1.
Local administration of epsilon-aminocaproic acid reduces post-operative blood loss from surgery for closed, Sanders III-IV calcaneal fractures
Zhong L, Xu Y, Wang Y, Liu Y, Huang Q
International orthopaedics. 2022
Abstract
PURPOSE To investigate whether local administration of epsilon-aminocaproic acid (EACA) is effective and safe in reducing the post-operative blood loss in surgery for Sanders III-IV calcaneal fractures. METHODS Patients with Sanders III-IV calcaneal fractures who were hospitalized in our hospital from January 2016 to February 2021 and underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the current study. Eighty five patients were randomly divided into two groups, EACA group (43) and control group (42). Twenty milliliters of 5% EACA solution or normal saline was perfused into the incision of patients in EACA group and control group, respectively. The volume of post-operative drainage was investigated as the primary outcome. Post-operative blood test, coagulation test, and wound complications were analyzed as the secondary outcomes. RESULTS The volume of post-operative drainage at 24 and 48 h was 164.8 ± 51.4 ml, 18.9 ± 3.8 ml for patients in EACA group, and 373.0 ± 88.1 ml, 21.2 ± 4.4 ml for patients in the control group, respectively. EACA greatly reduced the post-operative blood loss compared to the control (normal saline). The difference between the two groups was statistically significant. No statistically significant difference was found between EACA group and control group with regard to the pre-operative, baseline characteristics. Post-operative blood test results demonstrated that haemoglobin and hematocrit were significantly higher in EACA compared to those of control group. No significant difference was found between EACA group and control group in terms of the platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications. CONCLUSION Local administration of EACA is effective in post-operative blood loss reduction in ORIF surgeries for Sanders III-IV types of calcaneal fractures without increasing the incidence of periwound complication.
2.
The efficiency and safety of oral tranexamic acid in total hip arthroplasty: A meta-analysis
Xu Y, Sun S, Feng Q, Zhang G, Dong B, Wang X, Guo M
Medicine. 2019;98(46):e17796
Abstract
BACKGROUND Intravenous (IV), topical and combination of both application of tranexamic acid (TXA) can reduce blood loss, hemoglobin drop, and transfusion rate in patients following total hip arthroplasty (THA). Lately, published articles reported that oral TXA had as similar blood-saving as IV and topical TXA in THA. The purpose of this meta-analysis is to investigate the efficiency and safety of oral TXA in THA. METHODS We systematically searched articles about oral administration of TXA in THA from PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and the Chinese Wanfang database. STUDY ELIGIBILITY CRITERIA The outcomes were collected and analyzed by the Review Manager 5.3. RESULTS Nine RCTs and 1 CCT, containing 1305 patients, were ultimately included according to the inclusion criteria and exclusion criteria in the meta-analysis. The effectiveness of oral TXA was as similar as the IV or topical TXA in regard to hemoglobin drop (SMD = -0.14; 95% CI, [-0.28, 0.01]; P = .06), total blood loss (SMD = 0.01; 95% CI, [-0.13, 0.16]; P = .84), transfusion rate (OR = 0.76; 95% CI, [0.38, 1.55]; P = .37). Compared with single oral TXA or blank group, multiple oral TXA effectively reduced hemoglobin drop (SMD = -1.06; 95% CI, [-1.36, -0.77]; P < .05), total blood loss (SMD = -1.30; 95% CI, [-1.66, -0.94]; P < .05), transfusion rate (OR = 0.53; 95% CI, [0.29, 0.95]; P = .03). There were no significant difference in terms of length of stay and complication among all of enrolled studies. CONCLUSION Oral TXA has favorable effect of blood-saving and do not increase risk of complication in patients following THA. Oral TXA may have no effect in the length of stay. More high quality RCTs are necessary.
3.
Effect of tranexamic acid in patients with traumatic brain injury: a systematic review and meta-analysis
Weng S, Wang W, Wei Q, Lan H, Su J, Xu Y
World neurosurgery. 2018
Abstract
OBJECTIVE Tranexamic acid (TXA) reduces hemorrhage volume and consequently the need for operative intervention. However, its effectiveness and safety in traumatic brain injury (TBI) patients is unclear. We conducted this systematic review and meta-analysis to evaluate the safety and efficacy of TXA in TBI patients. METHODS In July 2018, a systematic search for studies including TBI patients treated with TXA was conducted using PubMed, Embase, and the Cochrane Library databases. Only related RCT were included. Main outcomes included hematoma expansion, surgery rate, death rate, neurological outcome, and any thrombosis events. RESULTS Of the identified 426 studies, five RCTs involving 917 patients met our inclusion criteria. For hematoma expansion, pooled results showed that TXA significantly decreased hemorrhage growth rate and total hemorrhage growth in TBI patients. Regarding clinical outcomes, pooled results of surgery, mortality, and neurological outcome showed no significant difference between the groups, and rate of thrombosis events was similar. Following sensitivity analysis, one study was excluded due to low quality. Then, results of TXA effect on mortality and neurological outcomes became significant. We confirm that the earlier the TXA treatment is performed, the smaller the size of hematoma will be. CONCLUSIONS TXA demonstrates significant effect in reducing the risk of hematoma expansion by lowering the mortality rate and improving favorable neurological outcomes in TBI patients, while not affecting thrombosis event rates. In addition, early TXA treatment is more effective in decreasing hematomas.