Update on Applications and Limitations of Perioperative Tranexamic Acid

Patel, Prakash A.; Wyrobek, Julie; Butwick, Alexander J.; Pivalizza, Evan G.; Hare, Gregory M. T.; Mazer, C. David; Goobie, Susan M.

doi:10.1213/ane.0000000000006039

Cited by 29 publications

(30 citation statements)

References 151 publications

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“…[11][12][13][14][21][22][23] Antifibrinolytics such as TXA and aminocaproic acid have also demonstrated a clear benefit in significantly reducing blood loss in high risk cases across a wide range of cardiac and noncardiac surgeries. [11][12][13][14][21][22][23][24][25] TXA bolus and infusion with doses based on pharmacokinetic modeling, is safe, inexpensive, and a reliable strategy to support hemostasis. 11…”

Section: Anesthetic Pbm Strategiesmentioning

confidence: 99%

Perioperative management of pediatric patients undergoing juvenile angiofibroma resection. A case series and educational review highlighting patient blood management

Longacre

Seshadri

Adil

et al. 2023

Pediatric Anesthesia

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Background: Juvenile nasopharyngeal angiofibromas are one of the most enigmatic, bloody tumors encountered by otorhinolarygnologists, head and neck surgeons, neurosurgeons, and anesthesiologists. Juvenile nasopharyngeal angiofibromas are rare, benign, highly vascular tumors with a propensity towards aggressive local invasion. Surgery, open or endoscopic, to remove the growth is the primary treatment of choice for Juvenile nasopharyngeal angiofibromas. Historically, surgical resection was associated with massive, rapid blood loss, traditionally managed by blood product transfusion and deliberate hypotension. Preventative management employing multimodal blood conservation strategies should be an essential standard of perioperative care for patients with Juvenile nasopharyngeal angiofibromas. Methods:We describe a contemporary and comprehensive approach in the management of patients with high grade Juvenile nasopharyngeal angiofibromas. This includes surgical strategies such as preemptive external carotid artery embolization, endoscopic surgical approach, and staged operations, as well as anesthetic strategies including antifibrinolytic therapy and acute normovolemic hemodilution. These surgeries, once synonymous with massive transfusion, may potentially be performed without allogeneic blood transfusion, or deliberate hypotension.Aims: Using a case series, the authors introduce a contemporary approach to multimodal, multidisciplinary blood conservation strategies for Juvenile nasopharyngeal angiofibromas surgery. Results:Here in the authors report on an updated contemporary perioperative clinical approach to patients with Juvenile nasopharyngeal angiofibromas. From an anesthetic perspective, we describe the successful use of normal hemodynamic goals, restrictive transfusion strategy, antifibrinolytic therapy, autologous normovolemic hemodilution, and early extubation in the care of three adolescent males with highly invasive tumors. We demonstrate that new surgical and anesthetic strategies have yielded a significant decrease in intraoperative blood loss and eliminated the need for transfusion of autologous red blood cells, which enable improved outcomes. Conclusions:The perioperative approach to elective surgery for Juvenile nasopharyngeal angiofibromas management is presented from a multidisciplinary patient blood management perspective.

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Section: Anesthetic Pbm Strategiesmentioning

confidence: 99%

Perioperative management of pediatric patients undergoing juvenile angiofibroma resection. A case series and educational review highlighting patient blood management

Longacre

Seshadri

Adil

et al. 2023

Pediatric Anesthesia

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“…It has a terminal half-life of around 2 h and it is excreted in the urine. In many clinical situations, the risk of thromboembolic events is not increased, but its use should be avoided in patients with hematuria, active intravascular clotting and thromboembolic disease (28). Although the causality and pathophysiological mechanism are unclear, TXA use is associated with improvement in clinical outcomes in acute trauma, postpartum hemorrhage and orthopedic surgery (29)(30)(31).…”

Section: Minimizing Blood Lossmentioning

confidence: 99%

A patient blood management perspective on Anemia in the obese patient journey

Duarte¹,

Wei

Cho³

2023

Front. Anesthesiol.

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Obesity and anemia are increasing prevalence around the globe. They can interplay and are both associated with high morbidity and poorer clinical outcomes. Inflammation and iron deficiency are important contributors to anemia in obese patients. Furthermore, obesity surgery can trigger high blood loss, increased demand for blood transfusions and long-term nutrient deficiency. Patient blood management programs have been crucial in improving patients' clinical results whilst minimizing costs in many different settings, such as orthopedic surgery, cardiovascular surgery, pregnancy and intensive care unit patients. In this mini-review, we will discuss applications of patient blood management principles in caring of obese individuals during the patient journey.

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“…TXA is a clot stabilizer, not a clot promoter and therefore does not initiate thromboembolism. Seizures have been previously reported with higher doses of TXA; however, safety has been established in children 30,31 . TXA is indicated for prophylaxis and/or treatment during trauma or surgery.…”

Section: Error Trap 3: Failure To Consider Specific Intraoperative Bl...mentioning

confidence: 99%

Error traps in Pediatric Patient Blood Management in the Perioperative Period

Tan

Murto

Downey

et al. 2023

Pediatric Anesthesia

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Pediatric patients with severe anemia, coagulopathy or clinically significant blood loss are frequently encountered in the perioperative environment. Appropriate management is most effective and safest when harnessing the patient's own hematopoietic system if time permits. In some situations, allogeneic blood component transfusion is necessary to preserve limb and/or life. While necessary to treat anemia, clotting disorders, or improve oxygen delivery, allogeneic blood transfusions can place pediatric patients at risk for respiratory complications, infection, alloimmunization, prolonged hospital stays, multi-organ failure, and death. 1 Therefore, finding ways to reduce unnecessary allogeneic blood transfusions may improve pediatric patient outcomes.Patient Blood Management (PBM) is a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving the patient's own blood, while promoting patient safety and empowerment. 2 In adult surgical patients, PBM has reduced overall transfusions, hospital costs, and adverse events.PBM is a new standard of care to optimize blood health. 3 This report focuses on providing insight and guidance to the pediatric anesthesiologists regarding evidence-based recommended clinical care considerations for pediatric PBM (pPBM).

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Update on Applications and Limitations of Perioperative Tranexamic Acid

Cited by 29 publications

References 151 publications

Perioperative management of pediatric patients undergoing juvenile angiofibroma resection. A case series and educational review highlighting patient blood management

Perioperative management of pediatric patients undergoing juvenile angiofibroma resection. A case series and educational review highlighting patient blood management

A patient blood management perspective on Anemia in the obese patient journey

Error traps in Pediatric Patient Blood Management in the Perioperative Period

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