Tranexamic Acid - Essay Example

?Alexander Cuevas McDonald Advanced Research Writing 8 April Use of Tranexamic acid: Literature Review Tranexamic acid is a common hemostat used to arrest bleeding either during or after surgery and in other medical conditions that lead to blood loss. Tranexamic acid competitively inhibits the activation of plasminogen to plasmin thus preventing plasmin from degrading fibrin. This synthetic antifibrinolytic agent is derived from amino acid lysine. This paper examines various print and online literatures that provide information on the use of tranexamic acid. Literature on the use of tranexamic acid in orthopedic surgery and other Hemorrhagic conditions Guatam, Katyal, Yamin, and Singh argue that tranexamic acid greatly decreases bleeding after operation and reduces the need for blood transfusion among patients after undergoing a total knee replacement (TKR) (590). The researchers indicate that tranexamic acid is an effective antifibrinolytic agent. Tranexamic acid competes with lysine for the binding sites on the plasminogen molecules. Thus, it effectively inhibits the formation of plasmin. The binding of tranexamic acid on lysine binding sites located on plasminogen molecules is reversible. Other studies have shown that a good number of orthopedics use tranexamic acid because of its safety, efficacy and affordability. The researchers conducted a double blind study involving 40 patients who had to undergo a unilateral TNR for osteoarthritis. The study occurred in a tertiary health care facility after obtaining approval from the hospital’s ethics committee. The procedure was conducted by three experienced orthopedic surgeons. The study aimed at determining whether tranexamic acid significantly reduces post operative blood loss and the need for blood transfusion in Indian patients undergoing TKR. One half of the group was given 10mg/kg of tranexamic acid prior to the surgery. The placebo group was given normal saline without tranexamic acid. The study found out that tranexamic acid significantly reduces post operative blood loss and the need for blood transfusions in patients undergoing TKR. However, the study lacked sufficient clinical evidence and literature to support the findings. The usefulness of the study to my research is that it illustrated the significance of tranexamic acid in reducing blood loss during surgical procedures. Furthermore, same results were posted in the study carried out by Dunn and Goa. The researchers’ study methodology relied on meta-analysis of previous studies. One study reported that the need for transfusion was reduced by 60% in patients administered with aprotinin (1005). On the other hand, the study indicated that administration of tranexamic acid reduced the need for transfusion by 43% (1005). In order to validate this information, the researchers conducted a meta-analysis of previous studies. The researchers utilized literatures that have been in the journals since 1966. The researchers used Adibase to locate literatures. In addition, the researchers found references from the list of published journals resourceful. The study endeavored to explore the use of tranexamic acid in surgery and other indications in order to recommend its usefulness and effects associated with its use. The researchers revealed that tranexamic acid can be used in various hemorrhagic conditions. They reported the acid can significantly reduce post operative blood lose and the need for blood transfusion. They noted that the acid is affordable and tolerable when compared to aprotinin. In addition, the researchers found out that tranexamic acid reduces mortality and urgent surgery in patients with upper gastrointestinal hemorrhage. The acid can also be use as an alternative to surgery in menorrhagia, reduces menstrual blood loss and, has been effectively used in reducing bleeding during child birth. The research seems to have been limited to literature that could be accessed via the search engine. The researchers also concentrated on past literature in evaluating their objective. However, the research provides a wide range of information on different studies conducted by different professionals on the research topic. In addition, the results of the research conducted by Yamasaki, Masuhara and Fuji agreed with the first two studies. The scope of the study was to determine the consequences of tranexamic acid on blood loss during and after total hip arthroplasty without cement. The researchers of this study acknowledge the availability of several techniques in reducing chances of allogeneic blood transfusion during total knee and hip arthroplasty. The researchers noted that tranexamic acid is essential in preventing post operative blood loss since the use of pneumatic tourniquet can substantially hasten fibrinolysis in the limb involved. The study involved 21 patients undergoing staged bilateral total arthroplasty without undergoing treatment of hip osteoarthritis (768). The researchers conducted the research for six months. Tranexamic acid was administered five minutes before skin incision in one group of patients. However, no tranexamic acid was administered in the placebo group. The magnitude of blood loss was then analyzed and the results of the two groups compared. The researchers concluded that preoperative administration of tranexamic acid in patients undergoing total hip arthroplasty without cement