1.
Role of tranexamic acid in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery: A meta-analysis
Zhao Y, Xi C, Xu W, Yan J
Medicine. 2021;100(7):e24678
Abstract
BACKGROUND This study aimed to explore the role of tranexamic acid (TXA) in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery. METHODS In this meta-analysis, a comprehensive search of literatures was performed from PubMed, Embase, Cochrane Library, and Web of Science from inception to June 23rd, 2020. Weighed mean difference (WMD) was used as the effect size for measurement data, and risk ratio for enumeration data. Publication bias was assessed by Begg test. RESULTS Totally 23 studies (11 randomized controlled trials and 12 cohort studies) involving 1621 participants were enrolled in this meta-analysis. The results showed that the administration of TXA can significantly decrease the intraoperative [WMD: -215.655, 95%CI: (-307.462, -123.847), P < .001], postoperative [WMD: -69.213, 95%CI: (-104.443, -33.983), P = .001] and total [WMD: -284.388, 95%CI: (-437.66, -131.116), P < .001] volumes of blood loss of patients undergoing multilevel spine surgery. It can also significantly reduce the intraoperative [WMD: -333.775, 95%CI: (-540.45, -127.099), P = .002] and postoperative [WMD: -114.661, 95%CI: (-219.58, -9.742), P = .032] volumes of transfusion. In addition, TXA was found to significantly increase the preoperative [WMD: 0.213, 95%CI: (0.037, 0.389), P = .018] and postoperative [WMD: 0.433, 95%CI: (0.244, 0.622), P < .001] hemoglobin levels as well as the preoperative platelet count [WMD: 14.069, 95%CI: (0.122, 28.015), P = .048]. CONCLUSION The administration of TXA can effectively reduce blood loss and transfusion, and improve hemoglobin levels and preoperative platelet count in patients undergoing multilevel spine surgery.
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.