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Background HAE leads to significant morbidity and mortality from unpredictable intermittent peripheral, abdominal and laryngeal swelling. Access to appropriate healthcare and effective therapies which can prevent and treat attacks, reduce the suffering and greatly improve quality of life. Although treatments such as C1 inhibitor (Berinert®), and Icatibant® are available in New Zealand (Aotearoa), there is no published data available on their use. Aims This study presents a national audit of Hereditary Angioedema (HAE) and Acquired Angioedema (AAE) in 2019. Results The total number of known adult (48) and children (3) HAE and Acquired Angioedema (3) patients is 54. Of these, 41/ 54 (75%) of HAE and AAE patients were recruited to the audit. Icatibant® has been available for treatment of acute HAE attacks since 2016, and is now used in 73% of HAE patients. Icatibant® is also used by patients for laryngeal attacks in the community, who may not then present to hospital. Androgens are used in half of the patients as prophylaxis but 33% of the latter were identified as not having regular liver ultrasound screening. Tranexamic acid is used as prophylaxis in one fifth of patients. Participants have had 40 children, half of whom may be affected. Three have been diagnosed with HAE, suggesting that the majority have not yet been tested. Conclusions Corrective actions arising from this audit will improve our capacity to provide long term care for HAE patients and their families. This article is protected by copyright. All rights reserved.

Melasma is a chronic and relapsing skin condition. Although melasma is usually asymptomatic, it can be associated with immense psychosocial stress and greatly impact a patient's quality of life. Over the years, many different treatments have been used, ranging from daily photoprotection, topical lightening creams, and oral agents to laser and light-based therapies; however, efficacy is often limited with such treatments, and there is currently no effective modality to prevent recurrence. While treatment strategies had originally centered on the use of hydroquinone, newer modalities now include oral tranexamic acid and lasers. We examined previous and ongoing debates related to melasma treatments and have reviewed the current efficacy and safety of available treatments. Critical components essential to the successful management of melasma are the setting of patient expectations and assurance of treatment compliance.

OBJECTIVES Melasma is a chronic acquired condition characterized by grayish-brown macules and patches with a distinct border on the face. Although various treatments methods have been suggested for treating melasma, none has been completely successful. The aim of the study was to compare the efficiency of erbium: yttrium-aluminum-garnet (Er:YAG) laser and 4% hydroquinone (HQ) with the effects of intradermal tranexamic acid (TA) and 4% HQ for the treatment of refractory melasma. METHODS The study included 31 female patients with refractory melasma. The left or right side of the patient's face was chosen randomly to receive laser therapy with topical HQ on the one side (i.e., the laser side) and intradermal injection of TA plus topical HQ on the other side (i.e., the mesotherapy side). Digital photography was performed at baseline, at the end of the treatment, and three months after the treatment as follow-up. Two independent dermatologists evaluated the modified Melasma Area and Severity Index (mMASI) score according to the pictures. Overall, 27 patients completed the study and went through the clinical evaluation. RESULTS Treatment using HQ in combination with either Er:YAG laser therapy or intradermal injection of TA significantly improved the hemi-mMASI and resulted in higher patient satisfaction. While the improvement was not significantly different between the two regiments after the treatment and upon follow up and both were equally efficient in the treatment of refractory melasma (p = 1.308), recurrence rate was higher after treatment with Er:YAG laser than TA (12% vs 34%). CONCLUSION This study confirmed the comparable efficacy of TA plus topical HQ versus Er:YAG laser plus topical HQ for the treatment of refractory melasma. Both groups improved significantly and no subject left the treatment because of adverse effects.

Background Microneedling as an adjuvant to topical medications has shown promising but variable results in the treatment of melasma. Objective To conduct a systematic review and meta-analysis on the efficacy of microneedling as an adjuvant to topical therapies for the treatment of melasma. Methods This study followed PRISMA guidelines. All comparative, prospective studies on the use of topical interventions with microneedling for the treatment of melasma were included. Studies involving radiofrequency microneedling were excluded. Results Twelve eligible studies comprising 459 patients from 7 different countries were included. Topical therapies included topical tranexamic acid, vitamin C, platelet-rich plasma, non-hydroquinone-based depigmentation serums, and hydroquinone-based depigmenting agents. Topical therapy with microneedling improved melasma severity with a large effect (standardized mean difference >0.8) beyond 8 weeks, with best results seen at 12 weeks. Compared to topical therapy alone, topical therapy with microneedling resulted in an additional improvement in melasma severity with a moderate effect at 8 weeks and a large effect at 12-16 weeks. Microneedling was well tolerated across studies, with no serious adverse events reported. Limitations Heterogeneity in study designs did not allow for a comparison of the efficacy of various topical therapies with microneedling. Conclusion Microneedling is useful adjuvant to topical therapies for the treatment of melasma.

Melasma is a common chronic refractory disorder of pigmentation affecting people with darker skin types. Overall prevalence varies between 8.8% and 40%, depending on the ethnicity of the population and the geographical area. Therapeutic management of melasma is challenging, with high recurrence rates which significant impacts on the quality of life. No single treatment is universally efficacious. Systemic treatments with tranexamic acid and polypodium leucotmatous had promising results, although the former was related to systemic side effects. Microneedling and peeling were also efficacious, although their superiority to topical hydroquinone, the gold standard in melasma treatment, remains to be established. Similarly, laser and light devices have been beneficial. However, recurrence rates remain high in all treatment groups. Combination therapies, either in double or triple combinations yielded the best results when compared to single terapies. Treatment choice should be made after Wood's lamp examination, as well as dermatoscopic evaluation, in order to select the best treatment option, targeted at each melasma subtype.

OBJECTIVES: Tranexamic acid is proposed as a treatment for gastrointestinal bleeding. The Haemorrhage Alleviation with Tranexamic Acid-Intestinal System trial evaluated extended-use (24 hr) high-dose tranexamic acid, prompting a reappraisal for tranexamic acid in gastrointestinal bleeding. DATA SOURCES: We conducted a systematic review and meta-analysis of randomized controlled trials comparing tranexamic acid with usual care or placebo in adults with gastrointestinal bleeding. We searched MEDLINE, EMBASE, and CENTRAL (inception to September 2019). DATA SELECTION: Two reviewers independently screened citations, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool in duplicate. The main outcomes were mortality, bleeding, and adverse events. DATA EXTRACTION: Studies were analyzed as high-dose IV tranexamic acid versus all other dosing strategies for tranexamic acid using fixed-effects models. We assessed certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Five randomized controlled trials evaluated extended-use high-dose IV tranexamic acid, seven evaluating low-dose IV or enteral tranexamic acid. Extended-use high-dose IV tranexamic acid did not reduce mortality (relative risk, 0.98%; 95% CI, 0.88-1.09; I2 = 63%; high certainty) or bleeding (relative risk, 0.92; 95% CI, 0.82-1.04; p = 0.17 and absolute risk differences, -0.7%; 95% CI, -1.5 to 0.3; high certainty) but resulted in a small increase in deep venous thrombosis (relative risk, 2.01; 95% CI, 1.08-3.72; I2 = 0%), pulmonary embolism (relative risk, 1.78; 95% CI, 1.06-3.0; I2 = 0%), and seizure (relative risk, 1.73; 95% CI, 1.03-2.93) with high certainty. Low-dose IV/enteral tranexamic acid did not reduce mortality (relative risk, 0.62; 95% CI, 0.36-1.09; I2 = 0%) but did reduce risk of rebleeding (relative risk, 0.5; 95% CI, 0.33-0.75; I2 = 9%) and need for surgery (relative risk, 0.58; 95% CI, 0.38-0.88; I2 = 11%), with moderate certainty. CONCLUSIONS: Extended-use high-dose IV tranexamic acid does not improve mortality or bleeding outcomes and increases adverse events. Low-dose/enteral tranexamic acid may be effective in reducing hemorrhage; more evidence is required to demonstrate its safety.

