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Tranexamic acid versus aminocapróic acid in multiple doses via the oral route for the reduction of postoperative bleeding in total primary hip arthroplasty: a prospective, randomized, double-blind, controlled study
Morales-Avalos R, Ramos-Morales T, García-Pedro JA, Espinoza-Galindo AM, Acosta-Olivo C, Morcos-Sandino M, Silva-Ramos HNG, Peña-Martínez VM, Rodríguez-Torres RA, Vilchez-Cavazos F
Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis. 2021
Abstract
To compare the effects of oral ε-aminocaproic acid (EACA) as a hemostatic agent versus the use of oral tranexamic acid (TXA) administered in multiple doses pre and postsurgery in patients undergoing elective primary total hip arthroplasty (THA). We enrolled 102 patients that were randomly divided into two groups: received three oral doses of EACA (2000 mg per dose) or three oral doses of TXA (1300 mg per dose). The medication was given according to the following schedule: 2 h before surgery and 6 and 12 h after surgery. The variables analyzed to compare the effectiveness of the hemostatic agents were total blood loss, hidden blood loss, external blood loss, transfusion rate, intraoperative blood loss, decreases in hemoglobin and hematocrit values, surgical drainage output, visual analog scale, and surgical complications. There were no significant differences between any of the study variables for the group receiving oral TXA and the group receiving oral EACA (P > 0.05). Our study showed that the use of oral EACA was similar to its counterpart TXA regarding the evaluated parameters. TXA did not have superior blood conservation effects, safety profile, or differences in functional scales compared with EACA in THA. We consider the use of multiple oral doses of aminocaproic acid at the selected dose to be effective as a standard protocol to achieve less blood loss and a lower rate of transfusion and adverse events related to the medication in patients undergoing a THA.
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2.
Double-row rotator cuff repair enhanced with platelet-rich therapy reduces re-tear rate: a systematic review and meta-analysis of randomized controlled trials
Villarreal-Villarreal GA, Simental-Mendía M, Garza-Borjón AE, Millán-Alanís JM, Vilchez-Cavazos F, Peña-Martínez VM, Acosta-Olivo CA
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2020
Abstract
PURPOSE To assess re-tear rate in arthroscopic double-row rotator cuff repair (double-row RCR) with and without platelet rich therapy (PRT) METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, Embase, and Scopus databases were searched for RCTs involving use of PRT exclusively in arthroscopic double-row RCR. A random-effects model and the generic inverse variance method were used for quantitative data synthesis. Heterogeneity was tested with the I(2) statistic index. RESULTS The nine RCT´s included within the meta-analysis demonstrated a risk reduction of 49% for re-tears in patients receiving PRT (risk ratio [RR] 0.51; 95% confidence interval [CI] 0.35 to 0.76; p = 0.0008; I(2) = 0%). Divided by tears sizes, re-tear risk reduction of 47% (RR, 0.53; 95% CI, 0.30 to 0.95; p = 0.03; I(2) = 0%) was found in small-medium tears and of 51% (RR, 0.49; 95% CI, 0.29 to 0.84; p = 0.009; I(2) = 0%) in large/massive tears. Linked double-row RCR resulted in risk reduction of 51% for re-tears in comparison with non-linked repairs. CONCLUSION Double-row RCR plus PRT significantly reduced re-tear rates in all sizes of rotator cuff tears. Linked double-row RCR and applying the PRT during the surgical procedure and in the tendon-bone interface reproduced the best outcomes. Clinically, all patients improved and no statistically significant difference was seen on the clinical and functional scores between both intervention groups. All patients achieved optimal values for PROMs. LEVEL OF EVIDENCE Level I Systematic reviews and meta-analysis of level 1 studies.
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First Comparative Study of the Effectiveness of the Use of Tranexamic Acid against epsilon-Aminocaproic Acid via the Oral Route for the Reduction of Postoperative Bleeding in TKA: A Clinical Trial
Morales-Avalos R, Ramos-Morales T, Espinoza-Galindo AM, Garay-Mendoza D, Pena-Martinez VM, Marfil-Rivera LJ, Garza-Ocanas L, Acosta-Olivo C, Cerda-Barbosa JK, Valdes-Gonzalez NL, et al
The journal of knee surgery. 2019
Abstract
Total primary knee replacement results in significant postoperative bleeding. There are reports that 20 to 50% of the patients require a blood transfusion, which has been related to many complications, resulting in the search for strategies to reduce bleeding. The use of oral antifibrinolytics is becoming a low cost and safe way of achieving this goal. The hypothesis of this study was that the use of oral aminocaproic acid could provide similar results to the use of oral tranexamic acid (TXA). The purpose was to compare the effects of oral aminocaproic acid as a hemostatic agent versus the use of oral TXA administered in multiple doses pre and postsurgery in patients undergoing total primary knee replacement. We enrolled 92 patients that were randomly divided into two groups: received three doses of aminocaproic acid (2,000 mg per dose) or three doses of oral TXA (1,300 mg per dose). The drugs were administered according to the following schedule: 2 hours before surgery and 6 and 12 hours after surgery. The variables that were analyzed to compare the effectiveness of the hemostatic agents were total blood loss; hidden blood loss; external blood loss; transfusion rate; intraoperative blood loss; decreases in hemoglobin and hematocrit values; surgical drainage output; visual analogue scale; and surgical complications. There were no significant differences between any of the study variables for the group receiving oral aminocaproic acid and the group receiving oral TXA (p > 0.05), with the exception of patients who received TXA, who presented with more adverse events (p = 0.04). Our study showed that the use of oral aminocaproic acid was similar to its counterpart TXA regarding the evaluated parameters. Although patients who received TXA presented an average of 140 mL less blood loss than patients in the epsilon-ACA group, the difference did not appear to be clinically important, the transfusion rate was very low, and there were no between-group differences in postoperative complications.
