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[PMID]:29505518
[Au] Autor:Zhang S; Huang Q; Xu B; Ma J; Cao G; Pei F
[Ad] Endereço:Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
[Ti] Título:Effectiveness and safety of an optimized blood management program in total hip and knee arthroplasty: A large, single-center, retrospective study.
[So] Source:Medicine (Baltimore);97(1):e9429, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Little has been published on blood management in total hip and knee arthroplasty (THA and TKA, respectively) patients focusing on both hematopoiesis and hemostasis. Our aim was to explore the effectiveness and safety of an optimized blood management program in THA and TKA patients in a large, single-center, retrospective study.We retrospectively reviewed consecutive primary unilateral THA and TKA patients' data at our institution through the National Health Database. They were divided into 3 groups according to an optimized blood management program: group A-combined use of intravenous and topical tranexamic acid (TXA); group B-use of recombinant human erythropoietin (rHuEPO) and iron supplements in addition to treatments in group A; group C-use of additional multiple boluses of TXA in addition to treatments in group B. The primary outcomes were hemoglobin (Hb) drop and calculated total blood loss (TBL). Other outcome measurements such as transfusion rate, postoperative length of stay (PLOS), venous thromboembolism (VTE), and mortality were also compared.From 2014 to 2016, a total of 1907 unilateral THA (986 in group A, 745 in group B, and 176 in group C) and 1505 unilateral TKA (795 in group A, 556 in group B, and 154 in group C) procedures were conducted at our institution. The Hb drop, calculated TBL, and PLOS in group C were significantly lower than those in groups A and B for THA and TKA patients. The transfusion rate in group C was also significantly less than in groups A and B for THA patients, while it was similar in groups A and B for TKA patients. No patients in group C received a transfusion. A significant difference was not detected in the incidence of deep vein thrombosis. No episode of symptomatic pulmonary embolism or all-cause mortality occurred within 30 days postoperatively.The current retrospective study suggests that for patients receiving primary unilateral THA or TKA, multiple boluses of intravenous TXA combined with topical TXA, rHuEPO, and iron supplements can reduce the calculated TBL, Hb drop, transfusion rate, and PLOS without increasing the incidence of VTE or mortality.
[Mh] Termos MeSH primário: Anemia/tratamento farmacológico
Antifibrinolíticos/administração & dosagem
Perda Sanguínea Cirúrgica/prevenção & controle
Eritropoetina/uso terapêutico
Ferro/uso terapêutico
Oligoelementos/uso terapêutico
Ácido Tranexâmico/administração & dosagem
[Mh] Termos MeSH secundário: Administração Intravenosa
Administração Tópica
Adulto
Idoso
Anemia/etiologia
Artroplastia de Quadril/efeitos adversos
Artroplastia do Joelho/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Proteínas Recombinantes/uso terapêutico
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antifibrinolytic Agents); 0 (Recombinant Proteins); 0 (Trace Elements); 11096-26-7 (Erythropoietin); 6T84R30KC1 (Tranexamic Acid); E1UOL152H7 (Iron)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180306
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009429


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[PMID]:27774838
[Au] Autor:Myles PS; Smith JA; Forbes A; Silbert B; Jayarajah M; Painter T; Cooper DJ; Marasco S; McNeil J; Bussières JS; McGuinness S; Byrne K; Chan MT; Landoni G; Wallace S; ATACAS Investigators of the ANZCA Clinical Trials Network
[Ad] Endereço:From the Alfred Hospital (P.S.M., D.J.C., S. Marasco, S.W.) and Monash University (P.S.M., J.A.S., A.F., D.J.C., S. Marasco, J.M., S.W.), Melbourne, VIC, St. Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital, Adelaide, SA (T.P.) - all in Australia; South West Cardiac Centre, D
[Ti] Título:Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery.