reduces post operative bleeding during the first twenty four hours, upon successful surgery (770). The study did not establish the efficacy of the acid. Moreover, it failed to elucidate the recommended dose and dosage of the acid. The study adds value to my research because it illustrates areas that require further investigation. The above studies emphasize on the reported efficacy and safety of tranexamic acid. However, the studies do not illustrate the recommended dose and dosages of tranexamic acid required to be administered for effective results to be realized. Analysis of studies that examined the efficacy of tranexamic acid Sekhavat, Tabatabaii, Dalili, Farajkhoda and Tafti were prompted by the increased cases of postpartum blood loss due to increased cases of caesarian section (CS) among women delivering. They argued many complications are bound to arise during CS when compared to the normal virginal delivery (72). The researchers believe that tranexamic acid can be used to arrest bleeding associated with surgery and other medical conditions. In order to ascertain whether this is true, the researchers studied a group of 90 patients who were to undergo CS. One group comprising of 45 patients was given tranexamic acid prior to CS while another group was given a placebo. The researchers then analyzed degree of blood loss amongst the patients in the two groups. The study aimed at elucidating the efficacy and safety of tranexamic acid in reducing blood loss after CS (72). The study revealed that tranexamic acid can be used safely and effectively to arrest bleeding caused by CS. The researchers suggested that more research should be done to assess the occurrence of thrombosis (75). They noted that most studies on the efficacy and safety of tranexamic acid has concentrated on orthopedic and cardiac surgery (75). Thus, there is a need for more research to be conducted to evaluate its use in other surgical procedures like obstetrics and gynecology. The study will be essential in my research because it shades light on the use of tranexamic acid in a different area other than the commonly studied areas of orthopedics and cardiology. The findings of Sekhavat et al. are supported the study conducted Abul-azm and Abdullah. Abul-azm and Abdullah are for the opinion that a single dose of 2g of tranexamic acid administered in the pericardial cavity prior to wound closure can significantly reduce blood loss and the need for blood transfusion (380). The sample size was 100 open heart surgery patients. The research methodology involved a double blinded, randomized, prospective controlled study. The researchers divided the patients into two groups. The first group was given tranexamic acid while the other group was administered with a placebo. The degree of blood loss and the need for blood transfusion was then documented. The researchers found out that in patients administered with tranexamic acid topically, there was a significant reduction in post operative bleeding and the rate of re-exploration of hemostasis. The study however failed to substantiate its finding with clinical evidence and supportive literature. The study re-affirmed the importance of tranexamic acid in reducing post operative bleeding; a feature that adds value to my intended research. The studies conducted by Sekhavat et al. and Abul-azm and Abdullah reaffirm the effectiveness of tranexamic acid in reducing post operative bleeding in two different disciplines; obstetrics and cardiology. Literature on the safety and effectiveness of tranexamic acid In another study, Waldow, Krutzsch, Wills, Plozte and Matschke researched on the use of tranexamic acid and aprotinin as antifibrinolytic agents in the reduction of postoperative blood loss and the need for transfusion in cardiac arrest patients. The researchers employed many random controlled studies on the reduction of preoperative bleeding and the transfusion of red blood cells. The patients under study were undergoing surgical procedures involving cardiopulmonary bypass and off-pump coronary artery bypass graft surgery. Waldo et al. used postoperative tube drainage from the chest to measure blood loss. The researchers concluded that the use of tranexamic acid and aprotinin as antifibrinolytic agents is safe. This was evidenced by cardiac surgery supported by cardiopulmonary bypass in preventing preoperative hyper fibrinolysis. However, the researchers realized that there was an increased tendency of renal failure, long term mortality, myocardial infarction and stroke in patients. Waldow et al. noted a reduction in associated complications as compared to meta-analysis studies carried out previously (60). The study is essential because it gives a comparison between the effectiveness and safety of tranexamic acid and aprotinin. Jimenez, J., Iribaren, Brouard, Hernandez, Palmero, Jimenez, A. et al. also analyzed the safety and effectiveness of tranexamic acid in the reduction of cardio pulmonary bypass inflammatory (40). The article looks at the use of tranexamic acid in the reduction of inflammatory response complications occurring after pulmonary bypass. The researchers aimed at determining whether the increase of postoperative doses of tranexamic acid would reduce these effects. The researchers used random double blinded dose dependent groups. The researchers found out that there was a significant reduction in fibrinolysis due to the