Introduction: Peritrochanteric fractures are common injuries occurring in elderly patients. Surgeries for these fractures are associated with significant blood loss. Intravenous tranexamic acid has a proven track record in many orthopaedic surgeries including trauma, arthroplasty and spine surgeries. Objective: To study the effect of local subfascial and intramuscular infiltration of tranexamic acid in reducing blood loss and the requirement for blood transfusion in intertrochanteric fracture surgery. Study Design: Single centre prospective analytical study. Materials and Methods: One hundred and thirty seven patients above 65 years of age were included in the study, divided into two groups: the intervention group received subfascial and intramuscular infiltration of 2g tranexamic acid before wound closure and the control group of alternate patients did not receive any tranexamic acid infiltration. The postoperative drain output was recorded, as well as the haemoglobin level and the patients needing blood transfusion. Results and Conclusions: The preoperative and postoperative haemoglobin values were recorded. The mean preoperative haemoglobin was 10.9% and 10.8% (p=0.79) in the trial and control groups respectively. The mean postoperative haemoglobin was 9.5gm% and 9.2gm% (p=0.36) in the two groups. The total postoperative blood loss in the tranexamic acid group and the control group was 190.3ml and 204.3ml respectively (p=0.25). Ten patients (14.9%) in the intervention group and 12 patients (17.1%) in the control group required blood transfusion. We conclude that tranexamic acid does not play a significant role in reducing postoperative blood loss and blood transfusion when used locally in peritochanteric fracture surgery. However a larger double blinded study comparing various modalities of use of tranexamic acid is needed to conclusively establish its role
Tranexamic Acid

No abstract available.
Melanosis* ; Tranexamic Acid*

No abstract available.
Anesthesia* ; Tranexamic Acid*

No abstract available.
Humans ; Plasma* ; Tranexamic Acid* ; Urticaria*

Objective: To determine the effect of a single intravenous dose of tranexamic acid on intraoperative bleeding, duration of surgery and surgical field visualization during endoscopic sinus surgery. Methods: Study Design: Double-blind, randomized, placebo-controlled trial. Setting: Tertiary Government Hospital in Quezon City Participants: 10 patients aged 18-75 years old diagnosed with chronic rhinosinusitis with or without nasal polyposis and unresponsive to medical treatment, who underwent endoscopic sinus surgery from September 2016 to August 2017, were randomly allocated to treatment group and control group respectively. The “odd” numbers were assigned to the treatment group (intravenous Tranexamic acid) given 1 dose of 100mg/ml (500mg tranexamic acid per 5 ml) tranexamic acid slow intravenous drip 1 hour prior to the procedure, while the “even” numbers assigned to the control group received the same amount of normal saline solution. Results: The mean duration of surgery of the tranexamic group was 185 minutes (standard deviation, SD 55.23) and the control group was 122.6 minutes (SD 42.03) showing no significant difference (p=.08). The mean blood loss of the tranexamic group was less at 240ml (SD 108.39) compared with the control group at 290ml (SD 74.16), although there was no statistically significant difference (p=.42). Intraoperative surgical field assessed by the surgeon based on the Boezart grading scale showed that 2 (40%) of the tranexamic group had higher bleeding score compared with the placebo group. However, this was not found to be statistically significant (p=.460). Due to the small sample size, a type II error occurred with alpha level of 0.05 and estimated power of 0.0885, with not enough basis to refute that a single dose of intravenous tranexamic acid has no effect in improving surgical field visualization during endoscopic sinus surgery. No drug side effects were noted after administration until after surgery. Conclusion Single dose intravenous tranexamic acid in functional endoscopic sinus surgery decreased mean intraoperative blood loss (but this was statistically insignificant), but its effect on surgical field visualization cannot totally be assessed due to small sample size. There was also no change in the observed duration of surgery. No untoward side effects associated were noted from administration of the drug until after the surgery finished.
Administration, Intravenous ; Tranexamic Acid ; Sinusitis

OBJECTIVE: The present study attempts to address the change of management results over time during the past 13 years in good-grade patients with intracranial aneurysm. METHODS: Six hundred twenty five (Hunt-Hess grade I to III) out of 826 patients with ruptured intracranial aneurysms operated by the same operator within 3 days after the attack from 1990 to 2002 were selected. Since 1998, endovascular aneurysmal occlusion was done in selected cases of 21 patients. The change of management results over time, including rebleeding rate, delayed ischemic neurologic deficit(DIND) as a cause of morbidity and mortality, and surgical outcome were examined. RESULTS: The ratio of poor-grade patients in all patients tended to decrease over the years. The early rebleeding rate declined from 5.0% to 1.2% with the use of tranexamic acid and computed tomography angiogram DIND as a cause of mortality and morbidity has decreased from 12.5% in 1990 to approximately 0% currently. Surgical outcome began to improve significantly in 1994 (poor outcome: 25% in 1990, 12.2% in 1994, 6.8% in 2002). CONCLUSION: These results suggest that the advances in care and increased experience of the operator significantly affect the change of overall outcome, and early detection of the aneurysm is needed for reducing the ratio of poor-grade patients.
Aneurysm* ; Humans ; Intracranial Aneurysm ; Mortality ; Tranexamic Acid

