Human ; Female ; Middle Aged ; Antifibrinolytic Agents ; Melanosis ; Orobanchaceae ; Tranexamic Acid

BACKGROUND: Substantial bleeding after cardiopulmonary bypass(CPB) complicates postoperative patients care. Recently, antifibrinolytic agents have been used as pharmacologic means of reducing blood loss and tranexamic acid(TA) has been known to have a great efficacy. However, the effective dose of TA is not well established and variable doses of TA have been tried. We compared the hemostatic effectiveness of three commonly recommended doses of TA in patients undergoing CPB. METHODS: With institutional review board approval, 80 patients undergoing valvular replacement were randomly divided into four groups; Group I(GI, n=19) was control group. In group II(GII, n=18) 10 mg/kg of TA was loaded and infused for 10 hours with a rate of 1 mg/kg/hr. In group III(GIII, n=22) 6 g of TA was loaded and 10 g of TA was loaded in group IV(GIV, n=21). Homologous blood was transfused when hematdegrees Crit was lower than 20% during CPB or lower than 25% after CPB. Amount of homologous transfusion(HT) and blood loss(BL) for 24 hours were measured. RESULTS: Ten patients were excluded due to reoperation, abnormal preoperative coagulation profile or incomplete records. There was no statistically significant difference in postoperative BL among 4 groups. However, the amounts of homologous transfusion were significantly lesser in GIII and GIV than in GI and GII. There was no specific complication. CONCLUSION: None of TA regimen did reduce the amount of postoperative BL. However the amount of HT was decreased in patients with loading larger dose of TA. Reduction of HT might be attributed to decrease in intraoperative BL which could not be measured. Therefore loading larger dose of TA may be more effective and convenient than loading and infusion of a small dose of TA.
Antifibrinolytic Agents ; Cardiopulmonary Bypass* ; Ethics Committees, Research ; Hemorrhage ; Humans ; Reoperation ; Tranexamic Acid*

BACKGROUND: Aprotinin and tranexamic acid are commonly used antifibrinolytics during liver transplantation, or cardiac surgery. However, it is not clear which drug is more effective to ameliorate the fibrinolysis. The aim of the study was to investigate the antifibrinolytic effect of both drugs at previously reported blood concentration and dose. METHODS: After inducing fibrinolysis by administering recombinant tissue plasminogen activator to rabbits, we checked the in vitro and in vivo antifibrinolytic effects at previously reported blood concentration and dose, and determined the minimum antifibrinolytic blood concentration. The previously reported blood concentration was 200 KIU/ml for aprotinin and 10 mcg/ml for tranexamic acid, and the previously reported dose was 4 mg/kg bolus plus 1 mg/kg/hr infusion for aprotinin and 10 mg/kg bolus plus 1 mg/kg/hr for tranexamic acid. RESULTS: In vitro experiment, there was effective antifibrinolytic action at previously reported blood concentration of aprotinin and the minimum antifibrinolytic blood concentration was 40 KIU/ml. For tranexamic acid, there was no antifibrinolytic action at previously reported blood concentration and the minimum antifibrinolytic blood concentration was 100 mcg/ml. In vivo experiment, there was antifibrinolytic action at previously reported dose of aprotinin and the minimum antifibrinolytic dose was 60% of previously reported dose. For tranexamic acid, there was no antifibrinolytic action at previously reported dose and the minimum antifibrinolytic dose was 10 times previously reported dose. CONCLUSION: The previously reported blood concentration and dose of aprotinin were greater and those of tranexamic acid were less than the minimum antifibrinolytic blood concentration and dose.
Antifibrinolytic Agents ; Aprotinin* ; Fibrinolysis ; Liver Transplantation ; Rabbits* ; Thoracic Surgery ; Tissue Plasminogen Activator ; Tranexamic Acid*