To determine whether locally injected tranexamic acid (TXA) used in the surgical treatment of fragility hip fractures can lower transfusion rates without increasing the risk of complications.Retrospective comparative cohort.Tertiary referral orthopaedic specialty hospital, Level I trauma center.A total of 490 patients (252 patients received TXA) 50 years of age and older who underwent surgery for a low-energy fragility fracture of the proximal femur between March 2018 and February 2020 were included in this study.Use of locally injected TXA at the time of wound closure.The main outcomes of this study were the number of patients requiring postoperative blood transfusions, incidences of venous thromboembolism, and surgical site infections.A statistically significant difference was noted in the frequency of transfusion between patients who received TXA compared with those who did not receive TXA (33% vs. 43%, respectively) (P = 0.034). There were no significant differences in venous thromboembolism incidence (0.4% vs. 0.8% TXA vs. No TXA) (P = 0.526) or infections (0.4% vs. 0.4% TXA vs. No TXA) (P = 0.965). Regression analysis indicated that the use of TXA reduced the need for postoperative blood transfusion by 31% (odds ratio: 0.688, 95% CI: 0.477-0.993, P = 0.045).Locally injected TXA significantly reduced the need for postoperative transfusion in the surgical treatment of fragility hip fractures. In addition, there was no increased risk of complications in those receiving TXA versus those who did not. Locally injected TXA seems to be both a safe and effective way to reduce postoperative blood transfusions in patients with fragility hip fractures.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

У статті подано сучасні рекомендації з інтенсивної терапії гострої крововтрати в акушерстві. Акушерські кровотечі залишаються провідною причиною материнської смертності в усьому світі. Нові стратегії лікування кровотеч передбачають використання гемостатичної реанімації з визначенням оптимального співвідношення для введення різних компонентів і препаратів крові. Масивні протоколи трансфузії рекомендують раннє використання продуктів крові й обмежують традиційний підхід ранньої масивної інфузійної терапії на основі кристалоїдів. За останні кілька років змінилися дані про гемостатичну реанімацію, і тепер ведуться обговорення щодо оптимальних стратегій інфузійно-трансфузійної терапії. Використання транексамової кислоти, концентрату фібриногену і концентрату протромбінового комплексу стало потенційно новою альтернативною стратегією лікування з поліпшеними профілями безпеки.

von Willebrand disease (VWD) disproportionately affects women because of the potential for heavy menstrual bleeding (HMB), delivery complications, and postpartum hemorrhage (PPH). To systematically synthesize the evidence regarding first-line management of HMB, treatment of women requiring or desiring neuraxial analgesia, and management of PPH. We searched Medline and EMBASE through October 2019 for randomized trials, comparative observational studies, and case series comparing the effects of desmopressin, hormonal therapy, and tranexamic acid (TxA) on HMB; comparing different von Willebrand factor (VWF) levels in women with VWD who were undergoing labor and receiving neuraxial anesthesia; and measuring the effects of TxA on PPH. We conducted duplicate study selection, data abstraction, and appraisal of risk of bias. Whenever possible, we conducted meta-analyses. We assessed the quality of the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. We included 1 randomized trial, 3 comparative observational studies, and 10 case series. Moderate-certainty evidence showed that desmopressin resulted in a smaller reduction of menstrual blood loss (difference in mean change from baseline, 41.6 [95% confidence interval, 16.6-63.6] points in a pictorial blood assessment chart score) as compared with TxA. There was very-low-certainty evidence about how first-line treatments compare against each other, the effects of different VWF levels in women receiving neuraxial anesthesia, and the effects of postpartum administration of TxA. Most of the evidence relevant to the gynecologic and obstetric management of women with VWD addressed by most guidelines is very low quality. Future studies that address research priorities will be key when updating such guidelines.

von Willebrand disease (VWD) is the most common inherited bleeding disorder. The management of patients with VWD who are undergoing surgeries is crucial to prevent bleeding complications. We systematically summarized the evidence on the management of patients with VWD who are undergoing major and minor surgeries to support the development of practice guidelines. We searched Medline and EMBASE from inception through October 2019 for randomized clinical trials (RCTs), comparative observational studies, and case series that compared maintaining factor VIII (FVIII) levels or von Willebrand factor (VWF) levels at >0.50 IU/mL for at least 3 days in patients undergoing major surgery, and those with options for perioperative management of patients undergoing minor surgery. Two authors screened and abstracted data and assessed the risk of bias. We conducted meta-analyses when possible. We evaluated the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We included 7 case series for major surgeries and 2 RCTs and 12 case series for minor surgeries. Very-low-certainty evidence showed that maintaining FVIII levels or VWF levels of >0.50 IU/mL for at least 3 consecutive days showed excellent hemostatic efficacy (as labeled by the researchers) after 74% to 100% of major surgeries. Low- to very-low-certainty evidence showed that prescribing tranexamic acid and increasing VWF levels to 0.50 IU/mL resulted in fewer bleeding complications after minor procedures compared with increasing VWF levels to 0.50 IU/mL alone. Given the low-quality evidence for guiding management decisions, a shared-decision model leading to individualized therapy plans will be important in patients with VWD who are undergoing surgical and invasive procedures.

PURPOSE The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF. METHODS A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture. Topics reviewed included: time from injury to definitive fixation, the role of inferior vena cava filters (IVCF), tranexamic acid (TXA) use, intraopoperative cell salvage, incisional negative pressure wound therapy (NPWT), intraoperative antibiotic powder use, heterotopic ossification prophylaxis, and pre- and postoperative venous thromboembolism (VTE) prophylaxis. RESULTS A total of 126 articles pertaining to the preoperative, intraoperative and postoperative management of PAF were reviewed. Articles reviewed by topic include 13 articles pertaining to time to fixation, 23 on IVCF use, 14 on VTE prophylaxis, 20 on TXA use, 10 on cell salvage, 10 on iNPWT 14 on intraoperative antibiotic powder and 20 on HO prophylaxis. An additional eight articles were reviewed to describe background information. Five articles provided information for two or more treatment modalities and were therefore included in multiple categories when tabulating the number of articles reviewed per topic. CONCLUSION The literature supports the use of radiation therapy for HO prophylaxis, early (

