1.
A multicenter, prospective, randomized clinical study to evaluate the efficacy and safety of fibrin sealant as an adjunct to sutured dural repair
Yu R, Zhu W, Kocharian R, Ilie B, Wang Z, Kang D, Zhao G, Yang H, Shu K, Liu X, et al
Chinese medical journal. 2022;135(20):2506-2508
2.
The Role of Knee Position in Blood Loss and Enhancement of Recovery after Total Knee Arthroplasty
Cao L, Yang H, Sun K, Wang H, Fan H, Cheng W
J Knee Surg. 2020
Abstract
The study aimed to investigate the effects of postoperative position of knee on blood loss and functional recovery after total knee arthroplasty (TKA). We enrolled patients who underwent TKA from 2017 to 2019 in our department with osteoarthritis of the knee in this prospective and randomized study. The patients were randomly allocated to flexion or extension group. In the flexion group, the affected leg was elevated by 30 degrees at the hip and the knee was flexed by 30-degree, postoperatively, while in the extension group, the affected knee was fully extended postoperatively. Patients' data related to postoperative blood loss, Hospital for Special Surgery scores, pain intensity, usage of analgesic drugs, circumference of knee, and range of motion (ROM) of knee were recorded to assess the influence of postoperative leg position on clinical outcomes. Although the transfusion rate was similar between the two groups (p > 0.05), other parameters related to blood loss (including total blood loss, hidden blood loss, usage of analgesic drugs, and postoperative circumference of knee) were significantly lower in the flexion group than those in the extension group (p < 0.05). After 6 weeks and 6 months of rehabilitation, patients gained a similar ROM in the affected knee in both groups (p > 0.05). The length of hospital stay and medical expenses were similar in both groups. Incidence of wound infection and other complications was also similar in both groups (p > 0.05). Elevation of the hip by knee flexion of 30 degrees is an effective and simple method to reduce blood loss after TKA, and contributes to reduction of the dosage of analgesic drugs in the early postoperative period. The routine application of the present protocol also did not increase medical costs and length of hospital stay after TKA.
3.
Effects of low-dose epinephrine on perioperative hemostasis and inflammatory reaction in major surgeries: a randomized clinical trial
Liu JL, Zeng WN, Wang FY, Chen C, Gong XY, Yang H, Tan ZJ, Jia XL, Yang L
Journal of Thrombosis and Haemostasis : Jth. 2017;16((1):):74-82
Abstract
BACKGROUND Haemostasis, thrombosis, and surgical stress-induced immune reaction are important for perioperative morbidity and recovery in major surgeries. OBJECTIVES This study aimed to evaluate the effects of combined administration of low-dose epinephrine (LDEPI) plus tranexamic acid (TXA) on perioperative blood loss, thromboembolic complications, and inflammatory response in total hip arthroplasty (THA). PATIENTS /METHODS Patients scheduled for THA (n = 195) were randomized into 3 interventions: intravenous (IV) LDEPI plus TXA (Group IV); topical (TP) diluted-epinephrine plus TXA (Group TP); and TXA alone as control (CT) (Group CT). The primary outcome was perioperative blood loss on postoperative day (POD) 1. Secondary outcomes included perioperative blood loss on POD 3, intraoperative blood loss, volume of drainage, transfusion values, coagulation and fibrinolysis parameters, inflammatory cytokines levels, cases of thrombosis, intravenous fluid on the operation day, and length of hospital stay. RESULTS The mean calculated total blood loss in Groups IV, TP, and CT was 631.2, 760.5 and 825.6 mL, respectively, on POD 1;treatment effect (difference), 194.4 mL (95% confidence interval, 146.7-242.0) and 65.0 mL (95% confidence interval, 17.4-112.7). Groups IV and TP had lower levels of pro-inflammatory cytokines (TNF-alpha, IL-1beta) with higher level of anti-inflammatory cytokine (IL-10), and faster growth of coagulation and fibrinolysis (without changing its peak levels) compare to Group CT early post-operation. No differences were observed in transfusion, thromboembolic and other outcomes among the groups. CONCLUSION The combined administration of LDEPI and TXA was more effective in reducing perioperative blood loss and alleviating the inflammatory response compared to TXA alone, without increasing the incidence of thromboembolic and other complications. This article is protected by copyright. All rights reserved.
4.
Network meta-analysis of randomized trials on the safety of vascular closure devices for femoral arterial puncture site haemostasis
Jiang J, Zou J, Ma H, Jiao Y, Yang H, Zhang X, Miao Y
Scientific Reports. 5:13761, 2015.. 2015;5:13761
Abstract
The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs) and haematomas by calculating the risk ratios and 95% confidence intervals. Forty RCTs including 16868 patients were included. Traditional meta-analysis demonstrated that there was no significant difference in the rate of CAVEs between all the VCDs and manual compression (MC). Subgroup analysis showed that FemoSeal and VCDs reported after the year 2005 reduced CAVEs. Moreover, the use of VCDs reduced the risk of haematomas compared with MC. Network meta-analysis showed that AngioSeal, which might be the best VCD among all the included VCDs, was associated with reduced rates of both CAVE and haematomas compared with MC. In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.