BACKGROUND: Tranexamic acid (TXA), a plasmin inhibitor, has been used orally or via intradermal injection to treat melasma; however, there are limited studies regarding efficacy and safety of topical application of TXA. OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of topical tranexamic acid in treatment of melasma. METHODS: We enrolled 25 female volunteers with melasma in a split-face trial lasting 10 weeks. Patients were instructed to apply cream containing tranexamic acid on only the right side of their face every night without application on the other side. The pigmentary index (PI) using API-100 and Melasma Area and Severity Index (MASI) were measured at 0, 5, and 10 weeks. Patient satisfaction questionnaires and safety evaluation by a dermatologist were performed at each follow-up visit. RESULTS: Twenty-five patients completed the study, and we noted reduction in both, mean MASI and PI scores. The mean MASI score was 7.75±5.10 at baseline, 6.72±4.25 at week 5, and 6.26±3.76 at week 10 p=0.008). The mean PI score on the right side of the face was 40.56±22.51 at baseline, 29.96±16.62 at week 5, and 26.88±15.97 at week 10. The PI on the right side of the face decreased by 26.1% (p<0.001) at week 5 and 33.7% (p<0.001) at week 10 compared to the baseline. Mean PI score on the unaffected side of the face was 40.56±22.60 at baseline, 37.48±17.79 at week 5, and 34.68±16.44 at week 10, although this reduction was not statistically significant (p=0.146). Only mild irritation occurred in two patients, no other serious adverse events were noted, and patients were generally satisfied with their results. CONCLUSION: Topical TXA can be considered a safe and effective option in the treatment of melasma.
Antifibrinolytic Agents ; Female ; Follow-Up Studies ; Humans ; Injections, Intradermal ; Melanosis* ; Patient Satisfaction ; Tranexamic Acid* ; Volunteers

Humans ; Tranexamic Acid ; Atrial Fibrillation ; Antifibrinolytic Agents ; Arthroplasty ; Blood Loss, Surgical ; Arthroplasty, Replacement, Hip

OBJECTS: To assess risk factors related to the occurrence of rebleeding in patients with aneurysmal subarachnoid hemorrhage (SAH) who had been planned to the early surgery, this study was conducted retrospectively. MATERIAL AND METHODS: During the period from January, 1993 to December, 1995, 258 patients with aneurysmal SAH who admitted within 3 days of their SAH and had been planned to early surgery were selected as study population. Ten variables including age, sex, hypertension history, rebleeding before admission, systolic blood pressure on admission, intracerebral or intraventricular hematoma, clinical grade, computed tomographic (CT) grade, admission time after SAH, hemostatic parameter were analyzed by the univariate and multivariate logistic regression method using the Statistical Analysis System (SAS). RESULTS: Of the 258 patients, 25 (9.69%) patients had rebleeding. Admission within 2 hours after SAH (p=0.001), clinical grade IV-V (p=0.015), rebleeding before admission (p=0.000), and intracerebral or intraventricular hematoma (p=0.04) appeared to be associated with a higher risk of rebleeding on the univariate analysis. Particularly, the patients who admitted to hospital within 2 hours after SAH and who are clinical grade IV or V appeared to be more likely to have early rebleeding. Rebleeding before admission was revealed as a independent factor associated with rebleeding on the multivariate logistic regression analysis. CONCLUSION: The short course use of antifibrinolytics, 3-dimensional CT angiography and endovascular surgery should be considered for the patients with aneurysmal SAH who have rebleeding history before admission, intracerebral or intraventricular hematoma, who admit to hospital within 2 hours after SAH, and who are clinical IV or V to minimize rebleeding in the interval between SAH attack and early surgery.
Aneurysm* ; Angiography ; Antifibrinolytic Agents ; Blood Pressure ; Hematoma ; Humans ; Hypertension ; Intracranial Aneurysm ; Logistic Models ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage*

Factor VII (FVII) deficiency is an infrequent hereditary bleeding disorder that can make excessive bleeding in surgical interventions, such as a postpartum hemorrhage in a cesarean section. Although a recombinant form of activated FVII has been applied for bleeding control in FVII-deficient patients, its applications in the field of obstetrics are still limited, especially in Korea. Replacement of blood products is still preferred as first-line therapy, with antifibrinolytic agents used as adjunctive therapy. We report herein the case of a successful cesarean section in an 18-year-old woman with FVII deficiency.
Adolescent ; Antifibrinolytic Agents ; Cesarean Section* ; Factor VII ; Factor VII Deficiency* ; Female ; Hemorrhage ; Humans ; Korea ; Obstetrics ; Postpartum Hemorrhage ; Pregnancy