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4.
Use of ethamsylate to reduce postoperative bleeding and transfusion rate in total hip arthroplasty. controlled clinical trial
Ramos-Sanchez TA, Ramos-Morales T, Morales-Avalos R, Blazquez-Saldana J, Pena-Martinez VM, Vilchez-Cavazos F
Cirugia Y Cirujanos. 2018;86((3)):270-276.
Abstract
Antecedentes: El sangrado secundario es una de las principales causas de morbilidad despues de la cirugia. El etamsilato se ha utilizado con buenos resultados para disminuir el sangrado en diversas patologias, como metrorragias, sangrado intraventricular, prostatectomias, cirugias de catarata y amigdalectomias. El objetivo de este estudio fue evaluar la efectividad del etamsilato para disminuir el sangrado en la cirugia de reemplazo total de cadera. Metodo: La poblacion se dividio en dos grupos. En el grupo control se realizo la hemostasia de manera convencional; en el grupo experimental se administro etamsilato. Resultados: Se incluyeron 34 pacientes, de los cuales 17 fueron aleatorizados al grupo de etamsilato y 17 al grupo control. No hubo diferencias en las caracteristicas de la poblacion entre los dos grupos. Al comparar los valores de hemoglobina preoperatoria y a las 24, 48 y 72 horas posquirurgicas entre ambos grupos, no se encontraron diferencias estadisticamente significativas. Tampoco hubo diferencia en el hematocrito ni en la cuantificacion del gasto por drenaje a las 24 y 48 horas. Hubo tres pacientes transfundidos en el grupo de etamsilato y siete en el grupo de control, lo cual no difirio significativamente (p = 0.62). Conclusion: En este estudio no se demostro un efecto sobre la reduccion de la hemorragia en pacientes sometidos a reemplazo total de cadera con el uso de etamsilato. Background: Secondary bleeding is one of the leading causes of morbidity after the surgery. Ethamsylate has been used with good results to decrease bleeding in various pathologies such as metrorrhagia, intraventricular bleeding, prostatectomies, cataract surgeries and tonsillectomies. The objective of this study was to evaluate the effectiveness of the hemostatic agent ethamsylate to decrease bleeding in total hip replacement surgery. Method: The population were divided into two groups, in the control group was performed the hemostasis conventionally; in the experimental group ethamsylate was administered. Results: A total of 34 patients were included, of whom 17 were randomized to the group of ethamsylate and 17 randomized to the control group. There were no differences in the characteristics of the population between the two groups. Comparing preoperative hemoglobin levels and at 24, 48 and 72 postsurgical hours between the control group and ethamsylate group there was no statistically significant difference. There was also no difference in the levels of hematocrit. In the quantification of expenditure by the drainage there was no difference between the groups at 24 and 48 hours. There were three patients transfused in the ethamsylate group and seven in the control group, which did not differ significantly (p = 0.62). Conclusion: An effect on the reduction of bleeding in patients undergoing total hip replacement with the use of hemostatic agent ethamsylate was not demonstrated in this study.
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5.
Delayed union of humeral shaft fractures: comparison of autograft with and without platelet-rich plasma treatment: a randomized, single blinded clinical trial
Acosta-Olivo C, Garza-Borjon A, Simental-Mendia M, Vilchez-Cavazos F, Tamez-Mata Y, Pena-Martinez V
Archives of Orthopaedic and Trauma Surgery. 2017;137((9):):1247-1252
Abstract
INTRODUCTION Despite an adequate orthopedic treatment with functional bracing, some patients develop a delayed union in humeral shaft fractures. The objective of the present study was to determine the bone consolidation time among patients with delayed union of diaphyseal humeral fractures who were managed with locking compression plate (LCP) fixation combined with an iliac crest autograft using platelet-rich plasma (PRP) as a co-adjuvant. MATERIALS AND METHODS This study was a controlled, randomized, experimental, longitudinal, comparative, prospective, blind clinical trial. Patients diagnosed with delayed union of a diaphyseal humeral fracture with at least 4 months of evolution were treated with an open reduction and LCP osteosynthesis combined with an iliac crest autograft. The experimental group also received PRP. The patients were assessed radiographically until 36 weeks of evolution. RESULTS A total of 16 patients were included. Both groups had similar demographic characteristics. The patients treated with PRP had an earlier beginning of bone consolidation. Furthermore, these same patients exhibited bone consolidation at 19.9 weeks, on average, in contrast to 25.4 weeks in the control group. CONCLUSIONS The use of PRP promotes earlier bone consolidation in patients with delayed union of the humeral shaft.