[So] Source:N Engl J Med;376(2):136-148, 2017 01 12.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. METHODS: In a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo coronary-artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after surgery. RESULTS: Of the 4662 patients who were enrolled and provided consent, 4631 underwent surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patients (16.7%) in the tranexamic acid group and in 420 patients (18.1%) in the placebo group (relative risk, 0.92; 95% confidence interval, 0.81 to 1.05; P=0.22). The total number of units of blood products that were transfused during hospitalization was 4331 in the tranexamic acid group and 7994 in the placebo group (P<0.001). Major hemorrhage or cardiac tamponade leading to reoperation occurred in 1.4% of the patients in the tranexamic acid group and in 2.8% of the patients in the placebo group (P=0.001), and seizures occurred in 0.7% and 0.1%, respectively (P=0.002 by Fisher's exact test). CONCLUSIONS: Among patients undergoing coronary-artery surgery, tranexamic acid was associated with a lower risk of bleeding than was placebo, without a higher risk of death or thrombotic complications within 30 days after surgery. Tranexamic acid was associated with a higher risk of postoperative seizures. (Funded by the Australian National Health and Medical Research Council and others; ATACAS Australia New Zealand Clinical Trials Registry number, ACTRN12605000557639 .).
[Mh] Termos MeSH primário: Antifibrinolíticos/uso terapêutico
Ponte de Artéria Coronária
Hemorragia/prevenção & controle
Complicações Intraoperatórias/prevenção & controle
Ácido Tranexâmico/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Antifibrinolíticos/efeitos adversos
Aspirina/uso terapêutico
Transfusão de Sangue/estatística & dados numéricos
Doença da Artéria Coronariana/mortalidade
Doença da Artéria Coronariana/cirurgia
Método Duplo-Cego
Feminino
Valvas Cardíacas/cirurgia
Hemorragia/induzido quimicamente
Seres Humanos
Masculino
Meia-Idade
Inibidores da Agregação de Plaquetas/uso terapêutico
Complicações Pós-Operatórias/induzido quimicamente
Reoperação/estatística & dados numéricos
Convulsões/induzido quimicamente
Trombose/induzido quimicamente
Ácido Tranexâmico/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antifibrinolytic Agents); 0 (Platelet Aggregation Inhibitors); 6T84R30KC1 (Tranexamic Acid); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1701
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1606424


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[PMID]:29384974
[Au] Autor:Zhu J; Zhu Y; Lei P; Zeng M; Su W; Hu Y
[Ad] Endereço:Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, China.
[Ti] Título:Efficacy and safety of tranexamic acid in total hip replacement: A PRISMA-compliant meta-analysis of 25 randomized controlled trials.
[So] Source:Medicine (Baltimore);96(52):e9552, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Hip osteoarthritis is one of the most prevalent musculoskeletal degenerative diseases in elderly. Total hip arthroplasty (THA) is the most effective surgical treatment for end stage hip osteoarthritis. Tranexamic acid (TA) is a potent drug to reduce surgical blood loss in surgery, therefore, as a potential drug for application in THA. OBJECTIVES: To identify the combined efficacy of TA administration in THA. A meta-analysis including 25 randomized controlled trials was conducted for generating synthesized effects. METHODS: This meta-analysis followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines for reporting systematic reviews and meta-analysis. A total of 25 Randomized controlled trials (RCTs) were included for meta-analysis. RESULTS: The pooled results illustrated that total blood loss, intraoperative blood loss, postoperative blood loss, hemoglobin drop, transfusion rate, and average hospital stay were significantly lower than controls (standardized mean difference or odds ratio (OR) (95%CI): -0.87, (-1.13,-0.61), -0.68, (-0.96,-0.39), -1.41, (-2.24,-0.59), -1.11, (-1.63,-0.58), 0.28, (0.20,-0.38), -0.17, (-0.49,0.14), P < .05, respectively). Moreover, TA acts efficiently without increasing risk of thromboembolic events with OR = 1.14, 95%CI = 0.50-2.62, P = .75. Subgroup analysis indicated no statistically significant differences between a higher dose of topical TA (≥2 g or 15 mg/kg) or a lower dose (<2 g or 15 mg/kg). CONCLUSION: The findings indicated that TA is clinically effective and safe in patients receiving total hip arthroplasty.
