Effects of Tranexamic Acid - Essay Example

? Critical Annotated Bibliography Tranexamic Acid Guatam, P. L., Katyal, S., Yamin , M., & Singh, A. . Effects of tranexamic acid on blood loss and transfusion requirement in total knee replacement in the indian population: A case study series. Indian Journal of Anesthesia, 55(6), 590-593. Guatam Parshotam is a professor and Incharge, critical care in the department of anesthesia, DMCH, Ludhiana. Kutyal Sunil on the other hand is a general physician at KMP hospital, India. Mohammad Yamin is a professor and head of orthopedics department at DMC hospital, India. Amandip Singh is also a doctor in the department of anaesthesiology at DMCH. The researchers assert that tranexamic acid significantly decreases blood loss after operation and reduces the need for blood transfusion among students after undergoing total knee replacement (TKR).According to the researchers, Tranexamic acid, which is a synthetic derivative of amino acid lysine, is an effective antifibrinolytic agent. The acid is may reversibly block lysine-binding sites on the plasminogen molecules, thus hinder the formation of plasmin. Other researchers have showed increased use of tranexamic acid in orthopaedic surgery due to its safety, efficacy and low cost. The research was conducted in a tertiary health care facility after obtaining approval from the hospital heath ethics committee with informal consent taken from patients involved in the study. The researchers used randomized double-blinded study involving 40 patients scheduled to undergo unilateral TKR for osteoarthritis. Three surgeons who had experience in the field to ensure validity of the test conducted the study. The first half of the population was injected with 10mg/kg of tranexamic acid. Conversely, the placebo group underwent the same procedure only that normal saline was used instead of tranexamic acid. The scope of the study was to determine if tranexamic acid significantly decreases post-operative blood loss and reduce the need for blood transfusion in Indian patients undergoing TKR. The conclusion derived by the researchers, revealed that tranexamic acid leads to a significant reduction in blood loss. Therefore, there is a need for blood transfusion for patients undergoing total knee replacement. It was concluded that routine administration of the acid was beneficial to patients undergoing operation. The limitation of the research is that it involved a limited number of populations. Also, the researchers did not monitor the plasminogen levels, D-dimer, thromboelastography, and fibrin degradation products. In addition, the researchers failed to measure hemoglobin levels of transfused blood and weigh sponges, which could have affected the accuracy of calculations. The text did not have sufficient clinical evidence and literature supporting the use of tranexamic acid in preventing preoperative blood loss. The relevance and usefulness of the text to my research is that it informed on the importance of the Tranexamic acid in reducing blood loss during operations in patients. Sekhavat, L., Tabatabaii, A., Dalili, M., Farajkhoda, T., & Tafti, A. (2009). Efficacy of tranexamic acid in reducing blood loss after cesarean section. The Journal Of Maternal-Fetal & Neonatal Medicine. Vol. 22(1), 72-75. The authors of this research journal are medical practitioners at the department of obstetrics and gynecology at Shahod Sehud Hospita, and Health Services, Yard, Iran. They have the ability to produce credible research that can be used in any academic research. The argument presented by the researchers is that cesarean section (CS) rate has been on the increase among women delivering and that CS posse many complications as compared to the normal vaginal birth due to complications related to postpartum bleeding. The medications that have been used to reduce bleeding include prostaglandins, oxytocin, and methylergonovine. The researchers however feel that tranexamic acid, a synthetic derivative of the amino acid lysine that has been applied for several years in the reduction of blood loss during and after surgical procedures can be tested and used during and after CS. The researchers feel that tranexamic acid is effective if used in the reduction of blood loss during and after CS. The study involved a population of 90 patients undergoing CS who were subdivided into two . The first lot received tranexamic acid before undergoing CS while the other 45 received placebo. Blood loss volume was measured at the end of the CS and compared between the two groups. The study aimed at determining the effectiveness and safety of using tranexamic acid in reducing blood loss after CS. Their research showed that tranexamic acid can be used effectively and safely to reduce blood loss resulting from CS. However, there is a need for more research to observe for the