1.
Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery
Yang B, Li H, Wang D, He X, Zhang C, Yang P
PLoS ONE. 2013;8((2):):e55436.
Abstract
BACKGROUND Tranexamic acid (TXA) is well-established as a versatile oral, intramuscular, and intravenous (IV) antifibrinolytic agent. However, the efficacy of IV TXA in reducing perioperative blood transfusion in spinal surgery is poorly documented. METHODOLOGY We conducted a meta-analysis of randomized controlled trials (RCTs) and quasi-randomized (qi-RCTs) trials that included patients for various spinal surgeries, such as adolescent scoliosis surgery administered with perioperative IV TXA according to Cochrane Collaboration guidelines using electronic PubMed, Cochrane Central Register of Controlled Trials, and Embase databases. Additional journal articles and conference proceedings were manually located by two independent researchers. RESULTS Totally, nine studies were included, with a total sample size of 581 patients. Mean blood loss was decreased in patients treated with perioperative IV TXA by 128.28 ml intraoperatively (ranging from 33.84 to 222.73 ml), 98.49 ml postoperatively (ranging from 83.22 to 113.77 ml), and 389.21 ml combined (ranging from 177.83 to 600.60 ml). The mean volume of transfused packed cells were reduced by 134.55 ml (ranging 51.64 to 217.46) (95% CI; P=0.0001). Overall, the number of patients treated with TXA who required blood transfusions was lower by 35% than that of patients treated with the comparator and who required blood transfusions (RR 0.65; 95% CI; 0.53 to 0.85; P<0.0001, I(2)=0%). A dose-independent beneficial effect of TXA was observed, and confirmed in subgroup and sensitivity analyses. A total of seven studies reported DVT data. The study containing only a single DVT case was not combined. CONCLUSIONS The blood loss was reduced in spinal surgery patients with perioperative IV TXA treatment. Also the percentage of spinal surgery patients who required blood transfusion was significantly decreased. Further evaluation is required to confirm our findings before TXA can be safely used in patients undergoing spine surgery. Systematic Review
2.
Evaluation of the quality of processed blood salvaged during craniotomy
Liang H, Zhao Y, Wang D, Wang B
Surgical Neurology. 2009;71((1):):74-80.
Abstract
BACKGROUND The objective of the study was to evaluate the quality of salvaged blood retrieved during craniotomy after the processing by autotransfusion devices and to compare the processing effects of 2 autotransfusion devices: ZITI-2000 (Jingjing Medical Equipment Limited, Beijing, PR China) and BRAT 2 (Cobe Cardiovascular Inc, Division of Sorin Biomedica Arvada Co, Arvada, Colo). METHODS Twenty-four patients scheduled for elective craniotomy were randomly allocated into 2 groups, and 1 of the 2 autotransfusion devices (ZITI-2000 and BRAT 2) was used for each group. The blood samples were collected, washed, and tested for select blood components. The efficacy of centrifugation and washing was assessed by determining the ER of PLTs, WBCs, K+, and fHb. The morphology of the washed erythrocytes and the 2-week-old PRBCs was evaluated by means of SEM. RESULTS Extensive hemolysis was observed in the collected blood of both ZITI-2000 and BRAT 2 groups, with fHb being 464. 8 +/- 111. 6 and 459. 0 +/- 91. 6 mg/dL, respectively. The ERs of PLTs, WBCs, K+, and fHb were >35%, >80%, >90%, and >90%, respectively. Although some shape-changed red cells were observed in the washed blood, discocytes were the dominant form in both groups, with the percentages of discocytes being 58. 0% +/- 8. 0% and 59. 7% +/- 8. 3%, respectively. A greater number of shape-changed red cells were found in 2-week-old PRBCs (P < . 01). CONCLUSION For craniotomies, the quality of salvaged blood processed by both devices (ZITI-2000 and BRAT 2) is equally satisfactory. Although extensive hemolysis is noted in the salvaged blood, IBS can be effectively and safely used.