1.
Antifibrinolytic agents in plastic surgery: current practices and future directions
Brown S, Yao A, Taub PJ
Plastic & Reconstructive Surgery. 141(6):937e-949e, 2018 Jun.. 2018;141((6):):937e-949e
Abstract
BACKGROUND Prevention of blood loss is a chief consideration in plastic and reconstructive surgery. The antifibrinolytic drugs tranexamic acid and epsilon-aminocaproic acid have emerged as promising agents to reduce both perioperative blood loss and transfusion requirements. However, published reports in the plastic surgery literature are lacking. The authors sought to summarize the current knowledge of the use of antifibrinolytics in plastic surgery by reviewing the existing literature for clinical outcomes and recommendations. METHODS A systematic review of the PubMed, Cochrane, and Google Scholar databases was conducted for publications examining the use of antifibrinolytics in plastic surgery. Studies were abstracted for procedure type, antifibrinolytic dose, time and mode of administration, blood loss, transfusion requirements, and complications. RESULTS Thirty-three studies were deemed eligible for inclusion, comprising a total of 1823 patients undergoing plastic surgical procedures with tranexamic acid (n = 1328) and/or epsilon-aminocaproic acid (n = 495). CONCLUSIONS Tranexamic acid and epsilon-aminocaproic acid are widely used to reduce blood loss and transfusion requirements in craniofacial and orthognathic surgery, without an increased risk of adverse events. Intravenous administration is most commonly used, although topical formulations show similar efficacy with a reduced systemic distribution. Tranexamic acid has also emerged as a promising agent in aesthetic surgery and burn care, due to its favorable safety profile and role in reducing blood loss, achieving an improved surgical field, and reducing edema and ecchymosis. Further investigation of these agents in the fields of burn care, aesthetic surgery, and microsurgery is warranted to standardize protocols for clinical use.
2.
Use of non-biologic treatments in antihistamine-refractory chronic urticaria: a review of published evidence
Holm JG, Ivyanskiy I, Thomsen SF
The Journal of Dermatological Treatment. 2017;:1-38
Abstract
BACKGROUND Knowledge of effectiveness and safety of the non-biologic, non-antihistamine treatments used for chronic urticaria is important as in some cases the principal guideline-recommended drug; omalizumab, has limited effect, side effects, or is too expensive or unavailable. Herein we systematically review the evidence for the use of the non-biologic treatments in antihistamine-refractory chronic urticaria. METHODS We performed a systematic review of the literature using PubMed and Webofscience and identified studies that reported use of one or more of the non-biological, non-antihistamine treatment options for chronic urticaria. The studies were evaluated based on study design, number of patients, effect of treatment and safety. RESULTS We identified 118 studies or case-series with 13 different treatments (azathioprine, chloroquine, colchicine, cyclosporine, dapsone, intravenous immunoglobulin (IVIG), methotrexate, montelukast, mycophenolate mofetil, plasmapheresis, sulfasalazine, tranexamic acid and ultraviolet light (UV) A, UVB) totaling 1682 patients. There was a paucity of controlled trials for most of the treatments reviewed albeit the strongest evidence in favour of a beneficial effect in chronic urticaria was, apart from montelukast and cyclosporine, seen for UV-therapy and dapsone followed by IVIG. CONCLUSION The treatment options reviewed should be seen as potential alternatives in treatment-resistant chronic urticaria where guideline-based selections have failed. However, larger controlled trials are warranted to advance the level of evidence, possibly supporting some treatments' future recommendation in selected patients.