الملخص
Abstract Background: Tranexamic acid was studied in four different dosage regimens and their efficacy was compared for perioperative blood loss reduction, blood transfusion requirements and deep vein thrombosis (DVT) complication. Methods: Two hundred patients undergoing major orthopedic procedures were divided into five groups containing 40 patients each: Placebo, low dose (bolus 10 mg kg-1), low dose + maintenance (bolus 10 mg kg-1 + maintenance 1 mg kg-1 hr-1), high dose (bolus 30 mg kg-1) and high dose + maintenance (bolus 30 mg kg-1 + maintenance 3 mg kg-1 hr-1). Surgical blood loss was measured intraoperatively and drains collection in the first 24 hours postoperatively. Blood transfusion was done when hematocrit falls less than 25%. DVT screening was done in the postoperative period. Results: The intraoperative blood loss was 440 ± 207.54 mL in the placebo group, 412.5 ± 208.21 mL in the low dose group, 290 ± 149.6 ml in the low dose plus maintenance group, 332.5 ± 162.33 mL in the high dose group and 240.7 ± 88.15 mL in the high dose maintenance group (p < 0.001). The reduction in postoperative blood loss in the drain for first 24 hours was 80 ± 44.44 mL in the placebo group, 89.88 ± 44.87 mL in the low dose group, 56.7 ± 29.12 mL in the low dose plus maintenance group, 77.9 ± 35.74 mL in the high dose group and 46.7 ± 19.9 mL in the high dose maintenance group (p < 0.001). DVT was not encountered in any patient. Conclusion: Tranexamic acid was most effective in reducing surgical blood loss and blood transfusion requirements in a low dose + maintenance group.
Resumo Justificativa: O ácido tranexâmico foi avaliado em quatro esquemas com diferentes posologias, comparando-se a eficácia de cada esquema quanto a redução na perda sanguínea perioperatória, necessidade de transfusão sanguínea e ocorrência de Trombose Venosa Profunda (TVP). Método: Duzentos pacientes submetidos a procedimentos ortopédicos de grande porte foram divididos em cinco grupos de 40 pacientes de acordo com o esquema de administração de ácido tranexâmico: grupo placebo, grupo baixa dose (bolus de 10 mg.kg-1, grupo baixa dose e manutenção (bolus de 10 mg.kg-1 + manutenção de 1 mg.kg-1.h-1), grupo alta dose (bolus de 30 mg.kg-1), e grupo alta dose e manutenção (bolus de 30 mg.kg-1 + manutenção de 3 mg.kg-1.h-1). A perda sanguínea cirúrgica foi medida no intraoperatório. Além disso, nas primeiras 24 horas pós-operatórias, foi medido o volume de sangue coletado no dreno. Era realizada transfusão de sangue se o valor do hematócrito fosse inferior a 25%. Foi realizada avaliação quanto à ocorrência de TVP no pós-operatório. Resultados: A perda sanguínea intraoperatória foi de 440 ± 207,54 mL no grupo placebo, 412,5 ± 208,21 mL no grupo baixa dose, 290 ± 149,6 mL no grupo baixa dose e manutenção, 332,5 ± 162,33 mL no grupo alta dose, e 240,7 ± 88,15 mL no grupo alta dose e manutenção (p < 0,001). A redução na perda sanguínea pós-operatória pelo dreno nas primeiras 24 horas foi de 80 ± 44,44 mL no grupo placebo; 89,88 ± 44,87 mL no grupo baixa dose, 56,7 ± 29,12 mL no grupo baixa dose e dose de manutenção, 77,9 ± 35,74 mL no grupo alta dose e 46,7 ± 19,9 mL no grupo alta dose e manutenção (p < 0,001). TVP não foi observada em nenhum paciente. Conclusão: O ácido tranexâmico administrado em baixa dose combinado à manutenção foi mais eficaz em reduzir a perda sanguínea cirúrgica e a necessidade de transfusão de sangue.
الموضوعات
Tranexamic Acid/administration & dosage , Blood Loss, Surgical/prevention & control , Orthopedic Procedures/methods , Antifibrinolytic Agents/administration & dosage , Blood Transfusion/statistics & numerical data , Drug Administration Schedule , Double-Blind Method , Prospective Studies , Postoperative Hemorrhage/prevention & control , Dose-Response Relationship, Drug , Middle Agedالملخص
Abstract Introduction: Tranexamic Acid (TXA), an antifibrinolytic that inhibits the fibrinolytic activity of plasmin is used to decrease perioperative blood loss and transfusion requirements in orthopedic surgery. The aim of our study was to compare postoperative bleeding in two intra-articular doses (1 g and 2 g) of tranexamic acid in adult patients undergoing unilateral total knee replacement. Method: We conducted a single-operator, randomized, and controlled, double-blind study in two groups. The G1 group received 1 g of intra-articular TXA and the G2 group 2 g of intra-articular TXA. Both groups received 15 mg kg-1 IV before the surgical incision (TXA induction dose) and then 10 mg kg-1, orally, 6 and 12 hours after the induction dose of TXA.The primary endpoint was bleeding measured by blood loss in postoperative drainage. Secondary outcomes were change in hemoglobin and hematocrit levels on the first and third postoperative days, and the need for transfusion during hospitalization. Results: In total, 100 patients were randomized, and 100 were included in the analysis. Blood loss in postoperative drainage was similar in both groups (200 ± 50 vs. 250 ± 50 mL, G1 and G2 groups respectively). Change in hematocrit and hemoglobin values (% of change) between preoperative and day 3 were not statically significant between groups G1 and G2 (18 ± 5 vs. 21 ± 4; 21 ± 7 vs. 22 ± 5 respectively). No patients received blood transfusion. Conclusions: Our study did not show superiority of 2 g of intra-articular tranexamic acid compared to 1 g.ClinicalTrials.gov Identifier NCT04085575