occurrence of thrombosis. The research on the efficacy of tranexamic acid in blood loss has been limited to orthopedic and cardiac surgeries. There is a need for more research in other areas such as obstetrics and gynecology operations. The researchers did not get support from any pharmaceutical company. The text has relevance to the research that I will be undertaking since it is not limited to areas where previous research has been done. Dunn, C., & Goa, K. (1999). Tranexamic acid: a review of its use in surgery and other indications. Journal of Drugs, 57(6), 1005-1032. Chrispher Dunn and Karen Goa are medical practitioners working with Adis International Limited, Auckland, New Zealand. The authors have valuable knowledge in drug evaluation. The core argument of the authors is that intravenous administration of tranexamic acid causes a reduction relative to placebo of 29 to 54% during post-operative blood losses in patients who are undergoing cardiac surgery with cardiopulmonary bypass. According to the researchers, tranexamic acid was superior to dipyridamole and similar efficacy to aprotinin in the reduction of blood loss. The researchers’ methodology was based on meta-analysis of previous research. According to one study, transfusion requirements were significantly reduced by 60% with aprotinin, and 43% with the application of tranexamic acid. The researchers conducted a meta-analysis of previous research in order to draw their conclusion on the subject. The authors used medical literature that has been in various journals since 1966. The literature was identified using Adibase while additional reference was identified from the list of reference of published articles. The scope of the study was to review the use of tranexamic acid in surgery and other indications in order to recommend on its usefulness and effects associated with its use. The researchers concluded that tranexamic acid can be used in a wide array of hemorrhagic conditions. It was noted that the drug reduces postoperative blood loss and need for transfusion in a number of surgeries, with potential tolerability and cost advantage in comparison to aprotinin. The acid also has the potential of reducing mortality rates and urgent surgery in patients with upper gastrointestinal haemorrhage. Tranexamic acid can provide an alternative to surgery in menorrhagia and reduces menstrual blood loss, and has been successful in controlling bleeding during childbirth. The research was limited to literature it could asses through the search engine and the researchers were not able to confirm the validity of some sources. The major limitation to research is that it depended on past literature in evaluating the research topic. The text provides a wide range of information on the research topic since it draws from a wide range of research materials conducted by professionals in the field of study. Yamasaki, S., Masuhara, K., & Fuji, T. (2005). Tranexamic acid reduces postoperative blood loss in cementless total hip arthroplasty. The Journal of Bone and Joint Surgery. American Volume, 87(4), 766-770. The authors of this journal work at the Department of Orthopaedic Surgery, Osaka Kose-Nenkin Hospital and they experience in this field of study to inform on the subject. The authors of this journal acknowledge that several techniques have been applied to in minimizing the likelihood of allogenic blood transfusion after total knee arthroplastry or total hip arthoplastry. The use of tranexamic acid during surgery can be attractive since the use of a pneumatic tourniquet can substantially increase activation of fibrinolysis in the limb involved thereby increasing bleeding after surgery. The methodology applied in this research involved investigating the effects of tranexamic acid in 21 patients undergoing staged bilateral total arthoplastry without undergoing treatment of hip osteoarthritis . The two procedures were undertaken at intervals of 16 months. Tranexamic acid was administered intravenously five minutes before skin incision while on the other side, tranexamic acid was not administered. The volume of blood loss after operation was recorded and the values compared between the two groups. The scope of the research was to determine the consequences of tranexamic acid on blood loss during and after total hip arthroplastry without cement. The conclusion that was drawn by the researchers was that preoperative administration of tranexamic acid in patients undergoing total hip arthroplastry without cement led to decreased blood loss after operation during the first twenty-four hours, during the first day upon successful surgery. The research failed to establish the efficacy of tranexamic acid. The research did not establish the recommended dose of tranexamic acid and the duration of its administration. They however identified areas that required further