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Effects of carbazochrome sodium sulfonate combined with tranexamic acid on hemostasis and inflammation during perioperative period of total hip arthroplasty: a randomized controlled trial
Luo Y, Releken Y, Yang D, Yue Y, Liu Z, Kang P
Orthopaedics & traumatology, surgery & research : OTSR. 2021;:103092
Abstract
BACKGROUND The hemostatic effect of tranexamic acid (TXA) combined with carbazochrome sodium sulfonate (CSS) in total hip arthroplasty (THA) has not been determined. Therefore we performed a randomized study aiming to evaluate the effects of CSS combined with TXA on perioperative blood loss and inflammatory response of THA. HYPOTHESIS CSS combined with TXA can effectively reduce perioperative blood loss and immune response compared to TXA. MATERIAL AND METHODS This randomized placebo-controlled trial assigned 150 patients undergoing unilateral primary total hip arthroplasty who underwent direct anterior approach surgery to 3 groups: group A received TXA plus topical CSS; group B received TXA only; and group C received placebo. The main outcome was total blood loss. Secondary outcomes included reduction in hemoglobin concentration, coagulation parameters, inflammatory marker levels, perioperative visual analog scale (VAS) pain score, transfusion rates, postoperative hospital stay, and incidence of thromboembolic events. RESULTS Total blood loss in group A (668.84±230.95mL) was lower than in group B (940.96±359.22 mL) and C (1166.52±342.85 mL, p < 0.05). We also found that compared with group B, postoperative hip pain, biomarker level of inflammation, visual analogue score (VAS) pain score in group A were significantly improved. The transfusion rate and unit of group A were significantly lower than group C (8 patients ; 17.5 units), but there was no statistical difference between group A (no transfusion) and group B (2 patients; 4 units). No differences were observed in thromboembolic and other outcomes among the groups. DISCUSSION The combined application of topic CSS and TXA is more effective than TXA alone following THA in regard of reducing total blood loss. In addition, CSS combined with TXA is better than TXA alone in terms of improving postoperative hip pain and reducing the level of inflammatory factors. LEVEL OF EVIDENCE I; randomized controlled study.
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Effect of carbazochrome sodium sulfonate combined with tranexamic acid on blood loss and inflammatory response in patients undergoing total hip arthroplasty
Luo Y, Zhao X, Yang Z, Yeersheng R, Kang P
Bone & joint research. 2021;10(6):354-362
Abstract
AIMS: The purpose of this study was to examine the efficacy and safety of carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) on blood loss and inflammatory responses after primary total hip arthroplasty (THA), and to investigate the influence of different administration methods of CSS on perioperative blood loss during THA. METHODS This study is a randomized controlled trial involving 200 patients undergoing primary unilateral THA. A total of 200 patients treated with intravenous TXA were randomly assigned to group A (combined intravenous and topical CSS), group B (topical CSS), group C (intravenous CSS), or group D (placebo). RESULTS Mean total blood loss (TBL) in groups A (605.0 ml (SD 235.9)), B (790.9 ml (SD 280.7)), and C (844.8 ml (SD 248.1)) were lower than in group D (1,064.9 ml (SD 318.3), p < 0.001). We also found that compared with group D, biomarker level of inflammation, transfusion rate, pain score, and hip range of motion at discharge in groups A, B, and C were significantly improved. There were no differences among the four groups in terms of intraoperative blood loss (IBL), intramuscular venous thrombosis (IMVT), and length of hospital stay (LOS). CONCLUSION The combined application of CSS and TXA is more effective than TXA alone in reducing perioperative blood loss and transfusion rates, inflammatory response, and postoperative hip pain, results in better early hip flexion following THA, and did not increase the associated venous thromboembolism (VTE) events. Intravenous combined with topical injection of CSS was superior to intravenous or topical injection of CSS alone in reducing perioperative blood loss. Cite this article: Bone Joint Res 2021;10(6):354-362.
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Hemostatic and Anti-Inflammatory Effects of Carbazochrome Sodium Sulfonate in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial
Luo Y, Zhao X, Releken Y, Yang Z, Pei F, Kang P
The Journal of arthroplasty. 2019
Abstract
BACKGROUND Postoperative recovery after total knee arthroplasty (TKA) is associated with postoperative anemia, allogeneic transfusion, and stress immune responses to surgery. Carbazochrome sodium sulfonate (CSS) reduces bleeding through several mechanisms. We assessed the effect of CSS combined with tranexamic acid (TXA) on postoperative anemia, blood transfusion, and inflammatory responses. METHODS This study was designed as a randomized, placebo-controlled trial of 200 patients undergoing unilateral primary TKA. Patients were divided into 4 groups: group A received TXA plus topical and intravenous CSS; group B received TXA plus topical CSS only; group C received TXA plus intravenous CSS only; group D received TXA only. RESULTS Total blood loss in groups A (609.92 +/- 221.24 mL), B (753.16 +/- 247.67 mL), and C (829.23 +/- 297.45 mL) was lower than in group D (1158.26 +/- 334.13 mL, P < .05). There was no difference in total blood loss between groups B and C. We also found that compared with group D, the postoperative swelling rate, biomarker level of inflammation, visual analog scale pain score, and range of motion at discharge in groups A, B, and C were significantly improved (P < .05). No thromboembolic complications occurred. There were no differences in transfusion rate, intraoperative blood loss, platelet count, or average length of stay among the 4 groups (P > .05). CONCLUSION CSS combined with TXA was more effective than TXA alone in reducing perioperative blood loss and inflammatory response and did not increase the incidence of thromboembolism complications.
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A comparison of surgical outcomes and complications between hemostatic devices for thyroid surgery: a network meta-analysis
Luo Y, Li X, Dong J, Sun W
European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (Eufos) : Affiliated With the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2016;274((3):):1269-1278
Abstract
This meta-analysis compared harmonic scalpel and LigaSure(R) systems with the conventional clamp-and-tie technique in thyroidectomy. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until December 30, 2015. Randomized controlled studies (RCTs) or two-arm prospective studies were included. The primary outcome was operation time. The data were evaluated both by pair-wise meta-analyses and network meta-analysis within a Bayesian framework using Markov chain Monte Carlo methods. Compared with the conventional hemostasis, there was a significant reduction in operation time with harmonic scalpel (HS) and LigaSure (LS) (difference in means = -24.27 min, 95 % CI -28.11 to -20.44 min, P < 0.001; and difference in means = -13.08 min, 95 % CI -16.88 to -9.27 min, P < 0.001, respectively). For total thyroidectomy and hemi-thyroidectomy, subgroup pair-wise meta-analyses found a reduction of 26.31 and 21.90 min in operation time for harmonic scalpel, and a reduction of 12.77 and 17.48 min for LigaSure, respectively. Among studies with mixed total and hemi-thyroidectomy, no significant difference in operation time was seen between harmonic scalpel and the conventional hemostasis (P = 0.313). Network meta-analysis also found harmonic scalpel and LigaSure to have less operation time than the conventional hemostasis, and that harmonic scalpel was associated with a significant 9.78 min reduction in operation time than LigaSure which was not seen in pair-wise comparison. Harmonic scalpel had significantly less risk of definitive recurrent laryngeal nerve palsy, intra-operation blood loss, and post-operation bleeding than the conventional hemostasis. LigaSure was associated with significantly less intra-operative blood loss than the conventional hemostasis (P = 0.023). There was no significant difference among three different procedures in rates of transient recurrent laryngeal nerve palsy. This study found that harmonic scalpel and LigaSure decreased operation time compared with the conventional hemostasis and that harmonic scalpels was associated with the lowest operation time.