Resumo Introdução: O Ácido Tranexâmico (TXA), agente antifibrinolítico que inibe a atividade fibrinolítica da plasmina, é usado para reduzir a perda sanguínea perioperatória e a necessidade de transfusão em cirurgia ortopédica. O objetivo do estudo foi comparar o efeito de duas doses intra-articulares (1 g e 2 g) de ácido tranexâmico no sangramento pós-operatório de pacientes adultos submetidos a prótese total unilateral de joelho. Método: Realizamos estudo com operador único, randomizado, controlado e duplo-cego em dois grupos. O grupo G1 recebeu 1 g de TXA intra-articular e o grupo G2, 2 g de TXA intra-articular. Os dois grupos receberam 15 mg.kg-1 IV antes da incisão cirúrgica (dose de indução de TXA) e 10 mg.kg-1 por via oral, 6 e 12 horas após a dose de indução de TXA. O desfecho primário foi o sangramento medido pela perda sanguínea na drenagem pós-operatória. Os desfechos secundários foram alteração nos níveis de hemoglobina e hematócrito no primeiro e terceiro dias de pós-operatório e necessidade de transfusão durante a hospitalização. Resultados: Cem pacientes foram randomizados e 100 foram incluídos na análise. A perda sanguínea pela drenagem pós-operatória foi semelhante nos dois grupos (200 ± 50 mL vs. 250 ± 50 mL, grupos G1 e G2, respectivamente). A variação nos valores de hematócrito e hemoglobina (% de variação) entre o pré-operatório e o dia 3 não foi estatisticamente significante entre os grupos G1 e G2 (18 ± 5 vs. 21 ± 4; 21 ± 7 vs. 22 ± 5, respectivamente). Nenhum paciente recebeu transfusão de sangue. Conclusões: O estudo não mostrou superioridade na dose de 2 g de ácido tranexâmico intra-articular em comparação à dose de 1 g. ClinicalTrials.gov Identifier NCT04085575.
الموضوعات
Humans , Male , Female , Aged , Tranexamic Acid/administration & dosage , Postoperative Hemorrhage/prevention & control , Arthroplasty, Replacement, Knee/methods , Antifibrinolytic Agents/administration & dosage , Hemoglobins/metabolism , Double-Blind Method , Hematocrit , Injections, Intra-Articularالملخص
Abstract Introduction Tranexamic acid is a hemostatic agent, which inhibits fibrin degradation, which may be beneficial in controlling bleeding during surgery. Objectives The purpose of this study was to provide a meta-analysis and review of the effects of tranexamic acid on hemorrhage and surgical fields and side effects on patients during endoscopic sinus surgery. Methods Two authors independently searched six databases (Medline, Scopus, Embase, Web of Science, Google Scholar and Cochrane library) from the start of article collection until July 2018. Postoperative complications such as intraoperative bleeding, operative time, hypotension, nausea, vomiting, and coagulation profile were included in the analysis of tranexamic acid (Treatment Group) and placebo (Control Group) during the operation. Results The amount of blood loss during surgery was statistically lower in the treatment group compared to the placebo group, and the surgical field quality was statistically higher in the treatment group than in the placebo group. On the other hand, there was no significant difference in operation time, hemodynamics, or coagulation profile between groups. In addition, tranexamic acid had no significant effect on vomiting and thrombosis compared to the Control Group. Conclusion This meta-analysis has shown that topical administration of tranexamic acid can reduce the amount of bleeding during surgery and improve the overall quality of the surgery. Hemodynamic instability during surgery, vomiting after surgery, or abnormal clotting profile were not reported. Additional studies are needed to confirm the results of this study because there are fewer studies.
Resumo Introdução O ácido tranexâmico é um agente hemostático, que inibe a degradação da fibrina e pode ser benéfico no controle do sangramento durante a cirurgia. Objetivos Fazer uma metanálise e revisão dos efeitos do ácido tranexâmico na hemorragia e nos campos cirúrgicos e efeitos colaterais em pacientes durante a cirurgia endoscópica do seio nasal. Método Dois autores realizaram independentemente uma busca em seis bancos de dados (Medline, Scopus, Embase, Web of Science, Google Scholar e Cochrane) desde o início da coleta de artigos até julho de 2018. Complicações pós-operatórias como sangramento intraoperatório, tempo operatório, hipotensão, náusea, vômitos e perfil de coagulação foram incluídos na análise do ácido tranexâmico (grupo de tratamento) e placebo (grupo controle) durante a cirurgia. Resultados A quantidade de perda de sangue durante a cirurgia foi estatisticamente menor no grupo de tratamento comparado com o grupo placebo e a qualidade do campo cirúrgico foi estatisticamente maior no grupo de tratamento do que no grupo placebo. Por outro lado, não houve diferença significante no tempo cirúrgico, hemodinâmica ou perfil de coagulação entre os grupos. Além disso, o ácido tranexâmico não teve efeito significante na ocorrência de vômitos e trombose em comparação ao grupo controle. Conclusão Esta metanálise mostrou que a administração tópica de ácido tranexâmico pode reduzir a quantidade de sangramento durante a cirurgia e melhorar a qualidade geral dela. Instabilidade hemodinâmica durante a cirurgia, vômitos após a cirurgia ou perfil de coagulação anormal não foram relatados. Estudos adicionais são necessários para confirmar os resultados desta pesquisa, porque há poucos estudos na literatura.