No abstract available.
Drainage* ; Humans ; Thoracic Surgery* ; Tranexamic Acid*

Background: The effective dose of Tranexamic Acid (TA) is unclear in reducing blood loss after cardiac surgery. In Vietnam, the doses of TA 10mg/kg for starting anaesthesia, 5mg/kg for transfusion into extracorporeal circulation solution, then using a maintained dose of 1mg/kg/gi\u1edd reduces blood loss and transfusion, but there is no statistical significant. Objectives: To evaluate blood loss and need for transfusion after cardiac surgery in patients receiving TA 20 mg/kg at induction + 10 mg/kg in extracorporeal circulation solution and 2 mg/kg/1h for maintenance; To evaluate coagulation profile after TA. Subject and methods: A double blind randomly controlled trial is conducted in 80 surgical cardiac patients equally divided into TA and control groups: Results: In the TA group, the post - operative blood loss is 393.50 \xb1 136.64 ml, Hematocrit (Hct) 35.31 \xb1 3.38 % with less individuals and smaller amount of blood and/or frozen fresh platelets needed than in control (p<0.001). Conclusions: An above dose of TA reduces approximately a half of blood loss and elevates Hct postoperatively, with significant lower requirements of transfusion than the control and higher amount of platelets, reduced D-dimers (p<0.05) and unchanged Fibrinogen, PT, INR and aPTT (p >0.05).
open heart surgery ; tranexamic acid ; blood loss

OBJECTIVETo evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury (TBI) mentioned in Cochrane Systematic Reviews published in the Cochrane Database of Systematic Reviews (CDSR).

METHODSAn exhausted literature search for all published Cochrane Systematic Reviews discussing therapeutic rather than prevention or rehabilitative interventions of TBI was conducted. We retrieved such databases as CDSR and Cochrane Injury Group, excluded the duplications, and eventually obtained 20 results, which stand for critical appraisal for as many as 20 different measures for TBI patients. The important data of each systematic review, including total population, intervention, outcome, etc, were collected and presented in a designed table. Besides, we also tried to find out the possible weakness of these clinical trials included in each review.

RESULTSAnalysis of these reviews yielded meanfuling observations: (1) The effectiveness of most ordinary treatments in TBI is inconclusive except that corticosteroids are likely to be ineffective or harmful, and tranexamic acid, nimodipine and progesterone show a promising effect in bleeding trauma, traumatic subarachnoid hemorrhage, TBI or severe TBI. (2) A majority of the systematic reviews include a small number of clinical trials and the modest numbers of patients, largely due to the uncertainty of the effectiveness. (3) The quality of most trials reported in the systematic reviews is more or less questionable. (4) In addition, lots of other complex factors together may lead to the inconclusive results demonstrated in the Cochrane Systematic Reviews.

CONCLUSIONSFor clinical physicians, to translate these conclusions into practice with caution is essential. Basic medication and nursing care deserve additional attention as well and can be beneficial. For researchers, high quality trials with perfect design and comprehensive consideration of various factors are urgently required.

OBJECTIVE: The goal of this study was to determine the effect of short-term usage of tranexamic acid (TXA), which is an antifibrinolytic agent, on patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS: We prospectively analyzed 80 consecutive patients who had undergone surgery for aSAH between January 2004 and December 2006. The patients were placed either in the TXA group for those who were treated with TXA (N=38) or in the n-TXA group for those who were not (N=42). The incidences of rebleeding and vasospasm (with using the transcranial Doppler (TCD) criteria), symptomatic vasospasm and hydrocephalus were compared between the two groups. RESULTS: Preoperative rebleeding occurred only in one patient in each group (2.6% of the TXA group and 2.3% of the n-TXA group (p>0.05). Vasospasm developed in 18 (47.4%) of the TXA patients and in 20 (47.6%) of the n-TXA patients (p>0.05). Among the patients with vasospasm, the number of symptomatic vasospasms was 16 (89%) in the TXA group and 11 (55%) in the n-TXA group (p<0.05). The patients with symptomatic vasospasm in the TXA group seemed to have worse outcomes than those in the n-TXA group (p>0.05). The incidence of hydrocephalus was not different between the two groups. CONCLUSION: We conclude that the preoperative short-term use of TXA can increase the risk of postoperative symptomatic vasospasm, although the incidence of vasospasm was not different between the two groups. According to our results, we recommend being very cautious of vasospasm and ischemic events when TXA is used preoperatively in patients with aSAH.
Aneurysm ; Humans ; Hydrocephalus ; Incidence ; Prospective Studies ; Subarachnoid Hemorrhage ; Tranexamic Acid