What Are the Optimal Dose of Administration and Time of Drainage for Topical Tranexamic Acid in Patients Undergoing Cardiac Surgery?

Nouraei, Seyed Mahmoud

doi:10.5090/kjtcs.2017.50.6.477

Cited by 5 publications

(6 citation statements)

References 6 publications

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“…51 Further research is required to establish a consensus on the concentration, mode of application, or duration of application required for optimal hemostatic effect. 24,52,53…”

Section: Route Of Administrationmentioning

confidence: 99%

“The Effects of Tranexamic Acid in Breast Surgery: A Systematic Review and Meta-Analysis”

Huynh

Wong

McRae

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Tranexamic acid (TXA) is used in trauma and surgical settings. Its role in reducing postoperative blood loss in breast surgery remains unclear. The primary objective of this study was to determine the effect of TXA on postoperative blood loss in breast surgery. Methods: Searches of the PubMed, Ovid MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases were performed from inception to April 3, 2020. Inclusion criteria were any retrospective reviews, prospective cohort studies, and randomized controlled trials that administered TXA (topical or intravenously) in the context of breast surgery. Quality of studies were evaluated using the risk of bias in randomized trials tool and the risk of bias in nonrandomized studies of interventions tool. Data were pooled, and a meta-analysis was performed. Results: In total, seven studies were included, representing 1226 patients (TXA, 632 patients; control, 622 patients). TXA was administered as follows: topically (20 mL of 25 mg/mL TXA intraoperatively; n =258 patients), intravenously (1 to 3 g perioperatively; n = 743 patients), or both (1 to 3 g daily up to 5 days postoperatively; n = 253 patients). TXA administration reduced hematoma formation in breast surgery (risk ratio, 0.48; 95% CI, 0.32 to 0.73), with no effect on drain output (mean difference, −84.12 mL; 95% CI, −206.53 to 38.29 mL), seroma formation (risk ratio, 0.92; 95% CI, 0.60 to 1.40), or infection rates (risk ratio, 1.01; 95% CI, 0.46 to 2.21). No adverse effects were reported. Conclusion:The use of TXA in breast surgery is a safe and effective modality with low-level evidence that it reduces hematoma rates without affecting seroma rates, postoperative drain output, or infection rates.

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“…51 Further research is required to establish a consensus on the concentration, mode of application, or duration of application required for optimal hemostatic effect. 24,52,53…”

Section: Route Of Administrationmentioning

confidence: 99%

“The Effects of Tranexamic Acid in Breast Surgery: A Systematic Review and Meta-Analysis”

Huynh

Wong

McRae

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…Topical use of TXA may provide a high drug concentration on the wound surface with negligible systemic concentrations. Topical use is still off‐label, with no consensus regarding the optimal TXA concentration in the solution applied, mode of application or duration of contact. Most publications come from joint replacement surgery, where instilling TXA as a bolus into the joint reduces bleeding equivalent to that following intravenous administration.…”

Section: Introductionmentioning

confidence: 99%

Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial

et al. 2019

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Background Topical administration of tranexamic acid (TXA) may be an alternative to intravenous administration to reduce bleeding with a lower risk of systemic adverse events. The aim of this study was to investigate whether moistening a surgical wound with TXA before closure, leaving a thin film of drug only, would reduce postoperative bleeding. Methods This was a two‐centre, stratified, parallel‐group, placebo‐controlled, double‐blind RCT. Patients undergoing mastectomy with or without axillary lymph node clearance were randomized 1 : 1 to moistening of wound surface before closure with either 25 mg/ml TXA or 0·9 per cent sodium chloride (placebo). The primary endpoint was postoperative bleeding as measured by drain production in the first 24 h. Secondary endpoints were early haematoma, total drain production, postoperative complications and late aspirations of seroma within 3 months. Results Between 1 January 2016 and 31 August 2018, 208 patients were randomized. Two patients were converted to a different surgical procedure at surgery, and four did not receive the intervention owing to technical error. Thus, 202 patients were included in the study (101 in the TXA and 101 in the placebo group). TXA reduced mean drain production at 24 h (110 versus 144 ml; mean difference 34 (95 per cent c.i. 8 to 60) ml, P = 0·011). One patient in the TXA group had early haematoma compared with seven in the placebo group (odds ratio (OR) 0·13 (95 per cent c.i. 0·02 to 1·07); P = 0·057). There was no significant difference in postoperative complications between TXA and placebo (13 versus 10; OR 1·11 (0·45 to 2·73), P = 0·824) or need for late seroma aspirations (79 versus 67 per cent; OR 1·83 (0·91 to 3·68), P = 0·089). Conclusion Moistening the wound with TXA 25 mg/ml before closure reduces postoperative bleeding within the first 24 h in patients undergoing mastectomy. Registration number: NCT02627560 (https://clinicaltrials.gov).

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“…26–30 Studies from cardiac and thoracic surgery are fewer, smaller, and not unambiguous. 31–38 Studies on topical use of tranexamic acid from other surgical areas have so far been scarce. 39–46…”

mentioning

confidence: 99%

“…26 The lowest tranexamic acid concentration that can be administered in a solution and still have a topical hemostatic effect is unknown, but concentrations below 5 mg/ml have been shown to be effective. 37,38,47 In oral and dental surgery, a high-concentration mouthwash (48 mg/ml) has been reported but is not commercially available. 43,48,49 Only a few studies have measured systemic tranexamic acid concentrations after topical use in surgery, and then mostly at a single time point, rendering peak levels uncertain and precluding a complete pharmacokinetic analysis.…”

mentioning

confidence: 99%

Serum Concentrations and Pharmacokinetics of Tranexamic Acid after Two Means of Topical Administration in Massive Weight Loss Skin-Reducing Surgery

Ausen

Pleym

Liu

et al. 2019

Plastic &Amp; Reconstructive Surgery

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What Are the Optimal Dose of Administration and Time of Drainage for Topical Tranexamic Acid in Patients Undergoing Cardiac Surgery?

Cited by 5 publications

References 6 publications

“The Effects of Tranexamic Acid in Breast Surgery: A Systematic Review and Meta-Analysis”

“The Effects of Tranexamic Acid in Breast Surgery: A Systematic Review and Meta-Analysis”

Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial

Serum Concentrations and Pharmacokinetics of Tranexamic Acid after Two Means of Topical Administration in Massive Weight Loss Skin-Reducing Surgery

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