الموضوعات
Humans , Tranexamic Acid/pharmacology , Epistaxis/drug therapy , Blood Loss, Surgical/prevention & control , Intraoperative Complications/drug therapy , Antifibrinolytic Agents/pharmacology , Tranexamic Acid/administration & dosage , Randomized Controlled Trials as Topic , Administration, Topical , Endoscopy/adverse effects , Nasal Surgical Procedures/adverse effects , Intraoperative Complications/etiology , Anesthesia, General , Antifibrinolytic Agents/administration & dosageالملخص
Introducción: El reemplazo total de rodilla es un procedimiento que puede generar una gran perdida de sangre durante el periodo posoperatorio. El acido tranexamico es un agente sintetico antifbrinolitico que, en los ultimos anos, se ha administrado por via intravenosa, con buenos resultados, al reducir el sangrado asociado al reemplazo total de rodilla. Sin embargo, existe escasa experiencia con su uso topico. Materiales y Métodos: Se llevo a cabo un estudio comparativo retrospectivo de 117 reemplazos totales de rodilla primarios, para comparar los resultados obtenidos en 63 cirugias con el uso topico de acido tranexamico y en 54 reemplazos sin acido tranexamico. Se compararon la tasa de transfusion, las concentraciones de hemoglobina y hematocrito a las 24 y 48 h, las curaciones requeridas, las comorbilidades y las complicaciones. Resultados: En el grupo con acido tranexamico topico, se redujo un 43,9% la tasa de transfusiones cuando se lo comparo con el otro grupo. Ademas, se registro una disminucion de 0,2-1,3 g/dl en la caida de la hemoglobina a las 24 h de la cirugia. No se detectaron complicaciones. Conclusiones: El uso topico de acido tranexamico en reemplazos totales primarios de rodilla disminuye los requerimientos de transfusiones, sin incrementar el riesgo de complicaciones. Nivel de Evidencia: III
Introduction: Total knee replacement is associated with extensive postoperative blood loss. Tranexamic acid is a synthetic antifibrinolytic agent that, in the last few years, has been successfully used intravenously to reduce bleeding after total knee replacement. However, topical application of tranexamic acid in total knee replacement remains largely unexplored. Methods: A retrospective study of 117 primary total knee replacements was conducted: 63 surgeries with topical tranexamic acid and 54 replacements without tranexamic acid. A comparison analysis was made, capturing results of blood transfusion rates, postoperative hemoglobin levels (24 and 48 hours), number of changed bandages, comorbidities and complications. Results: Tranexamic acid reduced blood transfusion rate by 43.9% when compared with the group without tranexamic acid. A lower decline in postoperative hemoglobin levels (24 hours) by 0.2-1.3 g/dL was also observed in this same group. There were no complications in both groups. Conclusions: Topically applied tranexamic acid was effective in reducing the need for blood transfusion following total knee replacement, without additional adverse effects. Level of Evidence: III
الموضوعات
Adult , Middle Aged , Aged , Aged, 80 and over , Postoperative Complications/prevention & control , Tranexamic Acid/therapeutic use , Blood Loss, Surgical/prevention & control , Arthroplasty, Replacement, Knee/methods , Antifibrinolytic Agents/administration & dosage , Retrospective Studies , Administration, Topical , Treatment Outcomeالملخص
INTRODUCCIÓN La epistaxis espontánea es uno de los problemas más frecuentes en consultas de urgencia. Existen nuevas alternativas de tratamiento, entre las que se encuentra el ácido tranexámico tópico. Sin embargo, su rol en el manejo de la epistaxis espontánea sigue siendo poco claro, existiendo controversia en cuanto a su efectividad y seguridad. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos cinco revisiones sistemáticas que en conjunto incluyeron un estudio primario, el cual corresponde a un ensayo aleatorizado. Concluimos que no está claro si el uso de ácido tranexámico tópico impacta en hemostasia o resangrado porque la certeza de la evidencia es muy baja, además su uso podría aumentar los efectos adversos.
INTRODUCTION Spontaneous epistaxis is one of the most frequent problems in emergency services. New treatment alternatives have emerged, including topical tranexamic acid. However, there is controversy about the actual efficacy of this alternative. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified five systematic reviews that analyzed only one primary study, corresponding to a randomized trial. We concluded it is not clear whether topical tranexamic acid has any impact on hemostasis or risk of rebleeding because the certainty of the evidence is very low. On the other hand, its use could increase adverse effects.
الموضوعات
Humans , Tranexamic Acid/administration & dosage , Epistaxis/drug therapy , Antifibrinolytic Agents/administration & dosage , Randomized Controlled Trials as Topic , Administration, Topical , Databases, Factual , Treatment Outcomeالملخص
BACKGROUND: Tranexamic acid (TXA) is widely used in orthopedic surgery to reduce perioperative bleeding. Since TXA inhibits fibrinolysis, there is concern that it may increase the risk of thromboembolic events. OBJECTIVES: To verify the prevalence of deep venous thrombosis (DVT) in patients receiving TXA during total knee arthroplasty and to compare topical with intravenous administration of the drug. METHODS: All patients admitted for total knee arthroplasty due to primary arthrosis between June and November of 2014 were recruited consecutively. Thirty patients were randomized to a "topical group&" (1.5 g TXA diluted in 50ml saline sprayed over the area operated, before tourniquet release), 30 to an intravenous; (20mg/kg TXA in 100 ml of saline, given at the same time as anesthesia), and 30 to a control group (100 ml of saline, given at the same time as anesthesia). All patients had duplex ultrasound scans of the legs on the 15th postoperative day. RESULTS: Deep venous thrombosis events occurred in five of the 90 patients operated (one out of 30 in the topical group [3.3%], four out of 30 in the control group [13.3%], and zero in the intravenous group). All were confirmed by duplex ultrasound scans and all were asymptomatic. Prevalence rates of DVT were similar between groups (p = 0.112 for control vs. intravenous; p = 0.353 for control vs. topical; and p =1.000 for intravenous vs. topical, according to two-sided exact tests). CONCLUSIONS: Both topical and intravenous administration of TXA are safe with regard to occurrence of DVT, since the number of DVT cases in patients given TXA was not different to the number in those given placebo.