[Mh] Termos MeSH primário: Antifibrinolíticos/administração & dosagem
Artroplastia de Quadril/métodos
Perda Sanguínea Cirúrgica/prevenção & controle
Osteoartrite do Quadril/cirurgia
Ácido Tranexâmico/administração & dosagem
[Mh] Termos MeSH secundário: Administração Intravenosa
Administração Tópica
Transfusão de Sangue
Hemoglobinas
Seres Humanos
Tempo de Internação
Ensaios Clínicos Controlados Aleatórios como Assunto
Trombose Venosa/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Antifibrinolytic Agents); 0 (Hemoglobins); 6T84R30KC1 (Tranexamic Acid)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009552


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[PMID]:29437056
[Au] Autor:Subramanyam KN; Khanchandani P; Tulajaprasad PV; Jaipuria J; Mundargi AV
[Ad] Endereço:Sri Sathya Sai Institute of Higher Medical Sciences-Prasanthigram, Puttaparthi, Andhra Pradesh 515134, India.
[Ti] Título:Efficacy and safety of intra-articular versus intravenous tranexamic acid in reducing perioperative blood loss in total knee arthroplasty: a prospective randomized double-blind equivalence trial.
[So] Source:Bone Joint J;100-B(2):152-160, 2018 Feb.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The aims of this study were to compare the efficacy and safety of intra-articular and intravenous (IV) tranexamic acid (TXA) in controlling perioperative blood loss in total knee arthroplasty (TKA) using a randomized, double-blinded equivalence trial. PATIENTS AND METHODS: A total of 182 patients aged between 45 and 75 years undergoing unilateral TKA at a tertiary centre were randomized to receive TXA, either 1.5 g intra-articularly after closure of the wound (n = 91) or two doses of 10 mg/kg IV (n = 91). The primary outcome measure was the reduction in the level of haemoglobin (Hb) in the blood on the fifth postoperative day. Secondary outcome measures were the total, visible, and hidden blood losses (TBL, VBL, HBL). We assumed equivalence of the primary outcome in both routes with a margin of ± 0.35gm/dl. Block randomization using computer-generated random numbers was used. The patients and the assessor of outcome were blinded. RESULTS: All patients completed the study. The mean difference in the reduction of the level of Hb between the two groups was -0.0055 gm/dl, with two-sided 95% confidence interval (CI) being -0.29 to 0.27, well within the predefined equivalence margin of ± 0.35gm/dl. The groups were comparable with regard to TBL, VBL, HBL, and complications. No patient needed a blood transfusion. CONCLUSION: A single intra-articular dose and two IV doses of TXA give equivalent efficacy and safety in the management of blood loss at TKA. Cite this article: 2018;100-B:152-60.
[Mh] Termos MeSH primário: Antifibrinolíticos/administração & dosagem
Artroplastia do Joelho
Perda Sanguínea Cirúrgica/prevenção & controle
Ácido Tranexâmico/administração & dosagem
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Infusões Intravenosas
Injeções Intra-Articulares
Masculino
Meia-Idade
Estudos Prospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:EQUIVALENCE TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antifibrinolytic Agents); 6T84R30KC1 (Tranexamic Acid)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B2.BJJ-2017-0907.R1


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[PMID]:29320623
[Au] Autor:Kulic A; Cvetkovic Z; Libek V
[Ti] Título:Primary hyperfibrinolysis as the presenting sign of prostate cancer: A case report.