OBJECTIVE: Spinal deformity surgery has the potential risk of massive blood loss. To reduce surgical bleeding, the use of tranexamic acid (TXA) became popular in spinal surgery, recently. The purpose of this study was to determine the effectiveness of intra-operative TXA use to reduce surgical bleeding and transfusion requirements in spinal deformity surgery. METHODS: A total of 132 consecutive patients undergoing multi-level posterior spinal segmental instrumented fusion (≥5 levels) were analyzed retrospectively. Primary outcome measures included intraoperative estimated blood loss (EBL), transfusion amount and rate of transfusion. Secondary outcome measures included postoperative transfusion amount, rate of transfusion, and complications associated with TXA or allogeneic blood transfusions. RESULTS: The number of patients was 89 in TXA group and 43 in non-TXA group. There were no significant differences in demographic or surgical traits between the groups except hypertension. The EBL was significantly lower in TXA group than non-TXA group (841 vs. 1336 mL, p=0.002). TXA group also showed less intra-operative and postoperative transfusion requirements (544 vs. 812 mL, p=0.012; 193 vs. 359 mL, p=0.034). Based on multiple regression analysis, TXA use could reduce surgical bleeding by 371 mL (37 % of mean EBL). Complication rate was not different between the groups. CONCLUSION: TXA use can effectively reduce the amount of intra-operative bleeding and transfusion requirements in spinal deformity surgery. Future randomized controlled study could confirm the routine use of TXA in major spinal surgery.
Antifibrinolytic Agents ; Blood Loss, Surgical ; Blood Transfusion ; Congenital Abnormalities* ; Hemorrhage ; Humans ; Hypertension ; Outcome Assessment (Health Care) ; Retrospective Studies ; Tranexamic Acid*

BACKGROUND: Congenital factor VII (FVII) deficiency is a rare hemorrhagic disorder that can cause excessive bleeding during and after surgery in affected patients. The recombinant form of activated factor VII (rFVIIa, NovoSeven(R) from Novo Nordisk, Bagsvaerd, Denmark), which was developed as a second-generation bypassing agent, has recently been used in the management of bleeding for patients with congenital FVII deficiency. METHODS: We reviewed the results of 8 surgical procedures in 5 patients with congenital FVII deficiency at the Kyung Hee University Hospital, Gangdong, Seoul, Korea, between January 2008 and June 2010. We administrated rFVIIa preoperatively in six patients and postoperatively in five patients. RESULTS: Between January 2008 and June 2010 at our center, 8 operations were performed successfully and no complications were observed in the 5 patients with congenital FVII deficiency. The median level of FVII activity was 2% (range, 0.6-7%). Four orthopedic procedures, 1 tonsillectomy, and 3 dental extractions were performed. The median duration of hospitalization was 8.5 days (range, 0-15 days). rFVIIa was administered at all procedures, except the dental extraction that was performed using only antifibrinolytic agents without any replacement. No bleeding or thrombogenic complications were observed in any case. CONCLUSION: Patients with congenital FVII deficiency who require surgery can be treated efficiently and safely with rFVIIa or antifibrinolytic agents. rFVIIa was well tolerated and maintained effective hemostasis and showed good clinical outcome after the major surgery.
Antifibrinolytic Agents ; Factor VII ; Factor VIIa ; Hemorrhage ; Hemorrhagic Disorders ; Hemostasis ; Hospitalization ; Humans ; Korea ; Orthopedic Procedures ; Recombinant Proteins ; Tonsillectomy

OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) is caused by the rupture of small blood vessels and other health problems. In ICH patients, hematoma enlargement is the most critical risk factor for poor outcomes. Tranexamic acid, an anti-fibrinolytic agent, has been used to reduce hematoma expansion. We analyzed the risk factors for hematoma expansion in ICH patients and compared the predictability of hematoma expansion in ICH patients with the use of tranexamic acid. METHODS: We performed retrospective analysis of ICH patients who underwent follow-up computed tomography scans from October 2008 to October 2018. Of the 329 included patients, 67 who received tranexamic acid and 262 who did not receive tranexamic acid were compared. We also analyzed the risk factors of 45 and 284 patients who did and did not experience hematoma expansion, respectively. RESULTS: Hematoma expansion was observed in 7 (10.4%) of 67 patients in the tranexamic acid group and 38 (14.5%) of the 262 patients who did not receive tranexamic acid. There was no statistically significant difference between patients who did and did not received tranexamic acid (p=0.389). In the multivariate logistic regression analysis of risk factors for hematoma expansion, spot sign and a maximal diameter of 40 mm were identified as risk factors. CONCLUSION: We could not confirm the effect of tranexamic acid on hematoma expansion in ICH patients. Spot sign and the maximal diameter of hematomas were confirmed as risk factors of hematoma expansion. If the maximal diameter is greater than 40 mm, the hematoma should be closely monitored.
Antifibrinolytic Agents ; Blood Vessels ; Cerebral Hemorrhage ; Follow-Up Studies ; Hematoma ; Humans ; Logistic Models ; Retrospective Studies ; Risk Factors ; Rupture ; Tranexamic Acid