CONTEXTO: O ácido tranexâmico é amplamente utilizado em cirurgia ortopédica para reduzir a hemorragia perioperatória. Como o ácido tranexâmico inibe a fibrinólise, há uma preocupação de que ele possa aumentar o risco de eventos tromboembólicos. OBJETIVOS: Verificar se o uso do ácido tranexâmico é seguro em relação à prevalência de trombose venosa profunda em pacientes submetidos a artroplastia total do joelho, e comparar as administrações tópica e intravenosa desse medicamento. MÉTODOS: Todos os pacientes consecutivamente admitidos para artroplastia total do joelho devido a artrose primária entre junho e novembro de 2014 foram recrutados. Os pacientes foram randomizados em um "grupo tópico" (1,5 g de ácido tranexâmico diluído em 50 ml de solução salina cobrindo toda a área operada antes de liberar o torniquete), um "grupo intravenoso" (20 mg/kg de ácido tranexâmico em 100 ml de solução salina no momento da anestesia) e um "grupo controle" (100 ml de solução salina com a anestesia). No 15º dia de pós-operatório, todos os pacientes foram submetidos a ultrassonografia vascular com Doppler de membros inferiores, independentemente de sintomas. RESULTADOS: Dos 90 pacientes operados, apenas cinco apresentaram trombose venosa profunda (um no grupo tópico e quatro no grupo controle). CONCLUSÕES: Tanto a administração tópica quanto a intravenosa de ácido tranexâmico são seguras em termos de ocorrência de trombose venosa profunda, pois o número de casos de trombose venosa profunda foi semelhante quando comparamos os pacientes que receberam ácido tranexâmico e os que receberam placebo. Novos estudos, com amostras maiores, são necessários para confirmar esse achado.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Aged , Tranexamic Acid/administration & dosage , Arthroplasty, Replacement, Knee/rehabilitation , Venous Thrombosis , Venous Thrombosis/history , Orthopedics/classification , Orthopedics/history , Orthopedics/methods , Randomized Controlled Trials as Topic , Prevalence , Antifibrinolytic Agents/administration & dosageالملخص
El objetivo de este estudio prospectivo, doble ciego y aleatorizado fue evaluar el impacto de la administración de ácido tranexámico (AT) después de cirugía cardiaca con circulación extracorpórea en el sangrado postoperatorio. Material y Método: Durante la inducción de la anestesia los pacientes recibieron un bolo de 10 mgkg-1 de AT, más 50 mg en el cebado de la máquina de circulación extracorpórea, seguido de una infusión continua de 1 mgkg-1h-1 hasta el término de la cirugía. En ese momento los pacientes fueron aleatoriamente distribuidos en 2 grupos: el grupo control recibió 10 mlh-1 de suero fisiológico, y el grupo de estudio una dosis de 1 mgkg-1h-1 de AT, en ambos casos durante el trascurso de 10 horas. El objetivo primario fue observar alguna diferencia en el sangrado durante el primer día de postoperatorio. El objetivo secundario fue observar alguna diferencia en la transfusión de sangre (glóbulos rojos, plaquetas) durante el primer día del postoperatorio y en la incidencia de reoperaciones. Tanto el anestesista como el cirujano fueron ciegos a la distribución de los pacientes en cada grupo. Se utilizó el t-test para el análisis de diferencias en las medias de las variables continuas y el z-test para las proporciones. Se consideró estadísticamente significativo un valor de p < 0,05. Se efectuó análisis de regresión múltiple para encontrar variables capaces de predecir sangrado durante el primer día postoperatorio...
The objective of this prospective, double blind, randomized trial is to evaluate the impact of tranexamic acid (TA) administration after cardiac surgery with cardiopulmonary bypass in postoperative bleeding. Materials and Methods: During induction of general anesthesia, patients received a bolus of TA of 10 mgkg-1 plus 50 mg in the CPB priming followed by a continuous infusion of 1 mgkg-1h-1 until the end of the surgery. Then, patients were randomly allocated into one of two groups: the isotonic saline (IS) group received 10 mlh-1 of isotonic saline and the TA group received an infusion of 1 mgkg-1h-1 of TA. Both groups received their infusions for 10 hours. Primary outcome was bleeding during first postoperative day (POD1). Secondary outcomes were blood transfusion (PRBC, platelets) during POD1 and surgical re-exploration. Anesthesiologists and surgeons were blind to patient allocation. A t-test was used to analyze differences in means of continuous variables and z-test for proportions. A p value < 0.05was considered statistically significant. Multiple regression analysis was performed to find variables able to predict bleeding in the POD1. Results: 273 patients were included, there were 15 lost per group. 125 patients in the TA group and 118 patients in the IS group were analyzed. Both groups were compared in their demographics characteristics, comorbidity and lab tests and no significant differences were found. No statistically significant differences between groups in the primary and secondary outcomes were found. Multiple regression analysis establishes the variable minutes in cardiopulmonary bypass was able to predict bleeding in the POD1. Conclusions: Postoperative infusion of TA does not decrease bleeding, transfusions and re-explorations during the POD1 of cardiac surgery with cardiopulmonary bypass...
الموضوعات
Humans , Male , Female , Middle Aged , Tranexamic Acid/administration & dosage , Antifibrinolytic Agents/administration & dosage , Thoracic Surgery/methods , Extracorporeal Circulation , Postoperative Hemorrhage/prevention & control , Double-Blind Method , Postoperative Period , Regression Analysisالملخص
INTRODUÇÃO: O ácido épsilon aminocapróico é um antifibrinolítico usado em cirurgia cardiovascular a fim de inibir a fibrinólise e reduzir o sangramento após circulação extracorpórea (CEC). OBJETIVO: Analisar a influência do uso do ácido aminocapróico no sangramento e na necessidade de hemotransfusão nas primeiras 24 horas em pós-operatório de cirurgias valvares mitrais. MÉTODOS: Estudo prospectivo, 42 pacientes, randomizados e divididos em dois grupos, de igual número: grupo I - controle e grupo II - ácido épsilon aminocapróico. No grupo II, foram infundidos 5 gramas de AEAC na indução anestésica, após heparinização plena, no perfusato da CEC, após reversão da heparina e uma hora após o final da cirurgia, totalizando 25 gramas. No grupo I, foi infundido apenas soro fisiológico nestes mesmos momentos. RESULTADOS: O grupo I apresentou volume de sangramento médio de 633,57 ± 305,7 ml e o grupo II média de 308,81 ± 210,1 ml, com diferença estatisticamente significativa (P=0,0003). O volume médio de hemotransfusão nos grupos I e II foi, respectivamente, de 942,86 ± 345,79 ml e de 214,29 ± 330,58 ml, havendo diferença significativa (P<0,0001). CONCLUSÃO: O ácido épsilon aminocapróico foi capaz de reduzir o volume de sangramento e a necessidade de hemoderivados no pós-operatório imediato de pacientes submetidos a cirurgias valvares mitrais.
