1.
Randomized controlled trial of tranexamic acid among parturients at increased risk for postpartum hemorrhage undergoing cesarean delivery
Sujata N, Tobin R, Kaur R, Aneja A, Khanna M, Hanjoora VM
International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2016;133((3):):312-5
Abstract
OBJECTIVE To assess the effects of tranexamic acid among patients undergoing cesarean delivery who were at high risk of postpartum hemorrhage. METHODS Between August 1, 2012, and April 30, 2013, a randomized controlled trial was performed at a tertiary care center in India. Women undergoing an elective or emergency cesarean delivery who were at high risk for postpartum hemorrhage were enrolled. They were randomly assigned using sealed, opaque envelopes to receive 10mg/kg tranexamic acid or normal saline 10min before skin incision. Anesthesiologists were not masked to group assignment, but patients and obstetricians were. The primary outcome was need for additional uterotonic drugs within 24h after delivery. Analyses were by intention to treat. RESULTS Thirty patients were assigned to each group. Additional uterotonic drugs were required in 7 (23%) patients assigned to tranexamic acid and 25 (83%) patients in the control group (P<0.001). CONCLUSION Intravenous tranexamic acid, administered before skin incision, significantly reduced the requirement for additional uterotonics among women at increased risk for postpartum hemorrhage. Clinical Trials Registry India: CTRI/2015/05/005752.
2.
Fibrin glue versus N-butyl-2-cyanoacrylate in corneal perforations
Sharma A, Kaur R, Kumar S, Gupta P, Pandav S, Patnaik B, Gupta A
Ophthalmology. 2003;110((2):):291-8.
Abstract
OBJECTIVE To compare the efficacy of fibrin glue and N-butyl-2-cyanoacrylate in corneal perforations. DESIGN Randomized, controlled clinical trial. PARTICIPANTS Forty-one patients (41 eyes) with corneal perforations up to 3 mm in diameter with a positive Seidel's test were randomly assigned to two groups (1 and 2). INTERVENTION Group 1 comprised 19 eyes treated with fibrin glue, and group 2 comprised 22 eyes treated with N-butyl-2-cyanoacrylate. MAIN OUTCOME MEASURES Number of eyes with successful healing, time required for healing, status of corneal vascularization, and complications were compared in the two groups. Power calculation was performed at alpha = 0. 05. RESULTS Fifteen (79%) eyes had successful healing of corneal perforation in group 1, compared with 19 (86%) eyes in group 2 (P > 0. 05) at 3 months' follow-up. The power to detect a difference between the two groups was 10%. Corneal perforation healed within 6 weeks in 12 (63%) eyes in group 1 and 7 (31. 8%) eyes in group 2 (P < 0. 05). Reapplication of glue was required in six (31. 5%) eyes in group 1 and seven (31. 4%) eyes in group 2 during the first 3 months of follow-up. The mean number of applications per eye was 1. 37 in group 1 and 1. 36 in group 2. An increase in deep corneal vascularization was observed in 2 (10. 5%) eyes in group 1 and 10 (45. 5%) eyes in group 2 (P < 0. 05). Giant papillary conjunctivitis occurred in one (5%) eye in group 1 and eight (36. 4%) eyes in group 2 (P < 0. 05). CONCLUSIONS Fibrin glue and cyanoacrylate tissue adhesive are both effective in the closure of corneal perforations up to 3 mm in diameter. Fibrin glue provides faster healing and induces significantly less corneal vascularization, but it requires a significantly longer time for adhesive plug formation.