investigation. This text has relevance to the research since it showed areas that required further investigation. Abul-Azm, A., & Abdullah, K. (2006). Effect of topical tranexamic acid in open-heart surgery. European Journal of Anaesthesiology, 23(5), 380-384. Both authors of the journal senior lecturers at Cairo University, Kasr El Ainy Faculty of Medicine, Department of Cardiothoracic Surgery and they have the authoritative knowledge to inform on the subject. The authors argue that a single dose of 2 g of tranexamic acid administered in the pericardial cavity prior to wound closure can significantly reduce blood loss and the need for blood transfusion. The study was conducted on 100 patients undergoing open-heart surgery. The study involved a double-blinded, randomized, prospective controlled study. The first group was administered with tranexamic acid while the second group were administered with placebo. The results for postoperative blood loss, need for blood transfusion and the rate of bleeding was recorded and documented. Topical application of tranexamic acid in patients undergoing surgery led to a significant reduction in bleeding after surgery and the rate of re-exploration for haemostasis. The text did not have sufficient clinical evidence and literature supporting the use of tranexamic acid in preventing pre-operative blood loss. The relevance and usefulness of the text to my research is that it informed on the importance of the Tranexamic acid in reducing blood loss during operations in patients. Henry, D., Carless, P., Fergusson, D., & Laupacis, A. (2009). The safety of aprotinin and lysine-derived antifibrinolytic drugs in cardiac surgery: a meta-analysis. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne, 180(2), 183-193. This study is informed by the growing recent concerns about the safety of aprotinin. This research builds on a research done by the same authors in 2007 review that compared the relative benefits and risks of oportinin and the lyaine analogues tranexamic acid and episilon aminocaproic acid. The methodology used in the research is meta-analysis of material research available through electronic databases, including MEDLINE, CENTRAL, EMBASE, Google, Google Scholarfor trails done with antifibrinolytic drugs used in adults scheduled for cardiac surgery. The search results we updated to January 2008. the results for aprotini and the tw lysine analogues were being compared indirectly. The results obtained were used in deducing the estimates of benefits and rosks by comparing estomates head-to-head. the trials of aportinin and epsilon and tranexamic acid were compared. The risk of death tended to be consitently greater when aprotinin was used as compared to lysine analogues. In addition, aprotin did no have clear advantages to effset the disavantages. Either episilon aminocaroic or tranexamic acid should be recomended in preventing postoperative bleeding. This research provides valuable materials for the area of this research. The major weakness of this research is that other sources that are not available through online search engines were not evaluated. Krohn, C., Sorensen, R., Lange, J., Riise, R., Bjornsen, S., & Brosstad, F. (2002). Tranexamic Acid Given into the Wound Reduces Postoperative Blood Loss by Half Orthopaedic Surgery. European Journal of Surgery, 168(12), 57-61. Claus Danckert, Johan Lange, Roger Soresensen, and Rolf Riise are medical researchers at Centre for Orthopedics while Stinte Bjornsen and Frank Brosstad are researchers at Research Institute for Internal Medicine, University of Oslo. The main argument presented by the researchers is that systematic use of fibrinolytic inhibitors such as tranexamic acid and trysylol have produced excellent results. However, they present that systemic inhibition of fibrinolysis pose the risk of thromboembolic complications. In addition to this, some reports have also related this procedure with development of respiratory distress in adults. They therefore argue that fibrinolytic inhibitors should be administered locally where fibrinolysis takes place. The research used prospective study in a University hospital setting involving 30 patients operated and 16 were randomly chosen to be given topical tranexamic acid. The scope of the research was to determine if the application of texanamic acid in the wounds inhibits post operative bleeding. From the research, the researchers concluded that application of texanamic acid in the wounds during surgery significantly reduced excessive fibrnolysis resulting to less blood-loss. The major weakness with the research is that the values used in deriving results were estimates and this could have resulted into errors. The text is useful for my research since it sheds light into the getting non-conventional ways of administering fibrinolytic