INTRODUCTION: The epsilon aminocaproic acid is an antifibrinolytic used in cardiovascular surgery to inhibit the fibrinolysis and to reduce the bleeding after CBP. OBJECTIVE: To analyze the influence of the using of epsilon aminocaproic acid in the bleeding and in red-cell transfusion requirement in the first twenty-four hours postoperative of mitral valve surgery. METHODS: Prospective studying, forty-two patients, randomized and divided in two equal groups: group #1 control and group #2 - epsilon aminocaproic acid. In Group II were infused five grams of EACA in the induction of anesthesia, after full heparinization, CPB perfusate after reversal of heparin and one hour after the surgery, totaling 25 grams. In group I, saline solution was infused only in those moments. RESULTS: Group #1 showed average bleeding volume of 633.57 ± 305,7 ml, and Group #2, an average of 308.81 ± 210.1 ml, with significant statistic difference (P=0.0003). Average volume of red-cell transfusion requirement in Groups 1 and 2 was, respectively, 942.86 ± 345.79 ml and 214.29 ± 330.58 ml, with significant difference (P<0.0001). CONCLUSION: The epsilon aminocaproic acid was able to reduce the bleeding volume and the red-cell transfusion requirement in the immediate postoperative of patients submitted to mitral valve surgery.
الموضوعات
Humans , /administration & dosage , Antifibrinolytic Agents/administration & dosage , Blood Loss, Surgical/prevention & control , Blood Transfusion/statistics & numerical data , Blood Volume/drug effects , Mitral Valve/surgery , Postoperative Complications/prevention & control , Epidemiologic Methodsالملخص
OBJETIVO: Verificar o efeito do uso tópico do ácido epsilon-aminocapróico (AEAC), aplicado na cavidade pericárdica, na redução do sangramento e necessidade de transfusão sanguínea no pós-operatório de revascularização cirúrgica do miocárdio. MÉTODOS: Entre outubro de 2007 e outubro de 2008, 53 pacientes da mesma instituição foram alocados em um estudo prospectivo, randomizado e duplo-cego. Foram selecionados portadores de insuficiência coronariana crônica com indicação para revascularização cirúrgica do miocárdio. Os pacientes foram divididos em dois grupos: grupo AEAC e grupo Placebo, comparados de acordo com as características clínicas, demográficas e variáveis operatórias. Foram avaliados o volume de sangramento pelos drenos, a necessidade de transfusão e os níveis de hemoglobina e hematócrito de pós-operatório. RESULTADOS: O sangramento pós-operatório pelos drenos nas primeiras 24 horas (grupo AEAC 154,66±74,64 x grupo placebo 220,21±136,42 ml; P=0,031) foi menor no grupo AEAC, porém, em 48 horas (grupo AEAC 259,14±420,07 x grupo placebo 141,67±142,58 ml; P=0,197) e a perda acumulada até a retirada dos drenos (grupo AEAC 832,07±576,86 x grupo placebo 827,50±434,12 ml; P=0,975) não apresentou diferença estatística significante. Houve menor necessidade de transfusão no grupo AEAC, com diferença estatística significante (grupo AEAC 185,90±342,07 x grupo placebo 439,42±349,07 ml; P=0,016). Os valores de hemoglobina (grupo AEAC 9,18±0,92 x grupo placebo 8,85±1,48 g/dL; P=0,331) e hematócrito (grupo AEAC 28,15±3,35 x grupo placebo 26,67±4,15 por cento; P=0,162) não mostraram diferença estatística significante na comparação entre os grupos. CONCLUSÕES: O uso tópico do ácido epsilon-aminocapróico apresentou efeito favorável na redução do sangramento nas primeiras 24 horas de pós-operatório e na necessidade de transfusão sanguínea após revascularização cirúrgica do miocárdio. Trabalhos adicionais com maior número de pacientes serão necessários ...
OBJECTIVE: Antifibrinolytic agents reduce bleeding after cardiac surgery, but there are adverse effects after their systemic use. These effects are avoided by topical application of antifibrinolytic agents in pericardial cavity. We compared the effects of topically applied epsilon-aminocaproic acid (EACA) and placebo on postoperative bleeding and transfusion requirements after coronary artery bypass surgery. METHODS: In this single center prospective, randomized, double-blind trial, 53 patients were randomized into two groups to receive EACA (24 g in 250 ml of saline solution) or placebo (250 ml of saline solution) before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. RESULTS: Postoperative bleeding within first 24 hours (h) period (EACA group 154.66±74.64 x Placebo group 220.21±136.42 ml; P=0.031) showed statistically significant inter-group difference, within 48 h (EACA group 259.14±420.07 x Placebo group 141.67±142.58 ml; P=0.614), as well as cumulative blood loss (EACA group 832.07±576.86 x Placebo group 827.50±434.12 ml; P=0.975), not showed statistically inter-group differences. Inter-group difference of blood product requirements was statistically significant (EACA group 185.90±342.07 x Placebo group 439.42±349.07 ml; P=0.016). Laboratory analyses showed no differences between the two groups postoperative (hematologic characteristics: hemoglobin (g/dl)- EACA group 9.18±0.92 x Placebo group 8.85±1.48 g/dL; P=0.11; hematocrit ( percent)-EACA group 28.15±3.35 x Placebo group 26.67±4.15 percent; P=0.06). CONCLUSION: Topical use of epsilon aminocaproic acid reduces postoperative bleeding in the first 24 hours and requirements of blood transfusion after coronary artery bypass graft surgery
الموضوعات
Female , Humans , Male , Middle Aged , /adverse effects , Antifibrinolytic Agents/adverse effects , Coronary Artery Bypass/adverse effects , Postoperative Hemorrhage/drug therapy , Administration, Topical , /administration & dosage , Antifibrinolytic Agents/administration & dosage , Blood Transfusion , Epidemiologic Methodsالملخص
We investigated the effect of the tranexamic acid in the reduction of the post operative bleeding in patients undergoing a total knee replacement. A prospective study was performed, 20 patients made up the study group, these individuals received an intravenous dose of 15 mg/kg weight just before the surgery and a second dose equal to the first one, before the release of the pneumatic tourniquet. The control group included 20 patients who underwent a total knee replacement and did not receive any kind of antifibrinolytic therapy. Patients who received the tranexamic acid had a mean postoperative bleeding of 383 mls +/- 236 versus the control group who had a mean of 1.025 mls +/- 281 of bleeding. The difference between both groups was statistically relevant according to the Mann Whitney test. There were no cases of clinical deep vein thrombosis (DVT), neither pulmonary thromboembolism. Based on the results reported in the literature and obtained in our study, we recommend the routinary use of the tranexamic acid in patients undergoing a total knee replacement.