Objective: To evaluate the use of tranexamic acid (TXA) and ε-aminocaproic acid (EACA) in reducing blood loss in hip and proximal femur trauma surgery. Methods: Prospective study with 49 patients surgically treated in a trauma hospital between Nov/2015 and Feb/2017. The patients were divided in two groups: TXA (n = 24) and EACA (n = 25). The comparison was made according to gender, age at the time of surgery, ASA, fracture and surgery type, estimated blood loss during surgical approach, hemoglobin and hematocrit levels pre and post-operative, and pharmacological cost. The data was processed using SPSS 22.0 with significance level of p < 0,05. Results: No significant difference was found in the variables age, gender, ASA and estimated blood loss during surgical approach. No patient needed blood transfusion. When evaluated post-operatively, the hemoglobin and hematocrit values decrease had no significant difference between the antifibrinolytics (p > 0.05). When analyzing total cost for both pharmacological agents, higher cost was observed in EACA than in TXA (US$ 16.09 - US$ 2.73), resulting in a US$ 13.36 addition per patient. Conclusion: Antifibrinolytic use was efficient on lowering the total blood loss, without the need of blood transfusion. Level of evidence II, Prospective Comparative Study. RESUMO Objetivo: Avaliar o uso do ácido tranexâmico (ATX) e aminocapróico (AEAC) na redução da perda sanguínea em cirurgias para trauma do quadril e femur proximal. Métodos: Estudo prospectivo com 49 pacientes operados em hospital de trauma entre nov./15 e fev./17. Pacientes divididos em dois grupos: ATX (n = 24) e AEAC (n = 25). Comparações feitas de acordo com o sexo, idade na cirurgia, ASA, tipo de fratura e cirurgia, perda sanguínea estimada durante a cirurgia, níveis de hemoglobina e hematócrito pré e pós-operatório e o custo das medicações. Dados processados no SPSS 22.0 com nível de significância de p < 0,05. Resultados: Não foram encontradas diferenças significativas entre as seguintes variáveis: idade, sexo, ASA e perda sanguínea estimada durante a cirurgia. Nenhum paciente necessitou de transfusão sanguínea nos dois grupos. Na avaliação pós-operatória, não houve diferença significativa entre os grupos nos valores de queda da hemoglobina e hematócrito (p > 0,05). Analisando os custos de ambos as medicações, observou-se um custo mais elevado do AEAC em relação ao ATX (R$ 90,00 - R$ 15), resultando em R$ 75, 00 a mais por paciente. Conclusão: O uso dos antifibrinolíticos foi eficiente na redução da perda sanguínea, sem a necessidade de hemotransfusões. Nível de evidência II, Estudo Prospectivo Comparativo.

Objective: To compare the effectiveness of tranexamic acid (TXA) in reducing blood loss and decreasing surgery duration in craniomaxillofacial surgery. Methods: The literature was searched systemat...

Introduction. Earlier studies of low-dose fibrin monomer (FM) demonstrated that low-dose FM has unique hemostatic properties in vivo.Aim — to compare the morphological consequences of intravenous administration of tranexamic acid (TXA) and FM with the hemostatic and hemostasiological effects in hypofibrinogenemia caused by the use of streptokinase after controlled liver injury.Materials and methods. The morphological pattern of fibrin formation in the liver injury area after spontaneous arrest of bleeding in the animals treated with streptokinase or placebo was studied in 73 male rabbits of the Chinchilla breed, split into four groups. In three groups, the study was performed under the conditions of intravenous administration of placebo, TXA, or FM against the background of fibrinolysis activation by streptokinase. Platelet count in the blood, the concentration of fibrinogen, as well as the results of calibrated thrombography, were taken into account.Results. Sequential administration of streptokinase and TXA was accompanied by decreased fibrinogen concentration (by 29.6 %) and, at the same time, a reduction in blood loss (by 15.4 times) in comparison with animals where placebo was used instead of TXA. A decrease in blood loss was associated with increased thickness of thrombotic deposits at the edge of the wound, mainly consisting of red blood cells. These observations were combined with data on the acceleration of thrombin formation in venous blood plasma in a calibrated thrombography test (Peak thrombin 65.4 nmol/L to 109.6 nmol/L in the placebo group). Compared to the observations where placebo was administered instead of FM, however, the sequential use of streptokinase and FM also led to a decrease in blood loss (by 11.0 times) despite decreased fibrinogen concentration (by 23.3 %). A decrease in blood loss was also associated with platelet consumption in venous blood and with increased thickness of thrombotic deposits on the injury surface, where, in addition to red blood cells, the accumulation of fibrin masses was determined by the morphological pattern.Conclusion. The mechanisms of the systemic hemostatic effect of TXA and FM are different, despite the similarity of the achieved hemostatic effects in the conditions of stimulation of blood fibrinolytic activity. These findings expand the understanding of new therapeutic possibilities for reducing post-traumatic blood loss.

Introduction Tranexamic acid, as a traditional hemostatic agent, is commonly used to treat or prevent excessive blood loss. However, the role of tranexamic acid in promoting good clinical outcomes and reducing mortality and risk of adverse events during the treatment of aneurysmal subarachnoid hemorrhage remains unclear. Methods In strict accordance with the inclusion and exclusion criteria, Cochrane Library, Embase, Web of Science, and PubMed databases were assessed for randomized controlled trials (published between 1980 and 2021). Data were analyzed using STATA 16.0 and RevMan 5.3. In addition, the fixed-effects model (M-H method) and effect size (risk difference; RD) were used as a pooled measure to combine data. We also performed a post hoc sensitivity analysis and subgroup analysis to evaluate each outcome with low heterogeneity. Results A meta-analysis revealed that although tranexamic acid was related to less rebleeding (RD = −0.06; 95% CI [−0.09, −0.03]; P = 0.0006), there is evidence that it has no an effect on good clinical outcomes or mortality (RD = −0.01; 95% CI [−0.05, 0.02]; P = 0.51; RD = 0.00; 95% CI [−0.03, 0.04]; P = 0.91). Tranexamic acid was associated with increased hydrocephalus (RD = 0.04; 95% CI [0.01, 0.08]; P = 0.02) and seizure (RD = 0.04; 95% CI [0.00, 0.08]; P = 0.05). The incidence of thromboembolic complications or delayed cerebral ischemia was not different in the two groups (RD = −0.01; 95% CI [−0.04, 0.03]; P = 0.62; RD = 0.00; 95% CI [−0.03, 0.03]; P = 0.96), and significant drug-related overall adverse events were identified (RD = 0.02; 95% CI [0.00, 0.04]; P = 0.03). Conclusions These findings indicate that the routine use of tranexamic acid is not suggested for patients with aneurysmal subarachnoid hemorrhage.

Objective: To compare the efficacy of tranexamic acid (TXA) versus etamsylate (ETM) in reducing postoperative ecchymosis in upper blepharoplasty. Introduction: With an increase in demand for shortened recoveries after facial aesthetic surgery, various optional approaches have been sought out. In terms of ecchymosis, TXA and ETM have been most commonly used. Method: A prospective, intrapatient split face study was conducted from January 2020 to January 2021 in 40 patients who underwent upper blepharoplasty under local anesthesia. Two equal anesthetic solutions were prepared; Solution A contained TXA and solution B contained ETM. Solution A was injected in the right eyelid and solution B in the left eyelid. Postoperative ecchymosis was assessed by 2 blinded evaluators, the assisting surgeon (Observer 1) and an external surgeon (Observer 2) at 48 h and on the seventh day using a scale published by Sagiv et al. Results: Postoperative ecchymosis was found to be less at 48 h by both observers with TXA solution. Moreover, at the seventh day, no ecchymosis was found in 32.5% with TXA solution compared to 2.5% with ETM solution. Kappa analysis showed concordance between observers. Conclusion: In our study, TXA solution was a more effective therapy when compared to ETM solution for reducing ecchymosis. Larger case studies are required to prove the difference for validation.