[So] Source:Vojnosanit Pregl;73(9):877-80, 2016 Sep.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Introduction: A bleeding syndrome in the setting of primary hyperfibrinolysis in a prostate cancer patient is only 0.40­ 1.65% of cases. The laboratory diagnosis of primary hyperfibrinolysis is based on the increase of biomarkers like D-dimer, fibrinogen split products, plasminogen, and euglobulin lysis test. These tests are not specific for primary hyperfibrinolysis. We reported a rare case of hemorrhagic syndrome caused by primary hyperfibrinolysis as the first clinical symptom of metastatic prostate cancer. Case report: A 64-year-old male was admitted to our hospital with large hematomas in the right pectoral and axillary areas (20 x 7 cm), right hemiabdomen (30 x 30 cm) and the left lumbal area, (25 x 5 cm). The patient had no subjective symptoms nor used any medication. Initial coagulation testing, prothrombin time (PT), and activated partial thromboplastin time (APTT) were within the normal range, while fibrinogen level was extremely low (1.068 g/L) (normal range 2.0­5.0) and the D-dimer assay result was high 1.122 mg/L (normal range < 0.23). The results obtained by rotation thrombelastometry pointed to primary fibrinolysis. Further clinical and laboratory examination indicated progressive malignant prostate disease. First line treatment for the patient was a combined administration of tranexamic acid (3 x 500 mg iv) and transfusion of ten units of cryoprecipitate (400 mL). Next day, fibrinolytic function measurements by rotation thrombelastometry were within the normal ranges. Fibrinogen level was normalized within two days (2.4 g/L). There were no newly developed hematomas. Conclusion: This case report shows primary hyperfibrinolysis with bleeding symptoms, which is an uncommon paraneoplastic phenomenon within expanded prostate malignancy. Rotation thrombelastometry in this severe complication helped to achieve the prompt and proper diagnosis and treatment.
[Mh] Termos MeSH primário: Adenocarcinoma/complicações
Transtornos da Coagulação Sanguínea/etiologia
Fibrinólise
Síndromes Paraneoplásicas/etiologia
Neoplasias da Próstata/complicações
[Mh] Termos MeSH secundário: Adenocarcinoma/sangue
Adenocarcinoma/secundário
Adenocarcinoma/terapia
Antifibrinolíticos/uso terapêutico
Biomarcadores/sangue
Transtornos da Coagulação Sanguínea/sangue
Transtornos da Coagulação Sanguínea/diagnóstico
Transtornos da Coagulação Sanguínea/tratamento farmacológico
Testes de Coagulação Sanguínea
Neoplasias Ósseas/secundário
Fator VIII/uso terapêutico
Fibrinogênio/uso terapêutico
Fibrinólise/efeitos dos fármacos
Hematoma/etiologia
Hemorragia/etiologia
Seres Humanos
Masculino
Meia-Idade
Síndromes Paraneoplásicas/sangue
Síndromes Paraneoplásicas/diagnóstico
Síndromes Paraneoplásicas/tratamento farmacológico
Neoplasias da Próstata/sangue
Neoplasias da Próstata/patologia
Neoplasias da Próstata/terapia
Ácido Tranexâmico/uso terapêutico
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antifibrinolytic Agents); 0 (Biomarkers); 0 (cryoprecipitate coagulum); 6T84R30KC1 (Tranexamic Acid); 9001-27-8 (Factor VIII); 9001-32-5 (Fibrinogen)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.2298/VSP150525076K


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[PMID]:29384916
[Au] Autor:Wang W; Yu J
[Ad] Endereço:Department of Joint and Limbs Surgery, The Affiliated Yangming Hospital of Ningbo University, Yuyao People's Hospital of Zhejiang Province, Yuyao, China.
[Ti] Título:Tranexamic acid reduces blood loss in intertrochanteric fractures: A meta-analysis from randomized controlled trials.
[So] Source:Medicine (Baltimore);96(52):e9396, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This meta-analysis aims to assess the efficacy and safety of tranexamic acid for reducing blood loss and transfusion requirements in patients with intertrochanteric fractures. METHODS: We conduct electronic searches of Medline (1966-2017.09), PubMed (1966-2017.09), Embase (1980-2017.09), ScienceDirect (1985-2017.09), and the Cochrane Library. Only randomized controlled trials (RCTs) are included. The quality assessments are performed according to the Cochrane systematic review method. Fixed/random-effect model is used according to the heterogeneity tested by I statistic. Meta-analysis is performed using Stata 11.0 software. RESULTS: A total of 4 RCTs are retrieved involving 514 participants. The present meta-analysis indicated that there were significant differences between groups in terms of total blood loss (weighted mean differences = -131.49, 95% confidence interval (CI): -163.63 to -99.35, P = .00), hemoglobin decline (weighted mean differences = -0.31, 95% CI, -0.44 to -0.19, P = .00), and transfusion rate (risk differences = -1.11, 95% CI, -0.19 to -0.04, P = .00). In addition, no increased risk of adverse effects was identified in both groups. CONCLUSION: Local administration of tranexamic acid is associated with a reduced total blood loss, postoperative hemoglobin decline, and transfusion requirements in patients with intertrochanteric fractures. High-quality RCTs are still required for further investigation.
