding complications in a wide variety of clinical situations. Soon after its development in the 1960s it found use in treatment of women with menorrhagia, and in inherited bleeding disorders. Subsequently it was used in surgery and with proven efficacy to reduce transfusion requirements and bleeding complications. Recent meta-analysis have provided further evidence of efficacy and safety. Tranexamic acid is now on the World Health Organization’s (WHO) list of essential drugs, and is the focus of ongoing worldwide trials. Similarly, there is increasing evidence base in both congenital and acquired bleeding disorders. We present a clinical narrative of the antifibrinolytic system and associated drugs to accompany the pharmacy review by Chaplin et al, with the aim of highlighting the evolution of TXA use in bleeding disorders over recent decades.

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Tranexamic acid for prophylaxis in haemophilia.

Cited by 8 publications

References 0 publications

Exploration of the pathogenesis of haemophilic joint arthropathy: understanding implications for optimal clinical management

Exploration of the pathogenesis of haemophilic joint arthropathy: understanding implications for optimal clinical management

Comparing methods of tranexamic acid administration and blood reinfusion in reducing blood loss during total knee arthroplasty.

Anti-fibrinolytic agents in bleeding disorders – A clinical perspective

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