Investigamos el efecto del ácido tranexámico en el sangrado post operatorio de pacientes sometidos a artroplastía total de rodilla. Este es un estudio prospectivo que contó con un grupo de 20 casos en los que se administró una dosis de 15 mgs/kg peso justo antes del inicio de la cirugía y se repitió antes de la deflación del torniquete neumático. Los pacientes que recibieron ácido tranexámico presentaron un sangrado postoperatorio promedio medido en el receptáculo del drenaje de 383 mls +/- 236 versus el grupo control que tuvo un sangrado promedio de 1.025 mls +/- 281. La diferencia fue estadísticamente significativa entre ambos grupos de acuerdo al test de Mann Whitney. No se registraron casos de trombosis venosa profunda clínica, ni de tromboembolismo pulmonar. Recomendamos el uso de este fármaco de manera rutinaria en este tipo de procedimientos dados los beneficios reportados en la literatura y comprobados en nuestro estudio.
الموضوعات
Humans , Middle Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee , Tranexamic Acid/therapeutic use , Antifibrinolytic Agents/therapeutic use , Blood Loss, Surgical/prevention & control , Tranexamic Acid/administration & dosage , Antifibrinolytic Agents/administration & dosage , Case-Control Studies , Fibrinolysis , Postoperative Hemorrhage/drug therapy , Osteoarthritis, Knee/surgery , Prospective Studiesالملخص
Tranexamic acid is generally used in the treatment of disorders that predispose one to bleeding. It is a synthetic lysine analog that has strong antifibrinolytic activity. Plasminogen binds to fibrin to form plasmin, which in turn degrades fibrin into fibrin degradation products. Tranexamic acid blocks the lysine binding site on plasminogen and prevents interaction with fibrin. Tranexamic acid reduces blood loss in open heart surgery, hip replacement, and gynecology procedures. In this first case of inadvertent intrathecal injection of Tranexamic acid in a pregnant woman, we found that a massive intrathecal injection of Tranexamic acid triggered refractory ventricular fibrillation and cardiovascular collapse, which did not respond to full resuscitation
الموضوعات
Humans , Female , Ventricular Fibrillation/chemically induced , Myoclonus/chemically induced , Seizures/chemically induced , Medication Errors , Antifibrinolytic Agents/administration & dosage , Injections, Spinal , Pregnant Women , Anesthesia, Endotracheal/adverse effectsالملخص
La enfermedad tromboembólica es un área de creciente interés; un diagnóstico y tratamiento adecuados son imprescindibles para la buena práctica médica, por lo cual requiere certeza en la toma de decisiones. Motivados por la diversidad de opciones del arsenal terapéutico, se decidió actualizar las pautas venezolanas de terapia antitrombótica y trombolítica, a través de la guía 2005. Metodología para el Desarrollo de las Guías de Práctica -Clínica Basadas en Evidencia.
الموضوعات
Humans , Male , Female , Antifibrinolytic Agents/administration & dosage , Arteries/pathology , Clinical Clerkship/standards , Clinical Clerkship , Thrombolytic Therapy/methods , Venous Thrombosis/pathology , Venous Thrombosis/therapy , Antifibrinolytic Agents/pharmacology , Practice Guidelines as Topic , Antibiotic Prophylaxis/methodsالملخص
La magnitud y el control del sangrado, junto al requerimiento de transfusión, han sido temas muy controvertidos en la cirugía ortognática. En la literatura se menciona el uso de técnicas y criterios disímiles y contradictorios. Hemos querido actualizar los criterios sobre el manejo del sangrado en la cirugía maxilofacial en base a nuestra experiencia con el uso de técnicas quirúrgicas y anestésicas actuales. Se presenta aquí una revisión crítica de las publicaciones sustentada por la experiencia clínica del equipo quirúrgico. Se discuten temas relacionados con el sangrado intraoperatorio tales como la predonación sanguínea, la reducción del sangrado mediante técnicas de hipotensión controlada, y el uso de vasoconstrictores o antifibrinolíticos junto a los fármacos anestésicos. Se realizan recomendaciones en base a nuestra experiencia clínica. La presente revisión concluye que con las técnicas actuales, como la anestesia hipotensiva y la anestesia basada en la analgesia simpaticolítica, se logra una mínima pérdida de sangre durante la cirugía ortognática. Estas técnicas prácticamente eliminan la necesidad de transfusiones sanguíneas, predonación y el uso rutinario de antifibrinolíticos, y las posibles complicaciones que estos conllevan.