inhibitors. Yaniv, E., Shvero, J., & Hadar, T. (2006). Hemostatic effect of tranexamic acid in elective nasal surgery. American Journal of Rhinology, 20(2), 227-229. The authors of this journal article are senior doctors at the Nose and Sinus Institute, Department of Otorhinolaryngology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel. This research mainly focuses on the use of Tranexamic acid to reduce blood loss in  the course of cardiac surgery by 29-54% as compared to placebo. Other research has also reported positive results for liver transplant, oral surgery and prostrate transplant. The authors assert that the efficacy of tranexamic acid in preventing blood loss during nasal surgery has never been investigated. The study was conducted in a hospital environment and it involved 400 patients undergoing a combination of endoscopic sinus surgery with conchtomy and septoplasty. The population was divided into two groups with the first acting and control. The bleeding was monitored during and after surgey for 2 weeks respectively. The scope of the study seeks to find out the effectiveness of tranexamic acid in controlling blood loss during and after nasal surgery. The greatest strength of this study is that it used the same surgeon and the same technique to prevent the introduction of confounding factors. The researchers were not able to use placebo for technical reasons which they did not specy in the research. This research explores into areas that have not been attempted by previous research and this sheds more light to the topic of the research. Waldow, T., Krutzsch, D., Wills, M., Plotze, K., and Matschke, K. (2009). Low dose aprotinin and low dose TranexamicAcid in elective cardiac surgery with cardiopulmonary bypass. IOS press. Waldow et al in their article focus on the use of Tranexamic acid and aprotinin as antifibrionolytic agents in the reduction of postoperative loss of blood, and also the requirements of transfusion in cardiac arrest patients. They study the effects of these drugs in cardiac surgery patients in a context with the reduction of blood loss and transfusion requirements in these patients. The methods used were many random controlled studies on the reduction of preoperative bleeding and the transfusion of red blood cells. The procedures involved in the observations include cardiopulmonnary bypass and off- pump coronary artery bypass graft surgery. The method employed by Waldow et al in measuring blood loss involves the use of postoperative tube drainage from the chest. They concluded that the use of aprotinin and Tranexamic anti?brinolytic agents show to be safe methods. This was more prevalent in selected cardiac surgery supported by cardiopulmonary bypass in preventing preoperative hyper?brinolysis. However, the author also found out that there was an increased tendency of renal failure, long-term mortality, myocardial infarction, and stroke in patients. Waldow et al found reduced associated complications as compared to the studies carried out in meta analysis by Brown et al. This article is noteworthy as it gives a study of not only Tranexamic Acid but also the related aprotinin. It shows the effectiveness of tranexamic acid alongside aprotinin and compares the results of the two. Jimenez, J. J., Iribbaren, L. J., Brouard M., Hernandez, D., Palmero S., Jimenez A., et al (2011). Safety and Effectiveness of two treatment regimes with Tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double blind, dose-dependent, phase IV clinical trial, Journal of Cardiothoracic Surgery. Jiminez et al in their article analyzes the use of tranexamic acid in the reduction of cardiopulmonary bypass inflammatory. The article looks at the use of tranexamic acid in the reduction of inflammatory response complications occurring after cardiopulmonary bypass. In their study, they aimed at establishing if the increase of postoperative doses of Tranexamic acid would reduce these effects. The methods they used in their research are, random double-blinded dose dependent groups. This article acknowledges significant, positive changes in fibrinolysis due to use of tranexamic acid before and after surgery. In conclusion, the article finds the use of Tranexamic acid in reducing postoperative bleeding and inflammatory response effective. However, the article notes that the safety of the drug dose administered was questionable. The study employed the consideration of safety at the expense of effectiveness. This article is beneficial as it majors on the study Tranexamic acid only and is not comparative to other alternatives. Alvarez, J. C., Santiveri, F.X., Ramos, I. Vela, E., Puig, L., & Escolano, F. (2008). Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied, Blackwell publishing limited. Alvarez et al in this article looks at the success of tranexamic acid in the reduction of transfusions in entire knee replacement even with the application of blood conservation programs. The study aims at establishing whether the use of tranexamic acid in knee surgery reduces blood loss. The method employed in the study involved a double-blinded perspective study involving patients scheduled for knee surgeries. The article concludes that the use of tranexamic acid in the reduction of blood loss in knee arthroplasty is effective as per the study. The article also notes that this drug was also to be effective with the use of other blood transfusion methods. Alvarez et al goes on to point out that tranexamic acid reduces blood loss during surgery is greater as compared to a total reduction of blood loss. The limitations, however, are assessment of complications and the exclusion of some patients after randomization, which could affect benefits of randomization and threat analysis. This article is beneficial as it critically analyses the effectiveness of tranexamic acid in reduction of blood loss when administered before and after surgery. Kazemi Seyyed, M.D., Faramarz Mossafa., M.D., Alireza Eajazi, M.D., Kaffashi Mohammad, M.D., Laleh Besheli, M.D., Bigdeli Mohammad, M.D., et al (2010) The Effect of Tranexamic Acid on Reducing Blood Loss in Cementless Total Hip Arthroplasty Under Epidural Anesthesia. Orthopedics journal. Kazemi et al looks at the effects of tranexamic acid administered both postoperatively and preoperatively on the level of bleeding intra operative and postoperative. The method used involved a random controlled double-blinded clinical trial of patients; the administrator being aware of the trial while the patient and the surgeon remained blinded. The study states that an administration of tranexamic acid before the total hip arthroplasty reduces bleeding without involving the risk of embolism and thrombosis. Kazemi et al focuses only on a line that is the use of tranexamic acid in cementless total hip arthroplasty. The conclusion of the article is that the administration of tranexamic acid before a total hip arthroplasty results in a significant reduction, in postoperative bleeding and hemoglobin levels. The limitation of this article was that there were little available studies in cementless total hip arthroplasty as compared to cemented total hip arthroplasty to facilitate remarkably accurate information. This article is relevant in the study because it involves the use of an increased population sample, compared to previous studies in the same field, and the aspect of blinding in order to obtain unbiased results. References Abul-Azm, A., & Abdullah, K. (2006). Effect of topical tranexamic acid in open-heart surgery. European Journal of Anaesthesiology, 23(5), 380-384. Alvarez, J. C., Santiveri, F.X., Ramos, I. Vela, E., Puig, L., & Escolano, F. (2008). Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied, Blackwell publishing limited. Dunn, C., & Goa, K. (1999). Tranexamic acid: a review of its use in surgery and other indications. Journal of Drugs, 57(6), 1005-1032. Guatam, P. L., Katyal, S., Yamin , M., & Singh, A. (2011). Effects of tranexamic acid on blood loss and transfusion requirement in total knee replacement in the indian population: A case study series. Indian Journal of Anesthesia, 55(6), 590-593. Henry, D., Carless, P., Fergusson, D., & Laupacis, A. (2009). The safety of aprotinin and lysine-derived antifibrinolytic drugs in cardiac surgery: a meta-analysis. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne, 180(2), 183-193. Jimenez, J. J., Iribbaren, L. J., Brouard M., Hernandez, D., Palmero S., Jimenez A., et al (2011). Safety and Effectiveness of two treatment regimes with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double-blind, dose-dependent, phase IV clinical trial, Journal of Cardiothoracic Surgery. Kazemi Seyyed, M.D., Faramarz Mossafa., M.D., Alireza Eajazi, M.D., Kaffashi Mohammad, M.D., Laleh Besheli, M.D., Bigdeli Mohammad, M.D., et al (2010) The Effect of Tranexamic Acid on Reducing Blood Loss in Cementless Total Hip Arthroplasty Under Epidural Anesthesia. Orthopedics journal. Krohn, C., Sorensen, R., Lange, J., Riise, R., Bjornsen, S., & Brosstad, F. (2002). Tranexamic Acid Given into the Wound Reduces Postoperative Blood Loss by Half Orthopaedic Surgery. European Journal of Surgery, 168(12), 57-61. Sekhavat, L., Tabatabaii, A., Dalili, M., Farajkhoda, T., & Tafti, A. (2009). Efficacy of tranexamic acid in reducing blood loss after cesarean section. The Journal Of Maternal-Fetal & Neonatal Medicine. Vol. 22(1), 72-75. Waldow, T., Krutzsch, D., Wills, M., Plotze, K., & Matschke, K. (2009). Low dose aprotinin and low dose TranexamicAcid in elective cardiac surgery with cardiopulmonary bypass. IOS press. Yaniv, E., Shvero, J., & Hadar, T. (2006). Hemostatic effect of tranexamic acid in elective nasal surgery. American Journal of Rhinology, Vol. 20(2), 227-229. Read More