Objectives This study aims to investigate the incidence and risk factors for blood transfusion in patients undergoing simultaneous bilateral total hip arthroplasty (SimBTHA). Patients and methods Between January 2011 and June 2021, a total of 341 patients (289 males, 52 females; median age: 53 years; range, 43 to 66 years) who underwent SimBTHA were retrospectively analyzed. The patients were divided into two groups as those who did and did not require allogeneic blood transfusion. Univariate and multivariate logistic regression models were used to identify independent risk factors for transfusion. Results The incidence of transfusion in SimBTHA was 12.9%. We found that a higher preoperative hemoglobin level (odds ratio [OR]: 0.91; 95% confidence interval [CI]: 0.86-0.96), tranexamic acid (TXA) use (OR: 0.25; 95% CI: 0.09-0.58), and intraoperative autologous blood transfusion from a closed suction drainage system (OR: 0.30; 95% CI: 0.09-0.80) were protective against the need for transfusion in patients after SimBTHA. In addition, drainage use (OR: 3.52; 95% CI: 1.49-8.32) and intraoperative blood loss (OR: 1.17; 95% CI: 1.04-1.33) were the independent risk factors for blood transfusion. Conclusion The risk factors for transfusion after SimBTHA should be evaluated to establish specific, personalized transfusion risk assessments for each individual patient. For SimBTHA, the main risk factors include intraoperative bleeding and the use of drainage tube, while higher preoperative hemoglobin levels, TXA use, and autologous blood transfusion from a closed suction drainage system may reduce transfusion risk.

This study aims to determine the effectiveness of using oral tranexamic acid in melasma patients, as well as to explain the definition of melasma, melasma epidemiology, melasma etiopathogenesis, and to explain the effectiveness of using oral tranexamic acid in melasma. The method used was to collect and analyze research articles on the effectiveness of the use of oral tranexamic acid topical drugs in Melasma patients. The articles are obtained through a search using Google Scholar, Pubmed. The term melasma comes from the Greek word "melas" which means black. Clinically melasma appears as macules or brown spots. Complaints of melasma usually occur symmetrically. The areas of melasma predilection are most commonly the cheeks, upper lip, chin and forehead, but can also be affected in other areas. (Debabrata, Handel et al., 2014). Research conducted for 6 months by Sufan et al ,. It is known that after therapy using Tranexamic Acid, there was a decrease in hyperpigmentation. After 6 months of treatment, the results were very good (10.8%, 8/74), good (54%, 40/74), moderate (31.1%, 23/74), and bad (4.1%). , 3/74). There were 4 patients (5.4%) who experienced mild gastrointestinal discomfort, 6 patients (8.1%) hypomenorrhea, subjects who rarely reported skin rash due to allergies as well as dizziness, alopecia, drowsiness and hyposexuality. From these results it is concluded that oral Tranexmatic Acid has good effectiveness in melasma therapy. (Sufan et al., 2012). From the results of this study it can be concluded that Tranexamic Acid has good effectiveness in the therapy of melasma. Where there are several risk factors that cause melasma, which can occur due to genetic factors, UV exposure, hormonal factors and inflammatory factors. Tranexamic acid will inhibit the action of tyrosinase activity by blocking the interaction of melanocytes and keratinocytes through inhibition of the plasminogen system. Keywords: Melasma, treatment for melasma, epidemiologi, etiologi, tranexamic acid,.

Introduction: Tranexamic acid (TXA) is a common adjunct to assist in hemostasis in a wide variety of applications. Although TXA has gained more popularity in facial cosmetic surgery, there are limited studies evaluating the effects of TXA in rhytidectomy patients, especially when used in tumescent solution. Purpose: The purpose of this study was to evaluate the effects of TXA on surgical time, postoperative ecchymosis, and need for aspiration when used in tumescent solution during cervicofacial rhytidectomy procedures. Materials and Methods: The authors designed a retrospective cohort study from an eligible population of all patients treated with cervicofacial rhytidectomy using tumescent solution at Williamson Cosmetic Center in Baton Rouge, LA, from January 1, 2019, to December 31, 2019. The outcome variables were surgical time, need for postoperative aspiration, and the duration of bruising postoperatively. The primary predictor variable was the use of TXA in the tumescent solution. Statistical analysis was performed using t tests and chi-square analyses. Results: Overall, 70 patients were included in the study with a mean age of 61.4 ± 7.2 years and 90% were female. Forty-five patients were in the TXA group and 25 in the non-TXA group. The use of TXA in tumescent solution was statistically significant for reducing ecchymosis ( p < .001). The majority of patients in the TXA group (60%) had bruising cleared by day 7, whereas the majority of patients in the non-TXA group (52%) had bruising cleared by day 28. There was a statically significant reduction in frequency of postoperative aspiration in the TXA group (8.9% in TXA group vs 40.0% in the non-TXA group, P = .002). The study did not demonstrate a significant difference in surgical time between the two groups. Discussion: Although there is a lack of recognition of the potential benefits of TXA, there has been an increased off-label use by numerous surgical specialties. Routes of administration include topical, oral, intravenous, local infiltrative, and by tumescent anesthesia. Improvements in intraoperative hemostasis and postoperative ecchymosis are some of the main benefits of TXA. Conclusions: Utilizing TXA in tumescent solution in patients undergoing cervicofacial rhytidectomy procedures is associated with an improvement in postoperative ecchymosis duration and a decreased need for postoperative aspiration compared with the non-TXA group.

Perioperative bleeding poses a major risk during liver surgery, which can result in increased transfusion requirements, morbidity, and mortality. Tranexamic acid (TXA) effectively reduces perioperative bleeding and transfusion requirements in trauma patients. However, there remains a lack of evidence of its use in liver surgery. This meta-analysis of randomised controlled trials evaluated the efficacy and safety of TXA in liver resection and transplantation. A comprehensive search of Medline, Embase, CENTRAL and Clinicaltrials.gov databases was undertaken to identify studies from January 1947 to September 2021. The outcomes of the need for blood transfusion, thromboembolic events and mortality were extracted from the included studies. Quantitative pooling of data was based on the random effects model. Six studies reporting on 429 patients were included. TXA reduced the need for perioperative blood transfusion in liver resection and transplantation (OR 0.09; 95% CI 0.01 to 0.72). More importantly, TXA did not increase the incidence of thromboembolic events (OR 2.22; 95% CI 0.47 to 10.43) and mortality (OR 0.60; 95% CI 0.13 to 2.76). TXA safely reduces the need for blood transfusion in patients undergoing liver resection and transplantation.

Background The relationship between late clinical outcomes after injury and early dynamic changes between fibrinolytic states is not fully understood. The authors hypothesized that temporal transitions in fibrinolysis states using rotational thromboelastometry (ROTEM) would aid stratification of adverse late clinical outcomes and improve understanding of how tranexamic acid modulates the fibrinolytic response and impacts mortality. Methods The authors conducted a secondary analysis of previously collected data from trauma patients enrolled into an ongoing prospective cohort study (International Standard Randomised Controlled Trial Number [ISRCTN] 12962642) at a major trauma center in the United Kingdom. ROTEM was performed on admission and at 24 h with patients retrospectively grouped into three fibrinolysis categories: tissue factor–activated ROTEM maximum lysis of less than 5% (low); tissue factor–activated ROTEM maximum lysis of 5 to 15% (normal); or tissue factor–activated ROTEM maximum lysis of more than 15% (high). Primary outcomes were multiorgan dysfunction syndrome and 28-day mortality. Results Seven-hundred thirty-one patients were included: 299 (41%) were treated with tranexamic acid and 432 (59%) were untreated. Two different cohorts with low-maximum lysis at 24 h were identified: (1) severe brain injury and (2) admission shock and hemorrhage. Multiple organ dysfunction syndrome was greatest in those with low-maximum lysis on admission and at 24 h, and late mortality was four times higher than in patients who remained normal during the first 24 h (7 of 42 [17%] vs. 9 of 223 [4%]; P = 0.029). Patients that transitioned to or remained in low-maximum lysis had increased odds of organ dysfunction (5.43 [95% CI, 1.43 to 20.61] and 4.85 [95% CI, 1.83 to 12.83], respectively). Tranexamic acid abolished ROTEM hyperfibrinolysis (high) on admission, increased the frequency of persistent low-maximum lysis (67 of 195 [34%]) vs. 8 of 79 [10%]; P = 0.002), and was associated with reduced early mortality (28 of 195 [14%] vs. 23 of 79 [29%]; P = 0.015). No increase in late deaths, regardless of fibrinolysis transition patterns, was observed. Conclusions Adverse late outcomes are more closely related to 24-h maximum lysis, irrespective of admission levels. Tranexamic acid alters early fibrinolysis transition patterns, but late mortality in patients with low-maximum lysis at 24 h is not increased. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