The magnitude and management of blood loss, as well as the necessity of transfusion have been controversial themes in orthognathic surgery. Different and contradictory techniques and criteria have been used and exposed in the current literature. The aim of this study is to bring up to date the criteria concerning management of blood loss in maxillofacial surgery, based on our clinical experience with recent surgical and anesthetic techniques. A critical revision of the literature is exposed, according to the experience of the surgical team of the Maxillofacial department in. Themes related to intraoperative blood loss, preoperative autologous blood donation, drugs used in the anesthetic technique, reduction of blood loss with hypotensive anesthesia, the use of epinephrine and antifibrinolytic agents are discussed. Finally we present some recommendations based on our experience. This study shows that blood loss during orthognathic surgery is minimal with techniques such as hypotensive anesthesia and the analgesic sympathicolytic based anesthesia. These techniques practically eliminate the necessity of transfusion, preoperative autologous donation, the use of habitual antifibrinolytic agents and its complications.
A intensidade e o controle do sangramento, e a necessidade de transfusao, sao assuntos muito controvertidos na cirurgia ortognática. Na literatura se menciona o uso de técnicas e critérios diferentes e contraditórios. Atualizamos os princípios do manejo do sangramento na cirurgia maxilofacial em base a nossa experiencia no uso das técnicas cirúrgicas e anestésicas atuais. Fazemos uma revisao crítica das publicaçoes sustentada pela experiencia clínica da equipe de cirurgia. Sao discutidos temas relacionados com o sangramento intra-operatório, tais como a pre-doaçao de sangue, a reduçao do sangramento mediante técnicas de hipotensao controlada, e o uso de vasoconstritores ou antifibrinolíticos junto aos fármacos anestésicos. Fazemos recomendaçoes em base a nossa experiencia clínica. Conclui-se que com as técnicas atuais, como a anestesia hipotensiva e a anestesia baseada na analgesia simpaticolítica, é possível reduzir ao mínimo a perda de sangre durante a círurgia ortognática. Estas técnicas praticamente eliminam a necessidade de transfusoes sanguíneas, a pré-doaçao e o uso rotineiro de antifibrinolíticos, e as possíveis conseqüentes complicaçoes.
الموضوعات
Humans , Anesthesia, Local/methods , Surgery, Oral/methods , Blood Loss, Surgical/prevention & control , Antifibrinolytic Agents/administration & dosage , Blood Transfusion, Autologous , Hypotension, Controlled , Oral Surgical Procedures/adverse effects , Oral Surgical Procedures/methodsالملخص
OBJECTIVE: To determine the efficacy of tranexamic acid in the treatment of idiopathic menorrhgia and to investigate the effect of medical treatment with tranexamic acid on the quality of life of the women with idiopathic menorrhagia. DESIGN: Open, non-comparative study. SETTING: Department of Obstetrics and Gynecology King Chulalongkorn Memorial Hospital. SUBJECTS: 40 women with idiopathic menorrhagia was confirmed by menstrual blood loss greater than 80 ml/ cycle (PBAC score > 100) and mid-luteal serum progesterone concentration greater than 5 pg/ml. INTERVENTION: Treatment with tranexamic acid 1 g orally, three times daily, for five days from day 1 of the menstruation for two consecutive menstrual periods. MAIN OUTCOME MEASURES: Menstrual blood loss was measured using the pictorial blood loss assessment chart (PBAC). Hematological assessments were made at the beginning, after the first treatment cycle and at the end of the study. Questionnaires were given to assess subjective endpoint, quality of life. Patients were asked to report any adverse event during the study period. RESULTS: Tranexamic acid reduces the mean PBAC score by 49%, from 350.5 to 178.6. Regarding the change in the quality of life measures, the proportion of women who felt a considerable degree of impairment during the menstruation was reduced from nearly 60% to less than 5% during their third menstruation. No serious adverse events were reported. CONCLUSION: Tranexamic acid is a safe and effective form of medical therapy in women with menorrhagia; also increases quality of life in these women.
الموضوعات
Administration, Oral , Adolescent , Adult , Antifibrinolytic Agents/administration & dosage , Female , Humans , Menorrhagia/drug therapy , Middle Aged , Quality of Life , Statistics, Nonparametric , Tranexamic Acid/administration & dosage , Treatment Outcomeالملخص
El sangrado persistente luego de la circulación extracorpórea es una de las complicaciones más frecuentes en la cirugía cardiovascular e implica la administración de repetidas transfusiones de sangre, con aumento significativo de la morbilidad y la mortalidad. El enfoque terapéutico de esta complicación incluye diferentes medidas, entre las cuales el suministro de antifibrinolíticos desempeña un importante rol preventivo. Se realizó un estudio en 50 niños con operaciones cardiovasculares bajo circulación extracorpórea, realizadas en el Cardiocentro del Hospital Pediátrico William Soler durante el período comprendido entre los meses de enero de 2001 a febrero de 2002. Antes de la circulación extracorpórea se administró 100 mg/kg de ácido épsilon aminocaproico como dosis inicial durante 20 min y se mantuvo luego a razón de 15 mg/kg/h hasta el cierre de la piel. No hubo complicaciones con la administración de este agente, a pesar de que se empleó en dosis altas al inicio. No hubo sangrado prolongado ni evidencia de trastornos significativos de la coagulación, lo cual atribuimos a las medidas preventivas adoptadas(AU)