[Mh] Termos MeSH primário: Antifibrinolíticos/uso terapêutico
Perda Sanguínea Cirúrgica/prevenção & controle
Fixação Interna de Fraturas/efeitos adversos
Fraturas do Quadril/cirurgia
Ácido Tranexâmico/uso terapêutico
[Mh] Termos MeSH secundário: Seres Humanos
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Antifibrinolytic Agents); 6T84R30KC1 (Tranexamic Acid)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009396


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[PMID]:29280698
[Au] Autor:Williams A; Biffen A; Pilkington N; Arrick L; Williams RJ; Smith ME; Smith M; Birchall J
[Ad] Endereço:Department of Anaesthesia,Derriford Hospital,Plymouth,UK.
[Ti] Título:Haematological factors in the management of adult epistaxis: systematic review.
[So] Source:J Laryngol Otol;131(12):1093-1107, 2017 Dec.
[Is] ISSN:1748-5460
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The management of epistaxis requires an understanding of haematological factors that may complicate its treatment. This systematic review includes six distinct reviews examining the evidence supporting epistaxis-specific management strategies relating to warfarin, direct oral anticoagulants, heparin, antiplatelet agents, tranexamic acid and transfusion. METHOD: A systematic review of the literature was performed using a standardised methodology and search strategy. RESULTS: Limited numbers of articles were identified in each systematic review, with level 1 evidence only regarding the use of tranexamic acid. No studies met the inclusion criteria within the heparin, direct oral anticoagulants or transfusion systematic reviews. Many studies were limited by small sample sizes and significant risk of bias. CONCLUSION: The management of major bleeding and transfusion practice is well documented in national guidance from multiple sources. The guidelines include advice on anticoagulants, antiplatelet agents and tranexamic acid. In the absence of more specific evidence, these guidelines should be applied in the management of epistaxis.
[Mh] Termos MeSH primário: Epistaxe/sangue
Epistaxe/terapia
[Mh] Termos MeSH secundário: Adulto
Anticoagulantes/efeitos adversos
Anticoagulantes/uso terapêutico
Transfusão de Sangue
Epistaxe/induzido quimicamente
Medicina Baseada em Evidências
Fidelidade a Diretrizes
Heparina/efeitos adversos
Heparina/uso terapêutico
Seres Humanos
Coeficiente Internacional Normatizado
Tempo de Internação
Inibidores da Agregação de Plaquetas/efeitos adversos
Inibidores da Agregação de Plaquetas/uso terapêutico
Ácido Tranexâmico/efeitos adversos
Ácido Tranexâmico/uso terapêutico
Resultado do Tratamento
Varfarina/efeitos adversos
Varfarina/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Platelet Aggregation Inhibitors); 5Q7ZVV76EI (Warfarin); 6T84R30KC1 (Tranexamic Acid); 9005-49-6 (Heparin)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1017/S0022215117002067


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[PMID]:29257010
[Au] Autor:Huang Z; Xie X; Li L; Huang Q; Ma J; Shen B; Kraus VB; Pei F
[Ad] Endereço:Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, ChengDu, Sichuan Province, People's Republic of China.
[Ti] Título:Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial.