OBJECTIVES In this study, we aimed to investigate the effect of tranexamic acid (TXA) on osteotendinous junction healing in a rat model, both biomechanically and histologically. MATERIALS AND METHODS Sixty-four male Wistar-Albino rats weighing 450 to 600 g were used in this study. The rats were divided into two groups as the experimental (n=16) and control (n=16) groups. Achillotomy and subsequent repair site was exposed to 1 mL of TXA in the experimental group, while 1 mL of saline was given to the control group. For biomechanical and histopathological investigation, each group was further divided into two subgroups. At the end of four weeks, all rats were sacrificed. Biomechanical tests were performed using the M500-50CT device. The Bonar, Movin, and Nourissat bone-tendon junction scoring systems were used for histopathological evaluation. RESULTS There was no statistically significant difference in the elongation at a maximum point, maximum loading, and maximum stress variables in the biomechanical study (p=0.558 p=0.775, and p=0.558, respectively). In the histopathological evaluation, the collagen content and layout were close to the native tissue in the experimental group (p=0.047 and p=0.008, respectively). Vascularity, hyalinization, and glycosaminoglycan content were significantly lower in the experimental group (p=0.004, p=0.014, and p=0.026, respectively). The total Bonar and Movin scores were more favorable in the experimental group (p

Background: Tranexamic acid has been reported to benefit the treatment of postinflammatory hyperpigmentation (PIH). Laser-assisted drug delivery (LADD) could facilitate the efficacy of topically ap...

The use of tranexamic acid (TXA) in hip fracture surgery remains inconclusive. The aim of the present meta-analysis was to assess the role of TXA use in hip fracture surgery, and attempt to disclose possible factors which might influence TXA efficacy and safety. A systematic computerized literature search was conducted to retrieve all randomized controlled trials (RCTs) and cohort studies regarding TXA use in hip fracture surgery. Overall efficacy and safety were evaluated. Then, subgroup and meta-regression analyses were conducted to disclose the influence of geographic area, fracture type, administration route, frequency and dosage of TXA, blood transfusion threshold, and follow-up duration on the overall effect. Thirty-four RCTs and 11 cohort studies were included. Patients receiving TXA had a significant decrease in the need for blood transfusion, reduced total, intra-operative and post-operative blood loss, a decrease in pre- and postoperative hemoglobin difference, without increasing thromboembolic events risk. Subgroup analysis showed that topical TXA had a lower transfusion rate compared with controls, yet the result did not reach statistical significance. Also, TXA had similar efficacy and safety profiles in patients with different frequency and dosage of TXA. Current evidence indicated that intravenous administration of TXA could significantly reduce blood transfusion and blood loss without increasing risk of thromboembolic events. The frequency and dosage of TXA might not alter the beneficial effect. The application of topical TXA should be cautious.

Purpose Tourniquets are routinely used in high tibial osteotomy (HTO). However, research on the necessity of tourniquets during HTO is lacking. This study was designed to investigate the necessity of tourniquets in HTO. Methods This was a prospective study that included patients who underwent HTO at the same hospital. The patients were randomised into Group A (non-tourniquet, n = 45) and Group B (tourniquet, n = 45). Same surgical techniques and haemostatic methods were used in the two groups. Results All patients were followed up for more than three months. There was no difference in operation time, and no intra-operative vascular or nerve damage occurred in either group. The hospital stay was shorter in group A than in group B (p 0.05). The post-operative visual analogue scale (VAS) pain scores and calf swelling were lower in group A (p 0.05). Conclusion Tourniquet use during HTO does not reduce post-operative blood loss, operation time or intra-operative complications, but not using a tourniquet shortens the hospital stay and reduces the post-operative usage of morphine and tourniquet-related complications, which promotes early recovery of knee function.

Background: The objective of this study was to evaluate the effectiveness and safety of tranexamic acid mesotherapy in the treatment of melasma in the Moroccan population. Materials and Methods: All the patients received an intradermal injection of tranexamic acid (5 mg/mL). No other local or general treatment was administered. The patients were kept under external photoprotection only. Pre- and post-treatment photographs were taken and analyzed with the Visioface® RD hardware. The evaluation was employed the MASI score. Results: All patients had a dark skin phototype. The average duration of melasma evolution was 3.67 years. The pre-treatment average MASI was 7.6. The post-therapeutic average MASI was 6. The Visioface® RD hardware estimated a 25% reduction in the surface area attained at month five. No serious side effects were reported. Conclusion: Tranexamic acid was proven to be an essential tool in treating melasma.

OBJECTIVES To assess the impact of antifibrinolytics in children with life-threatening hemorrhage. DESIGN Secondary analysis of the MAssive Transfusion epidemiology and outcomes In Children study dataset, a prospective observational study of children with life-threatening bleeding events. SETTING Twenty-four children's hospitals in the United States, Canada, and Italy. PATIENTS Children 0-17 years old who received greater than 40 mL/kg of total blood products over 6 hours or were transfused under activation of massive transfusion protocol. INTERVENTION/EXPOSURE Children were compared according to receipt of antifibrinolytic medication (tranexamic acid or aminocaproic acid) during the bleeding event. MEASURES AND MAIN RESULTS Patient characteristics, medications administered, and clinical outcomes were analyzed using Cox proportional hazard and Kaplan-Meier survival analysis. The primary outcome was 24-hour mortality. Of 449 patients analyzed, median age was 7 years (2-15 yr), and 55% were male. The etiology of bleeding was 46% traumatic, 34% operative, and 20% medical. Twelve percent received antifibrinolytic medication during the bleeding event (n = 54 unique subjects; n = 18 epsilon aminocaproic acid, n = 35 tranexamic acid, and n = 1 both). The antifibrinolytic group was comparable with the nonantifibrinolytic group on baseline demographic and physiologic parameters; the antifibrinolytic group had longer massive transfusion protocol duration, received greater volume blood products, and received factor VII more frequently. In the antifibrinolytic group, there was significantly less 6-hour mortality overall (6% vs 17%; p = 0.04) and less 6-hour mortality due to hemorrhage (4% vs 14%; p = 0.04). After adjusting for age, bleeding etiology, Pediatric Risk of Mortality score, and plasma deficit, the antifibrinolytic group had decreased mortality at 6- and 24-hour postbleed (adjusted odds ratio, 0.29 [95% CI, 0.09-0.93]; p = 0.04 and adjusted odds ratio, 0.45 [95% CI, 0.21-0.98]; p = 0.04, respectively). CONCLUSIONS Administration of antifibrinolytic medications during the life-threatening event was independently associated with improved 6- and 24-hour survivals in bleeding children. Consideration should be given to use of antifibrinolytics in pediatric patients with life-threatening hemorrhage.