The persistent bleeding after the extracorporeal circulation is one of the most frequent complications in cardiovascular surgery and implies the administration of repeated blood transfusions with a significant increase of morbidity and mortality. The therapeutic approach of this complication includes different measures, among which the administration of antifibrinolytics plays an important preventive role. A study of 50 children that underwent cardiovascular surgery under extracorporeal circulation performed at the Heart Center of William Soler Children's Hospital from January 2001 to February 2002, was conducted. 100 mg/kg of aminocaproic epsilon acid were administered before the extracorporeal circulation as an initial dose for 20 min. It was maintained then at a rate of 15 mg/kg/h until the closure of the skin. No complications were observed, in spite of the fact that it was used at high doses at the beginning. There was neither prolonged bleeding nor evidence of marked coagulation disorders, which may be attributed to the preventive measures that were taken(AU)
الموضوعات
Humans , Male , Female , Child , Cardiovascular Surgical Procedures/methods , Blood Coagulation , Anesthesia, Cardiac Procedures/methods , Aminocaproic Acid/administration & dosage , Antifibrinolytic Agents/administration & dosage , Blood Transfusion/methodsالملخص
Cada dia se hacen más esfuerzos para disminuir el sangrado y las transfusiones en cirugias de corazón. Estos esfuerzos se deben entre otros a la posibilidad de transmitir infecciones (p. ej., SIDA y Hepatitis); a la dificultad para obtener donantes de sangre; y al rechazo de los pacientes en aceptar una transfusión. Los antifibrinoliticos se han vuelto cada vez, mas populares porque reducen el sangrado perioperatorio y por lo tanto las transfusiones. El sangrado de causa no-quirurgica post-circulación extracorporea es multifactorial, juegan un papel el consumo de factores de coagulación, la hipotermia, los medicamentos que reciba el paciente en el preoperatorio (p. Ej. Antiagregantes plaquetarios y anticoagulantes) la disminución transitoria en la actividad plaquetaria post bomba y en algunos casos estados hiperfibrinoliticos. Por estas dos ultimas explicaciones es que los antifibrinoliticos han resultados utiles. El medicamento más estudiado es la aprotinina y ha demostrado que disminuye tanto el sangrado como las transfusiones de los pacientes sometidos a cirugia de corazón. Sin embargo sus costos son muy altos y puede presentar un mayor numero de reacciones anafilactoideas. Por su parte el ácido tranexcimico y el ácido epsilon aminocaproico son antifibrinoliticos sinteticos, que cuestan la decima parte de la aprotinina, y que tambien disminuyen el sangrado perioperatorio en un 30 por ciento. Sin embargo no hay todavia claridad respecto a su capacidad para reducir las transfusiones
الموضوعات
Antifibrinolytic Agents/administration & dosage , Thoracic Surgery/methods , Hemorrhageالملخص
Introducción: Con frecuencia la transfusión intraoperatoria se basa en criterios individuales y subjetivos. En cirugía cardiovascular se transfunden plaquetas y otros componentes de banco, asumiendo que la circulación extracorpórea produce el deterioro de los mismos. A su vez, con el propósito de disminuir el sangrado intraoperatorio, se indican drogas antifibrinolíticas como la aprotinina o el ácido-aminocaproico. Es controvertido el efecto adicional de la aprotinina como "protector plaquetario", así como la transfusión rutinaria de hemoderivados y drogas antifibrinolíticas en ausencia de criterios objetivos. En la búsqueda de los mismos, empleamos el tromboelastograma con técnicas nuevas para comprobar las siguientes hipótesis: 1.- evaluar el impacto de la circulación extracorpórea sobre las plaquetas y 2.- establecer si la aprotinina ejerce efecto protector sobre las últimas. Materiales y métodos: Se estudiaron prospectivamente 52 pacientes de cirugía cardiovascular divididos en 2 grupos: aprotinina (A) y control (C), empleando una técnica anestésica estándar, monitoreo invasivo, laboratorio de medio interno, coagulograma básico y tromboelastograma. Del último se midió la variable máxima amplitud, lo que con modificaciones técnicas (celite, heparinasa, reopro), permitió evaluar con precisión la función plaquetaria durante las distintas etapas de la cirugía (MA1 = basal, MA2 = en circulación extracorpórea). Los grupos se randomizaron por cuadros, recibiendo el A: 2 millones de UKIU postinducción en infusión endovenosa, 2 millones en la circulación extracorpórea y 500 mil por hora hasta la terminación de la cirugía. Resultados: 1.- La diferencia entre MA1 y MA2 en el grupo A estableció una P = 0.0006 y en el grupo C una P = 0.0001. 2.- Función plaquetaria de A vs C = NS. Conclusiones: 1.- En ambos grupos se demuestra que la circulación extracorpórea produciría un significativo deterioro de la función plaquetaria. 2.- La aprotinina no produce ningún efecto protector sobre la plaqueta.
الموضوعات
Humans , Anesthesia, Endotracheal , Aprotinin/administration & dosage , Aprotinin/adverse effects , Blood Platelets/physiology , Extracorporeal Circulation/adverse effects , Thoracic Surgery/methods , Platelet Transfusion , Antifibrinolytic Agents/administration & dosage , Antifibrinolytic Agents/pharmacokinetics , Monitoring, Physiologicالملخص
Las pérdidas hemorrágicas y las necesidades de transfusión sanguínea homólogas son comparadas en tres grupos de pacientes operados en Cirugía Cardíaca bajo Circulación Extra-Corpórea (CEC), recibiendo aprotinina (grupo A), ácido tranexámico (grupo T) o formando el grupo control (grupo C). El protocolo randomizado prospectivo y abierto, fue aprobado por el Comité de Etica del Hospital. El estudio comprende 100 pacientes. Los tres grupos son comparables en edad, sexo, patología, duración de la CEC y del clampaje aórtico. El grupo A recibió 500.000 UIK de aprotinina a la inducción de la anestesia, más 500.000 UIK/hora durante la CEC. El grupo T recibió 15 mg/kg de ácido tranexámico en dos veces; a la inducción de la anestesia y al fin de la CEC. El grupo C no recibió ningún antifibrinolítico. El volumen total de pérdidas drenadas en el período postoperatorio, fue menos importante en el grupo A (486 + 340 ml) y en el grupo T (482 + 345 ml) que en el grupo C (819 + 573 ml) p < 0,01. El número de pacientes transfundidos fue más importante en el grupo C (20/32) que en grupo A (12/33) y el grupo T (11/35) p < 0,05. La aprotinina y el ácido tranexámico reducen en 40 por ciento las pérdidas hemorrágicas en el postoperatorio de cirugía cardíaca bajo CEC. Las necesidades transfusionales fueron reducidas en un 50 por ciento en los grupos A y T comparados con el grupo C.