1.
Prophylactic administration of tranexamic acid combined with thromboelastography-guided hemostatic algorithm reduces allogeneic transfusion requirements during pediatric resective epilepsy surgery: A randomized controlled trial
Zhang T, Feng H, Xiao W, Li J, Liu Q, Feng X, Qi D, Fan X, Shan Y, Yu T, et al
Frontiers in pharmacology. 2022;13:916017
Abstract
Background: Intraoperative bleeding and allogeneic transfusion remain common problems in pediatric resective epilepsy surgery. Tranexamic acid (TXA) is a widely recommended antifibrinolytic drug that reduces blood loss and transfusion requirements for bleeding patients. Thromboelastography (TEG)-guided hemostatic algorithm is commonly used in bleeding management. This trial was designed to validate the efficacy of a multimodal coagulation therapy involving continuous TXA infusion with TEG-guided hemostatic algorithm in reducing allogeneic exposure risk in pediatric resective epilepsy surgery. Methods: Eighty-three children undergoing resective epilepsy surgery were randomized into a treatment group (Group T; n = 42) and a control group (Group C; n = 41). Group T received prophylactic TXA (10 mg/kg followed by 5 mg/kg/h) with TEG-guided hemostatic algorithm, whereas Group C received conventional coagulation management. The primary outcome was allogeneic transfusion rate during surgery, and the secondary outcomes were intraoperative blood loss, incidence of postoperative seizures, and thromboembolic events during hospitalization. Results: The incidence of intraoperative allogeneic transfusion reduced by 34.7% with the use of a multimodal coagulation therapy (19.0% in Group T vs. 53.7% in Group C; RR 0.355, 95% CI 0.179-0.704; p = 0.001). This was mainly triggered by a significant reduction (44.1%) in intraoperative plasma transfusion (7.1% in Group T vs. 51.2% in Group C; RR 0.139, 95% CI 0.045-0.432; p = 0.000). The risk of intraoperative RBC transfusion was lower in Group T than in Group C, but the difference was not statistically significant (14.3% in Group T vs. 29.3% in Group C; RR 0.488, 95% CI 0.202-1.177; p = 0.098). No platelets were transfused in both groups. Further, 19 (45.2%) patients in Group T received fibrinogen concentrates guided by TEG data, whereas 1 (2.4%) patient in Group C received fibrinogen concentrates empirically. There were no significant differences in estimated blood loss and postoperative seizures between the two groups, and no thromboembolic events were observed after surgery. Conclusion: Prophylactic administration of TXA combined with TEG-guided hemostatic algorithm can be an effective multimodal coagulation strategy for reducing allogeneic transfusion requirements during pediatric resective epilepsy surgery. Clinical Trial Registration: www.chictr.org.cn/index.aspx, identifier ChiCTR1800016188.
2.
Application of tranexamic acid and diluted epinephrine in primary total hip arthroplasty
Wu Y, Zeng Y, Bao X, Xiong H, Fan X, Shen B
Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis. 2018;29((5):):451-457.
Abstract
Tranexamic acid (TXA) and diluted epinephrine (DEP) has been reported to be an efficient and well tolerated way for reducing blood loss in total hip arthroplasty (THA). This meta-analysis was designed to compare the effectiveness of combination application of TXA with DEP in primary THA. The following electronic databases were searched, including PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure and Google Search Engine, for published studies involving the TXA with DEP in primary THA. All randomized controlled trials (RCTs) were included. Statistical analysis was assessed using RevMan 5.3 software. Five independent RCTs were included, with a total sample size of 496 patients. The application of TXA with DEP can significantly reduce total blood loss (mean difference, 246.13; 95% CI, -369.95 to -122.32; P < 0.0001), hidden blood loss (mean difference, 299.98; 95% CI -433.61 to -166.35; P < 0.0001) and transfusion requirements (risk ratio, 0.50; 95% CI 0.28-0.90; P = 0.02) compared with the TXA alone. There were no significant differences in intraoperative blood loss (P = 0.46), drainage volume (P = 0.61), length of stay (P = 0.53) and the rate of DVT (P = 0.56) between the two groups. On the basis of current evidence, this meta-analysis showed that the application TXA with DEP is a well tolerated and efficacious treatment to reduce total blood loss, hidden blood loss and transfusion requirements in primary THA, without increasing the risk of DVT in primary THA.