OBJECTIVE We conducted a meta-analysis of all randomized controlled trials (RCTs) that examined the benefits of tranexamic acid (TXA) among cancer patients undergoing head and neck (HN 265 and 275 patients were assigned to the TXA and control group, respectively. Overall, the included RCTs revealed a low risk of bias. The volume of postoperative bleeding was significantly lower in favor of the TXA group compared with the control group (n = 7 RCTs, WMD = - 51.33 ml, 95% CI [- 101.47 to - 1.2], p = 0.04). However, no significant difference was found between both groups regarding the volume of intraoperative bleeding (n = 6 RCTs, WMD = - 3.48 ml, 95% CI [- 17.11 to 10.15], p = 0.62), postoperative hemoglobin (n = 3 RCTs, WMD = 0.42 mg/dl, 95% CI [- 0.27 to 1.11], p = 0.23), duration of drainage tube removal (n = 4 RCTs, MD = - 0.41 days, 95% CI [- 1.14 to 0.32], p = 0.27), and operation time (n = 6 RCTs, WMD = 1.59 min, 95% CI [- 10.09 to 13.27], p = 0.79). TXA was safe and did not culminate in thromboembolic events or major coagulation derangements. CONCLUSION TXA administration is safe and significantly reduces the volume of postoperative bleeding. However, no difference is identified between TXA and control groups regarding the volume of intraoperative bleeding, postoperative hemoglobin level, duration of drainage tube removal, and operation time.

To report surgical outcomes in patients treated with conversion total hip arthroplasty (CTHA) for early failure of cephalomedullary nails (CMNs). A retrospective review was conducted of CTHA for treatment of failed CMN within 1 year of initial surgery for intertrochanteric (IT) hip fractures. The cohort was matched 1:5 to patients who underwent elective primary THA (PTHA). Patient demographics, mechanism of CMN failure, surgical outcomes, and complication rates were assessed. 22 patients met criteria with a mean time to failure of 145 days. Modes of failure included: lag screw cut-out with superior migration (9, 40.9%), or medialization (8, 36.4%), and aseptic nonunion with implant failure (2, 9.0%) and without implant failure (3, 13.6%). Fourteen of the patients (63.6%) had acetabular-sided damage secondary to lag screw penetration, all in the screw cut-out groups. Patient demographics were similar between cohorts. Compared to PTHA, CTHA patients had increased operative time, blood loss, LOS, and readmission rates. After IMN failure, the operative leg was shorter than the contralateral leg in all cases. CTHA restored leg lengths to

INTRODUCTION Treatment of melasma is challenging. Topical TA has shown promising results as an adjuvant, when combined with microneedling or QS Nd:YAG laser. The efficacy of both combinations has been demonstrated but the efficacy between these two combinations has never been compared. AIM AND OBJECTIVES To compare the efficacy and side effects of microneedling and QS Nd:YAG laser when combined with topical 3% TA gel. MATERIALS AND METHODS 60 patients were randomized into 2 groups. Group A received Nd:YAG laser sessions monthly with daily 3% TA gel while Group B underwent microneedling monthly with daily 3% TA gel. A total of 5 sessions were given with follow-up after 2 months. Evaluation using modified Melasma Area and Severity Index (mMASI), Patient satisfaction score, and photography was done at baseline, 3rd session, 5th session, and final follow-up. RESULTS Mean fall in mMASI at follow-up in Group A was 5.12 ± 2.66 to 2.33 ± 1.33 and Group B was 4.60 ± 2.38 to 1.88 ± 1.08 (p

Article, Blood Advances. 5(19): 3830-3838 (2021)

The utility of tranexamic acid (TXA) in patients with Marfan syndrome (MFS) is uncertain given associated aberrations within the vasculature and clotting cascade. Therefore, this study aimed to assess the association of TXA use with intraoperative blood loss and allogeneic blood transfusions in patients with MFS who underwent spinal arthrodesis. We queried our institutional database for MFS patients who underwent spinal arthrodesis for scoliosis between 2000 and 2020 by one surgeon. We excluded procedures spanning

Tranexamic acid (TXA) is an anti-fibrinolytic agent which has been proven beneficial in multiple surgical specialties where significant bleeding can occur. Whilst it has been widely available for over 40 years its use within Otorhinolaryngology is still limited. Operations in Otorhinolaryngology are particularly varied with some such as tonsillectomy having the potential for significant life threatening bleeding. Other operations are performed within small confined surgical fields and even small amounts of bleeding can significantly detriment surgical field and increase technical difficulty and operative time. This review evaluated the current literature on the benefits of tranexamic acid within the field of Otorhinolaryngology and Head and Neck Surgery. Overall TXA was demonstrated to be a safe drug with no major adverse effects including thromboembolic events reported in any study. It has been shown to be of particular benefit in rhinology by improving surgical field, reducing operative time and reducing postoperative swelling and ecchymosis. The benefit in tonsillectomy is less clear and further studies are required to evaluate its potential use in the reduction of post tonsillectomy haemorrhage rates.

Tranexamic acid (TXA) is a lysine analog that exhibits an anti-fibrinolytic effect by directly preventing the activation of plasminogen as well as inhibiting activated plasmin from degrading fibrin clots, thereby promoting hemostasis and reducing the duration and quantity of blood loss. The aims of this study were to summarize the indications, routes of administration, safety, and clinical outcomes of TXA use throughout the different subspecialities in orthopedic surgery. Given that orthopedic procedures such as TKA, THA, fracture fixation, and various spine surgeries involve significant intraoperative blood loss, TXA is indicated in providing effective perioperative hemostasis. Additionally, use of TXA in orthopedic trauma has been indicated as a measure to reduce blood loss especially in a group with potential for hemodynamic compromise. TXA has been implicated in reducing the risk of blood transfusions in orthopedic trauma, joint surgery, and spine surgery, although this effect is not seen as prominently in sports medicine procedures. There remains disagreement in literature as to whether TXA via any route of administration can improve other clinically significant outcomes such as hospital length of stay and total operative time. Procedures that rely extensively on clarity on visualization of the surgical field such as knee and shoulder arthroscopies can greatly benefit from the use of TXA, thereby leading to less intraoperative bleeding, with better visual clarity of the surgical field. While most studies agree thrombosis due to TXA is unlikely, new research in cells and animal models are evaluating whether TXA can negatively impact other aspects of musculoskeletal physiology, however with conflicting results thus far. As of now, TXA remains a safe and effective means of promoting hemostasis and reducing intraoperative blood loss in orthopedic surgery.

