Search

Background: Tranexamic acid (TXA) has been used to treat acute bleeding in trauma-related settings, with low side effects. However, the benefits of prophylactic TXA use remain unclear, raising the possibility of administration before PPH diagnosis. Methods: The study followed the PRISMA 2020 guidelines and developed a systematic review and meta-analysis of blinded and randomized clinical trials to determine the impact of prophylactic TXA use on bleeding volume in cesarean or vaginal deliveries, focusing on English studies. Result: TXA showed significant effects on post-partum bleeding reduction, with lower hemoglobin variation compared to the control group. However, some studies reported mild side effects and the effect was even greater in cesarean delivery. Risk factors for bleeding were considered. Conclusion: Promising outcomes have been observed in lowering blood component requirements and preventing postpartum hemorrhage (PPH) with TXA, a prophylactic treatment for PPH. Even though the use of uterotonics was reduced, a recent multicenter RCT conducted in France was unable to demonstrate a meaningful decline in PPH diagnoses. The study also showed a great deal of variability in TXA use and how it affected cesarean deliveries.

Introduction: Tranexamic acid (TXA) is an antifibrinolytic agent currently approved and utilized in the treatment of dysfunctional uterine bleeding, traumatic extracranial hemorrhage, anterior epistaxis, and dental procedures on patients with hemophilia. There is a paucity of literature evaluating the use of TXA for hemostasis in patients on direct oral anticoagulants (DOACs).Case Report: Our patient, a 72 year-old male on rivaroxaban, presented with persistent bleeding following a punch biopsy of the buccal mucosa. Given the site of bleeding, inability to effectively tamponade, patient’s anticoagulated state, and risk of impending airway compromise, a dressing was soaked with 500 milligram (mg) of TXA and was held in place with pressure using a makeshift clamp until a thrombus formed. Hemostasis was achieved preventing the need for acute ENTotolaryngologic intervention and/or intubation. The patient was observed in the medical setting overnight and discharged home without any recurrence of bleeding or adverse events.Discussion: This case report describes our experience achieving hemostasis for an otherwise uncontrollable oral bleed in an anticoagulated patient on a DOAC who could not be reversed. Intervention is simple to perform, cost-effective, and requires few resources which are readily available in most emergency departments.Conclusion: We report a novel application of TXA to control an oral mucosal bleed in an anticoagulated patient which was on a DOAC refractory to traditional measures.

Introduction: Post-tonsillectomy hemorrhage is a potentially life-threatening, postoperative complication that is commonly encountered in the emergency department (ED).Case Report: Herein, we describe the case of a 22-year-old male who presented to the ED with an active post-tonsillectomy hemorrhage. He rapidly became hypotensive and experienced an episode of syncope. Immediate interventions included intravenous fluids, emergency release blood and nebulized tranexamic acid (TXA). After completion of the nebulized TXA, the patient’s bleeding was controlled.Conclusion: To our knowledge, this is the first case in the emergency medicine literature that describes the use of nebulized TXA in an adult to achieve hemostasis in post-tonsillectomy hemorrhage.

Regulation of the development, production, marketing, and sales of medical pharmaceuticals and devices in the United States fall under the regulatory functions of the Food and Drug Administration (FDA). The current FDA approval process takes an average of 10 years from start to completion, and costs over $100 million. As a result, companies use many different methods to find additional use of their drugs through marketing directly to the physician, or recycling of previously approved drug moieties. In this work, an evaluation of the in vitro and ex vivo biocompatibility of polymers and drugs in different phases of FDA approval are evaluated. These include polymers and drugs that are 1) being studied for FDA approval (Chapter 3), 2) used for purposes other than their initial clinical setting purposes (Chapter 4 and 5), and 3) deemed safe from studies in the 1960s-1970s and have been used due to their low “toxicity” (Chapter 6). An alternative method of drug delivery is explored to improve the palatability and allow for more precise control of the concentration of drugs delivered for colonoscopy preparations to help alleviate side effects and improve compliance rates is explored in Chapter 7. The cytotoxicity of reagents (NIPAM) used in current experimental protocols prior to FDA approval were investigated as described in Chapter 3. Although other forms of polymerized NIPAM are non-toxic to cells, cpNIPAM purchased from retailers should be purified prior to use to prevent unintended cytotoxic effects. Current surgical procedures often encourage the use of antifibrinolytics to prevent excessive bleeding (Chapter 4), antibiotics, and antiseptics to prevent infection (Chapter 5). This work demonstrated that each of the antibiotics, antiseptics, and antifibrinolytic tested are detrimental to knee joint cells. Chapter 6trong

Introduction: The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to assess thesafety and impact on patient mortality of tranexamic acid (TXA) administration in cases of trauma-inducedhemorrhagic shock. The current study further aimed to assess the feasibility of prehospital TXA administrationby paramedics within the framework of North American emergency medicine standards and protocols.Methods: This is an ongoing multi-centered, prospective, observational cohort study with a retrospectivechart-review comparison. Trauma patients identified in the prehospital setting with signs of hemorrhagicshock by first responders were administered one gram of TXA followed by an optional second one-gram doseupon arrival to the hospital, if the patient still met inclusion criteria. Patients administered TXA make up theprehospital intervention group. Control group patients met the same inclusion criteria as TXA candidates andwere matched with the prehospital intervention patients based on mechanism of injury, injury severity score,and age. The primary outcomes were mortality, measured at 24 hours, 48 hours, and 28 days. Secondaryoutcomes measured included the total blood products transfused and any known adverse events associatedwith TXA administration.Results: We included 128 patients in the prehospital intervention group and 125 in the control group.Although not statistically significant, the prehospital intervention group trended toward a lower 24-hourmortality rate (3.9% vs 7.2% for intervention and control, respectively, p=0.25), 48-hour mortality rate (6.3%vs 7.2% for intervention and control, respectively, p=0.76), and 28-day mortality rate (6.3% vs 10.4% forintervention and control, respectively, p=0.23). There was no significant difference observed in knownadverse events associated with TXA administration in the prehospital intervention group and control group. Areduction in total blood product usage was observed following the administration of TXA (co

BackgroundMultilevel spinal fusions have typically been associated with significant blood loss. Previous studies have shown a reduction in blood loss with antifibrinolytics in both adolescent and adult spinal deformity patients. While this has been mirrored in other subspecialties as well, the dosing of TXA remains highly variable. To date, there remains a paucity of data guiding dosing for TXA in spine surgery and orthopedic surgery as a whole.Methods/designOne hundred and fifty patients from 3 institutions (50 each site) will be consecutively enrolled and randomized to either a high dose of TXA (50mg/kg loading followed by 20mg/kg hourly) or a lose dose (10mg/kg, then 1mg/kg hourly). Both surgeons and patients will be blinded to the treatment group. Primary outcomes will be perioperative blood loss, drain output, and transfusion rate. Secondary outcomes will be length of stay, complications, and overall cost.DiscussionThe primary goal of this study is to provide level-1 comparative data for two TXA dosing regimens in adult spinal deformity surgery. Management of blood loss remains a critical factor in reducing complications during spinal deformity surgery. The null hypothesis is that there is no difference between high- and low-dose TXA with respect to any of the primary or secondary outcomes.