scholarly journals 1484 Tranexamic Acid Use to Decrease Blood Loss in Primary Shoulder and Elbow Replacement: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Varma ◽  
R Donovan ◽  
M Whitehouse ◽  
S Kunutsor ◽  
A Blom
Keyword(s):  
Systematic Review ◽  
Blood Transfusion ◽  
Length Of Stay ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Meta Analysis ◽  
Postoperative Blood Loss ◽  
Perioperative Blood Loss ◽  
Transfusion Requirements ◽  
Elbow Replacement

Abstract Tranexamic acid (TXA) is an inexpensive, commonly used antifibrinolytic agent that has been shown to significantly reduce perioperative blood loss and transfusion requirements after total hip and knee replacement. We conducted a systematic review and meta-analysis to synthesise the latest evidence regarding the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER). We systematically searched MEDLINE, EMBASE and CENTRAL from inception to 03 September 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss, and secondary outcomes included the need for blood transfusion and venous thromboembolic (VTE) complications. Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss, postoperative blood loss, change in haemoglobin (Hb) and total Hb loss when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in postoperative blood loss, change in Hb, change in Hct and length of stay. This meta-analysis demonstrates that TXA administration in primary TSR significantly decreases blood loss compared with placebo and is associated with lower blood loss and shorter length of stay compared with no treatment with no increase in VTE complications. TXA administration should be part of a wider blood management strategy to minimise perioperative blood loss and blood transfusion requirements in patients undergoing TSR. Further research is needed to demonstrate if a similar treatment benefit exists in patients undergoing TER.

Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

Perfusion ◽  
2017 ◽  
Vol 32 (5) ◽  
pp. 350-362 ◽  
Author(s):  
Idris Ghijselings ◽  
Dirk Himpe ◽  
Steffen Rex
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Postoperative Blood Loss ◽  
Transfusion Requirements ◽  
Significant Difference ◽  
Secondary Outcomes

This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit. Sixteen studies were identified, of which only ten met the inclusion criteria, representing a total of 824 adult patients: 4 studies compared gelatin with crystalloid, and 6 studies gelatin with HES priming. Only 2 of the studies comparing HES and gelatin reported postoperative blood loss after 24 hours. No significant difference in postoperative blood loss was found when results of both studies were pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled results of 3 studies comparing gelatin and crystalloids as a priming solution could not demonstrate significant differences in postoperative bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No differences regarding any of the secondary outcomes could be identified. This systematic review suggests gelatins to have a safety profile which is non-inferior to modern-generation tetrastarches or crystalloids. However, the grade of evidence is rated low owing to the poor methodological quality of the included studies, due to inconsistent outcome reporting and lack of uniform endpoint definitions.

scholarly journals Efficacy of tranexamic acid in reducing blood loss and blood transfusion in idiopathic scoliosis: a systematic review and meta-analysis

2017 ◽  
Vol 3 (4) ◽  
pp. 531-540 ◽  
Author(s):  
Turki Alajmi ◽  
Halah Saeed ◽  
Khalid Alfaryan ◽  
Ahmed Alakeel ◽  
Thamer Alfaryan
Keyword(s):  
Systematic Review ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Tranexamic Acid ◽  
Meta Analysis

scholarly journals Tranexamic acid use to decrease blood loss in primary shoulder and elbow replacement: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Richard L. Donovan ◽  
Jonny R. Varma ◽  
Michael R. Whitehouse ◽  
Ashley W. Blom ◽  
Setor K. Kunutsor
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Meta Analysis ◽  
Elbow Replacement ◽  
Decrease Blood Loss

EFFECT OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS DURING THORACOLUMBAR SPINE SURGERY

2021 ◽  
pp. 32-34
Author(s):  
Santhi KS ◽  
Smrithi JP ◽  
Susan T Cheeran
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Spine Surgery ◽  
Normal Saline ◽  
Thoracolumbar Spine ◽  
Hemodynamic Instability ◽  
Blood Transfusions ◽  
Perioperative Blood Loss ◽  
Transfusion Requirements

BACKGROUND: Spine surgeries are usually associated with excessive blood loss, which increases morbidity and mortality due to hemodynamic instability and subsequent blood transfusions. Tranexamic acid (TXA), an antibrinolytic drug, inhibits the activation of plasminogen, is found to be useful in reducing blood loss. METHODOLOGY: A prospective observational study conducted in Government Medical College, Kottayam for a period of twelve months, randomly assigned forty-eight adult patients (ASA I or II) undergoing thoracolumbar spine surgery into two groups, who received either a bolus of 10 mg/kg IV TXA after induction followed by an infusion of 1 mg/kg/h of TXA up to closure of skin, or an equivalent volume of normal saline. Blood investigations, surgical parameters, perioperative blood loss and blood transfusions were assessed. RESULTS: Both groups in the study were comparable with respect to demographic variables, baseline laboratory indices and surgical parameters. The mean perioperative blood loss was 44% less (P<0.05) and blood transfusion requirements were 71% reduced (P<0.05) in patients who received TXA. Mean surgical duration as well as postoperative hemoglobin drop was signicantly reduced in TXA group compared to Normal Saline group (NS). CONCLUSION: Tranexamic acid reduces perioperative blood loss and blood transfusion.

The Effect of Desmopressin on Reducing Blood Loss in Cardiac Surgery – A Meta-Analysis of Double-Blind, Placebo-Controlled Trials

1995 ◽  
Vol 74 (04) ◽  
pp. 1064-1070 ◽  
Author(s):  
Marco Cattaneo ◽  
Alan S Harris ◽  
Ulf Strömberg ◽  
Pier Mannuccio Mannucci
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Meta Analysis ◽  
Postoperative Blood Loss ◽  
Controlled Trials ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Transfusion Requirements ◽  
The Mean ◽  
Excessive Blood Loss

SummaryThe effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials, with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in placebo-treated patients fell in the upper third of distribution (>1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.

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