An increasing number of studies have investigated the effect of various methods in avoiding complications in rhinoplasty. Our study aims to analyze the connections between various choices in rhinoplasty and the rate of multiple complications by summarizing results in related meta-analyses. Through Pubmed, MEDLINE, Embase, and the Cochrane Database were associated systematic reviews searched to gather and review the available evidence of different plans and health outcomes in rhinoplasty for this umbrella review. The study included 14 systematic reviews with 128 meta-analyses of randomized clinical trials. Edema and ecchymosis were the two most investigated outcomes. The implementations of steroid, tranexamic acid, periosteal preservation, external approach in lateral osteotomy, and piezoelectric osteotomy were linked with significantly lower incidence of several complications. Multiple administration of steroids was found to be associated with fewer complications in a prolonged time. With summarized evidence of complications related to rhinoplasty, this research can help surgeons to avert patients from suffering complications and optimize cosmetic outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Blood loss is a potential cause of morbidity and mortality in craniosynostosis surgery. Recent reports have suggested that the use of tranexamic acid (TXA), an antifibrinolytic agent, mitigates this blood loss. A retrospective cohort study of patients undergoing craniosynostosis surgery at a tertiary craniofacial hospital in Sydney was undertaken. Primary outcomes were blood loss and transfusion requirements. Two groups were compared: those who received intravenous prophylactic TXA and those who underwent surgery without TXA. Statistical analysis was performed with Student t test and the Mann-Whitney U test for nonparametric results. We identified 206 patients who underwent craniosynostosis surgery over an 8 year period; 78 control patients and 128 patients that received TXA. Tranexamic acid was found to result in a weight-adjusted calculated blood loss mean difference of 9.6 ml/kg across all procedures (P = 0.0332 95% confidence interval 0.7734-18.4266). The actual blood loss reduction achieved with TXA was 6.7 ml/kg in spring cranioplasties, compared to 15.2 ml/kg in fronto-orbital remodeling procedures. There was a statistically and clinically significant reduction in postoperative transfusion incidence, with transfusions required in 27% of controls and 6% of TXA patients (P

Blood loss is a potential cause of morbidity and mortality in craniosynostosis surgery. Recent reports have suggested that the use of tranexamic acid (TXA), an antifibrinolytic agent, mitigates this blood loss. A comprehensive systematic review and subsequent meta-analysis was undertaken, with the view to clarify the effectiveness of TXA in reducing blood loss and transfusion requirements in craniosynostosis surgery. Medline and PubMed databases were searched using the preferred reporting items for systematic reviews and meta-analyses technique, and 7003 articles were assessed based on predefined selection criteria. Seven trials were identified, of which 2 were randomized controlled trials and the remainder retrospective cohort studies. All trials were assessed using the Jadad and strengthening the reporting of observational studies in epidemiology scores. The meta-analysis found a clear statistical reduction in blood loss in those patients who received TXA perioperatively, with a combined blood loss reduction of 7.06 ml/kg (95% confidence interval -8.97 to -5.15, P

OBJECTIVE To evaluate the effects of administering tranexamic acid (TXA) after cardiopulmonary bypass, instead of after anesthesia induction, on postoperative seizures and blood transfusion requirements. METHODS Adult patients who underwent valve surgery and/or coronary artery bypass grafting at West China Hospital between July 1, 2011 and December 31, 2016 were retrospectively analyzed. Patients either received TXA after bypass (n = 2062) or not (n = 4236). Logistic regression and propensity score matching analysis were performed to assess effects of TXA on postoperative seizures and blood product requirements in hospital. RESULTS Among 6298 patients, seizures occurred in 2.4% (102/4236) in the no-TXA group and 2.7% (56/2062) in the TXA group (P = 0.46). The number of patients receiving any blood products was greater in the no-TXA group (57.3%, 2428/4236) than in the TXA group (53.1%, 1095/2062) (P

Melasma merupakan kelainan hipermelanosis didapat yang timbul khas pada area kulit yang sering terpapar sinar matahari. Terapi melasma relatif sulit karena sering timbul kronisitas pada melasma. Hingga saat ini terapi dengan formula Kligman masih menjadi pilihan, namun formula Kligman mempunyai beberapa efek samping terutama untuk pemakaian jangka lama. Cysteamine bekerja dengan menghambat enzim tirosinase. Asam traneksamat bekerja dengan menghambat aktivitas plasmin di keratinosit yang diketahui sebagai stimulator aktivitas tirosinase Tujuan penelitian membuktikan dan menganalisa efektivitas terapi layering krim cysteamine 5% dan asam traneksamat 3% dibandingkan formula Kligman modifikasi pada penderita melasma terhadap perbaikan skor MASI. Metode penelitian eksperimental, pre and post control grup design double-blind randomized controlled trial dengan 28 sampel pasien melasma yaitu kelompok A menggunakan layering krim cysteamine 5% dan asam traneksamat 3% dibandingkan dengan kelompok B menggunakan formula Kligman modifikasi (hidrokuinon 4%, tretinoin 0,05% dan fluocinolone acetonide 0,01%). Penilaian dan pengukuran efektivitas terapi dilakukan saat minggu ke-0, 2, 4 dan 8, dengan penilaian skor MASI. Analisis yang digunakan adalah uji t-berpasangan dan uji Wilcoxon. Uji statistik dianggap bermakna jika p

This review article examines evidence supporting the use of oral therapies in treating idiopathic, actinic, and metabolically induced skin hyperpigmentation. A thorough review of the literature regarding oral treatments for hyperpigmentation was systematically conducted through PubMed. Keywords used in the primary search include “Hyperpigmentation,” “Melanosis” or “Melasma,” “Lightening,” “Oral,” and “Therapeutics.” The search was limited to the English language, and no timeframe restrictions were implemented. Numerous orally administered therapies have been proposed for the treatment of skin hyperpigmentation. There is an abundant body of literature demonstrating the efficacy of orally administered tranexamic acid, glutathione, isotretinoin, and proanthocyanidin. It is reasonable to expect that the most effective oral therapies will address known underlying causes of hyperpigmentation such as thyroid disease, diabetes, and hormonal imbalance. Improvement due to oral therapy of otherwise unresponsive skin hyperpigmentation or hyperpigmentation of unknown cause is less predictable. This review is limited by the strength of evidence contained within the available studies. Clinical studies investigating the treatments discussed within this article are limited in number, at times lack blinding in the study design, and are based on small sample sizes. Based on existing research, the most promising oral remedies for hyperpigmentation appear to be tranexamic acid, glutathione, isotretinoin, and proanthocyanidin. Additional studies to better establish safety and efficacy are necessary.

The article confirms the significance of the time interval of at least 18 hours between the hemostatic and anticoagulant therapy, which is of particular importance when tranexamic acid is used. An analysis of the thrombohemorrhagic complications developed in the early postoperative period after arthroplasty of large joints of the lower extremities was carried out. In addition, the most significant coagulation parameters were determined, whose deviation from the norm before surgery increased the risk of thrombosis and bleeding after joint replacement among male and female patients.

Background: Melasma is a common acquired hypermelanosis characterized by irregular light to dark brown macules and patches seen mainly in women and over sun-exposed skin on the face. We have undertaken this RCT to compare the efficacy between oral Tranexamic acid and Topical Triple combination as Tranexamic acid is having good safety profile. Objectives: To compare the therapeutic efficacy of oral Tranexamic acid versus Topical Triple combination for the treatment of Melasma using MASI score. To compare the adverse effects profile of each treatment modality. Materials and Methods: Total subjects (66 patients) were divided into 2 groups (A and B, each with 33 patients) by simple randomization method.Patients and analysers were blinded to treatments. Group- A received topical triple combination cream once daily (15-minutes) at night for 8 weeks followed by maintenance regimen of biweekly application of product for 4 weeks and oral placebo tablets (calcium gluconate 250mg) twice daily for 12 weeks. Group-B received oral Tranexamic acid tablets 250mg twice daily for 12 weeks with topical placebo cream (Moisturizer) once daily at night for 8 weeks followed by maintenance regimen of biweekly application of product for 4 weeks. MASI score was assessed at baseline and monthly follow-up visits along with simultaneous serial digital photographs, with the recording of side effects. Results: Both groups showed significant decrease in MASI score in each followup visits without any statistically significant difference. Conclusion: In epidermal melasma topical triple combination is preferred over oral tranexamic acid. In dermal and mixed variety oral tranexamic acid is better. Keywords: Melasma, Tranexamic Acid, Triple Combination

Gastric antral vascular ectasia (GAVE) is an uncommon clinical entity leading to recurrent gastrointestinal bleeding. There is no consensus regarding treatment of GAVE. Endoscopic therapy is the preferred treatment option, but has a fairly high recurrence rate. Surgical resection can completely resolve GAVE, but is invasive with a relatively high risk of postoperative complications. Recently, the role of pharmacotherapy for GAVE has been recognized. However, the evidence is limited to scattered case reports or small case series. This review comprehensively summarizes the efficacy and side effects of drugs commonly used for the treatment of GAVE, including octreotide, cyproheptadine, cyclophosphamide, prednisolone, estrogen-progesterone, thalidomide, bevacizumab, and tranexamic acid.