[So] Source:J Bone Joint Surg Am;99(24):2053-2061, 2017 Dec 20.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Tourniquet use during primary total knee arthroplasty is thought to reduce intraoperative blood loss and improve visibility. Our goal was to investigate whether tourniquet use is necessary for controlling intraoperative blood loss when alternatives such as tranexamic acid (TXA) are available. METHODS: One hundred and fifty patients were equally randomized to 3 groups. Group A was treated with a tourniquet as well as multiple doses of intravenous TXA (20 mg/kg 5 to 10 minutes before the skin incision and 10 mg/kg 3, 6, 12, and 24 hours later) along with 1 g of topical TXA, Group B was treated the same as Group A but without the tourniquet, and Group C was treated with the tourniquet only. RESULTS: The amount of intraoperative blood loss was similar for the 3 groups. Group B had significantly less hidden blood loss than Group A (p = 0.018) and Group C (p < 0.001). No significant differences (p > 0.05) were observed between Group A and Group B with regard to total blood loss, drainage volume, intraoperative blood loss, transfusion rate, or maximum change in the hemoglobin (Hb) level. We also found significantly more benefits for Group B compared with Groups A and C with regard to postoperative swelling ratio, levels of inflammatory biomarkers, visual analog scale (VAS) pain scores, range of motion at discharge, Hospital for Special Surgery (HSS) score, and patient satisfaction. There were no significant differences (p > 0.05) in the deep venous thrombosis or pulmonary embolus rates among the 3 groups. More wound secretion was observed in the groups in which a tourniquet was used. CONCLUSIONS: Patients treated with multiple doses of intravenous and topical TXA without a tourniquet had less hidden blood loss, a lower ratio of postoperative knee swelling, less postoperative knee pain, lower levels of inflammatory biomarkers, better early knee function, and even better early satisfaction than those treated with a tourniquet. Long-term follow-up should be performed to evaluate the effects on prosthetic fixation and long-term survival of total knee arthroplasty performed without a tourniquet. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Artroplastia do Joelho/métodos
Perda Sanguínea Cirúrgica/prevenção & controle
Medição da Dor
Torniquetes/utilização
Ácido Tranexâmico/administração & dosagem
[Mh] Termos MeSH secundário: Administração Tópica
Idoso
Artroplastia do Joelho/efeitos adversos
Perda Sanguínea Cirúrgica/fisiopatologia
China
Terapia Combinada
Feminino
Seguimentos
Seres Humanos
Injeções Intravenosas
Masculino
Meia-Idade
Dor Pós-Operatória/fisiopatologia
Dor Pós-Operatória/prevenção & controle
Estudos Prospectivos
Medição de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
6T84R30KC1 (Tranexamic Acid)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01525


  9 / 2633 MEDLINE  
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[PMID]:27776904
[Au] Autor:Bin Abd Razak HR; Binte Abd Razak NF; Tan HA
[Ad] Endereço:Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. Electronic address: hamidrazak@gmail.com.
[Ti] Título:Prevalence of Venous Thromboembolic Events Is Low in Asians After Total Knee Arthroplasty Without Chemoprophylaxis.
[So] Source:J Arthroplasty;32(3):974-979, 2017 03.
[Is] ISSN:1532-8406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This retrospective cohort study was designed to establish the prevalence of clinically significant venous thromboembolic events (VTE) in our patients undergoing total knee arthroplasty (TKA) without chemoprophylaxis. METHODS: A single-surgeon cohort of patients who underwent TKA from 2006 to 2014 were included. All patients had a pneumatic tourniquet applied and a drain inserted postoperatively. Tranexamic acid was not used perioperatively. All patients were under a standardized postoperative protocol with routine mechanical prophylaxis against VTE. None of the patients received prophylactic anticoagulation. All patients ambulated on the second postoperative day. Only symptomatic patients were referred for radiological examination to exclude VTE. We evaluated the patient demographics and calculated the prevalence of VTE in our cohort. RESULTS: A total of 966 patients were reviewed. Mean age was 66.1 ± 7.8 years. Mean body mass index was 28.2 ± 4.7 kg/m . Mean tourniquet time was 53 ± 23 minutes. Patients stayed in hospital for a mean of 5.4 ± 3.1 days. There was 100% compliance to mechanical prophylaxis. And 11.1% of our patients were on concomitant antiplatelet or anticoagulant use. There were 8 patients with clinically significant VTE. This translates to a prevalence of 0.82%. Seven patients developed deep vein thrombosis and 1 patient died from massive pulmonary embolism. CONCLUSION: The prevalence of clinically significant VTE in our patients who underwent TKA without routine chemoprophylaxis is 0.82%. With proper patient selection, risk stratification, and stringent perioperative protocols, routine chemoprophylaxis may not be necessary in Asians undergoing TKA.