Periprosthetic joint infections (PJIs) represent a devastating consequence of total joint arthroplasty. The European Knee Associates (EKA), the American Association of Hip and Knee Surgeons (AAHKS) International Committee, and the Arthroplasty Society in Asia (ASIA) board members were interested in quantifying differences in arthroplasty surgeons’ use of various PJI prevention measures to provide clinical recommendations to reduce PJI incidence. A prospective Microsoft Forms online survey was distributed among EKA, AAHKS International Committee, and ASIA members and their affiliated arthroplasty surgeons. The survey consisted of 20 single and multiple response questions focused on PJI prevention strategies at three perioperative periods: preoperatively, intraoperatively, and postoperatively. Three hundred and ninety-four arthroplasty surgeons from 6 different continents completed the survey. Preoperative: (A) PJI Risk Stratification: 40.6% routinely set thresholds (e.g., BMI, HgbA1C) to be met to qualify for surgery, 36.5% only review past medical history; 9.1% use machine learning to personalize PJI risk; (B) BMI limit: 36% no limit; 15.4% BMI

Background Recent evidence suggests tranexamic acid (TXA) may improve outcomes in aesthetic surgery patients. Objectives This systematic review aimed to investigate the impact of TXA use in aesthetic plastic surgery on bleeding and aesthetic outcomes. Methods A systematic literature search was conducted to identify studies evaluating TXA use in aesthetic plastic surgery. The primary outcome of interest was perioperative bleeding, reported as total blood loss (TBL), ecchymosis, and hematoma formation. Meta-analyses analyzing TBL and postoperative hematoma were performed. Results Of 287 identified articles, 14 studies evaluating TXA use in rhinoplasty (6), rhytidectomy (3), liposuction (3), reduction mammaplasty (1), and blepharoplasty (1) were included for analysis. Of 820 total patients, 446 (54.4%) received TXA. Meta-analysis demonstrated TXA is associated with 26.3 mL average blood loss reduction (95% CI, –40.0 to –12.7 mL; P Conclusions TXA is associated with decreased blood loss and a trend toward decreased hematoma formation in aesthetic plastic surgery. Its use has the potential to increase patient satisfaction with postoperative recovery and decrease costs associated with complications, including hematoma evacuation. Level of Evidence: 4

Aim: To compare the efficacy and safety of topical 3% tranexamic acid gel vs 35% glycolic acid peel in the treatment of melasma over face. Materials and Methods: This is an open labelled, Randomised Controlled Trial(RCT) conducted on 60 patients. Patients were randomly divided equally into 2 groups – Group A and Group B. Patients of Group A used topical 3% tranexamic acid gel twice a day and Group B patients were treated with 35% glycolic acid peel with a contact period of 5 minutes once in every 2 weeks. Patients were assessed every month for a period of 3 months and recurrence was assessed for the next consecutive 3 months following the treatment. Patients were asked to use a broad spectrum sunscreen before sun exposure during the entire study. Assessment of reduction in pigmentation was made by MASI score, subjective and objective valuation (blind observer) and photographic comparison. Safety profile was assessed by the side effects. Results: The mean value of Melasma Area and Severity Index(MASI) score for glycolic acid group at baseline was 14.41 which reduced to 7.05 at end of 3rd month. In tranexamic acid group, the mean value of MASI score at baseline was 14.58 which reduced to 5.96 at the end of 3rd month. The mean percentage of improvement in MASI score in glycolic acid group 52% whereas in tranexamic acid group it is 61%. The side effects were minimal in this study. Side effects were more in glycolic acid group than tranexamic acid group. A total of 8 patients had recurrence during follow up. In glycolic acid group, 5 patients had recurrence whereas in tranexamic acid group, only 3 patients had recurrence. The percentage of recurrence in glycolic acid group is 16.7 % whereas in glycolic acid group it is 10.7%. Conclusion: Tranexamic acid is a novel emerging therapy for melasma. In this study it has been found that topical 3% tranexamic acid is equally efficacious as 35% glycolic acid peel with minimal side effects in the treatment of melasma.

There are no published data on Australian adult cystic fibrosis (CF) patient outcomes post bronchial arterial embolisation (BAE). We report 20 years of experience of BAE at a major Australian tertiary adult CF centre, where 46 patients underwent 100 BAE during this period. Mortality rate was comparable to previous studies (4% per year) and most who died had repeat BAE requirements. A higher proportion (9 out of 45) of patients were transplanted compared to previous publications. Repeat BAE was common and significantly higher in patients already on tranexamic acid.

Given the dramatic increase in critically ill patients who present to the emergency department for care, along with the persistence of boarding of critically ill patients, it is imperative for the emergency physician to be knowledgeable about recent developments in resuscitation and critical care medicine. This review summarizes important articles published in 2020 that pertain to the resuscitation and care of select critically ill patients. These articles have been selected based on the authors annual review of key critical care, emergency medicine and medicine journals and their opinion of the importance of study findings as it pertains to the care of critically ill ED patients. Several key findings from the studies discussed in this paper include the administration of dexamethasone to patients with COVID-19 infection who require mechanical ventilation or supplemental oxygen, the use of lower levels of positive end-expiratory pressure for patients without acute respiratory distress syndrome, and early initiation of extracorporeal membrane oxygenation for out-of-hospital cardiac arrest patients with refractory ventricular fibrillation if resources are available. Furthermore, the emergency physician should not administer tranexamic acid to patients with acute gastrointestinal bleeding or administer the combination of vitamin C, thiamine, and hydrocortisone for patients with septic shock. Finally, the emergency physician should titrate vasopressor medications to more closely match a patient's chronic perfusion pressure rather than target a mean arterial blood pressure of 65 mmHg for all critically ill patients.

Background Tranexamic acid (TXA) has shown significant reductions in blood loss and transfusion rates in total knee arthroplasty (TKA). However, the optimal administration route continues to be debated. The aim of this trial was to compare the effectiveness of intravenous (IV) versus peri-articular injection (PAI) application of tranexamic acid in patients undergoing total knee arthroplasty. Methods We conducted a randomized controlled, double-blinded study. A total of 93 patients undergoing primary unilateral TKA were randomly distributed between 2 groups: the IV group (47 cases; 1 g TXA IV) and the PAI group (46 cases; 1 g TXA injected peri-articularly). The amount of total and hidden blood loss (HBL), drainage, transfusion rate, hemoglobin and hematocrit drift, and complications were recorded. Results Peri-articular injection of TXA reduced total blood loss (P < 0.001) and HBL more than IV use of TXA (P < 0.001). No patients in either group received a transfusion. No symptomatic deep venous thrombosis or other severe complications occurred. Conclusion Peri-articular injection of TXA significantly reduced total blood loss and hidden blood loss to a greater degree than IV injection in total knee arthroplasty without reduction of drainage volume. Trial registration Chinese Clinical Trial Registry, ChiCTR-INR-16010270. Date of registration: December 27, 2016.