[Mh] Termos MeSH primário: Artroplastia do Joelho/efeitos adversos
Tromboembolia Venosa/epidemiologia
Tromboembolia Venosa/etiologia
[Mh] Termos MeSH secundário: Idoso
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos
Quimioprevenção
Feminino
Seres Humanos
Masculino
Meia-Idade
Período Pós-Operatório
Prevalência
Embolia Pulmonar/epidemiologia
Estudos Retrospectivos
Torniquetes
Ácido Tranexâmico
Trombose Venosa/epidemiologia
Trombose Venosa/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
6T84R30KC1 (Tranexamic Acid)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


  10 / 2633 MEDLINE  
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[PMID]:29215478
[Au] Autor:Smith SR; Murray D; Pockney PG; Bendinelli C; Draganic BD; Carroll R
[Ad] Endereço:Department of Colorectal Surgery, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia.
[Ti] Título:Tranexamic Acid for Lower GI Hemorrhage: A Randomized Placebo-Controlled Clinical Trial.
[So] Source:Dis Colon Rectum;61(1):99-106, 2018 Jan.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Lower GI hemorrhage is a common source of morbidity and mortality. Tranexamic acid is an antifibrinolytic that has been shown to reduce blood loss in a variety of clinical conditions. Information regarding the use of tranexamic acid in treating lower GI hemorrhage is lacking. OBJECTIVE: The aim of this trial was to determine the clinical efficacy of tranexamic acid when used for lower GI hemorrhage. DESIGN: This was a prospective, double-blind, placebo-controlled, randomized clinical trial. SETTINGS: The study was conducted at a tertiary referral university hospital in Australia. PATIENTS: Consecutive patients aged >18 years with lower GI hemorrhage requiring hospital admission from November 2011 to January 2014 were screened for trial eligibility (N = 265). INTERVENTIONS: A total of 100 patients were recruited after exclusions and were randomly assigned 1:1 to either tranexamic acid or placebo. MAIN OUTCOME MEASURES: The primary outcome was blood loss as determined by reduction in hemoglobin levels. The secondary outcomes were transfusion rates, transfusion volume, intervention rates for bleeding, length of hospital stay, readmission, and complication rates. RESULTS: There was no difference between groups with respect to hemoglobin drop (11 g/L of tranexamic acid vs 13 g/L of placebo; p = 0.9445). There was no difference with respect to transfusion rates (14/49 tranexamic acid vs 16/47 placebo; p = 0.661), mean transfusion volume (1.27 vs 1.93 units; p = 0.355), intervention rates (7/49 vs 13/47; p = 0.134), length of hospital stay (4.67 vs 4.74 d; p = 0.934), readmission, or complication rates. No complications occurred as a direct result of tranexamic acid use. LIMITATIONS: A larger multicenter trial may be required to determine whether there are more subtle advantages with tranexamic acid use in some of the secondary outcomes. CONCLUSIONS: Tranexamic acid does not appear to decrease blood loss or improve clinical outcomes in patients presenting with lower GI hemorrhage in the context of this trial. see Video Abstract at http://links.lww.com/DCR/A453.
[Mh] Termos MeSH primário: Antifibrinolíticos/uso terapêutico
Doenças do Sistema Digestório/complicações
Hemorragia Gastrointestinal/tratamento farmacológico
Ácido Tranexâmico/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Método Duplo-Cego
Feminino
Hemorragia Gastrointestinal/etiologia
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antifibrinolytic Agents); 6T84R30KC1 (Tranexamic Acid)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171215
[Lr] Data última revisão:
171215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000943



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