use of tranexamic prior to and after the surgery. Thus, the article concluded that the use of tranexamic acid to control bleeding and inflammatory reactions was effective (70). The researchers however questioned the safety if tranexamic acid. The study is essential to the current topic because it focused mainly on the effectiveness of tranexamic acid. It can be noted that Waldo et al. and Jimenez et al. studies examined the effectiveness and safety of tranexamic acid as an antifibrinolytic agent. Waldo et al. study compared tranexamic acid to aprotinin. Waldo et al. study revealed that tranexamic acid is safe and effective in reducing post operative blood loss. Jimenez et al. study concentrated on the effectiveness of tranexamic only. Its findings were not conclusive on the safety of tranexamic acid. These two studies resemble the other study conducted by Sekhavat et al. which was discussed earlier. Sekhavat et al. studied explored the safety and effectiveness of tranexamic acid in the reduction of post operative blood loss after Caesarian Section (CS). The study concluded that tranexamic acid is safe and effective in the reduction of post operative blood loss in CS. Thus, it can be argued that all these studies except that conducted by Jimenez et al. approved tranexamic acid as safe antifibrinolytic agent. Moreover, these studies indicated that tranexamic acid effective in reducing post operative bleeding. In addition, three other studies conducted in orthopedics reveal the safety and effectiveness of tranexamic acid. In the first study conducted by Krohn, Sorensen, Lange, Riise, Bjornsen and Brosstad tranexamic acid was administered into the wound, and its effectiveness was analyzed. The researchers argued that the systemic use of antifibrinolytic agents such as tranexamic acid and tysylol produce excellent results. However, the researchers were concerned about the possibility of an occurrence of thromboembolic complications. Furthermore, some studies had indicated that these agents cause respiratory distress in adults. They therefore suggested that antifibrinolytic agents should be administered locally (61). The researchers used a prospective study in a university hospital involving sixteen patients who had undergone surgery. The scope of the study was to determine whether topical administration of tranexamic acid on wounds inhibits post operative bleeding. The researchers found out that topical administration tranexamic acid on wounds reduces excessive fibrinolysis and associated post operative blood loss. However, accuracy of the results was questionable because values used in deriving the results were estimates. The literature is essential because it gives findings regarding non conventional methods of administering antifibrinolytic inhibitors. In the second study, Alvarez, Santiveri, Ramos, Vela, Puig and Escolano looked at the use of tranexamic acid in the reduction of transfusions in entire knee replacement even with the application of blood conservation programs. The scope of the study involved assessing whether tranexamic acid reduces blood loss in knee surgery (75). The researchers used a double blinded perspective study involving patients scheduled for knee surgeries. The study concluded that tranexamic acid is effective in the reduction of post operative bleeding after knee arthroplasty (80). The study also indicated that the magnitude of blood loss reduction during surgery is greater as compared to a total reduction of blood loss. The study is beneficial because it analyzes the use of tranexamic acid before and after surgery. In the other study, Kazemi, Mossafa, Eajazi, Kafashi, Besheli and Mohammad sought to assess the effects of tranexamic acid administered preoperatively and postoperatively on the level of bleeding intra operative and post operative (60). The methodology used involved a random controlled double blinded clinical trial of patients. Apparently, the administrator was aware of the trial while the patient and the surgeon were blinded. The study stated that administration of tranexamic acid the total hip arthroplasty reduces bleeding without involving the risk of embolism and thrombosis. They focused on a line that is the use of tranexamic acid in cement less total hip arthroplasty. The researchers concluded that the administration of tranexamic acid before total hip arthroplasty results in a significant reduction, in post operative bleeding and hemoglobin levels. The limitations of the study included unavailability of studies in cement less total hip arthroplasty as compared to cemented total hip arthroplasty to facilitate accurate data. This article is useful because it involves the use of increased population sample, compared to various studies in the same field, and the aspect of blinding. The three studies indicated that tranexamic acid significantly reduces blood loss after total knee or hip arthroplasty. These three studies were in agreement with the findings of Yamasaki and Fuji and Guatam et al. discussed earlier. Yamasaki and Fuji study aimed at determining the consequences of tranexamic acid on blood loss during and after total hip arthroplasty without cement. The researchers concluded that preoperative administration of tranexamic acid in patients undergoing total hip arthroplasty without cement reduces post operative bleeding during the first twenty four hours, upon successful surgery. The study did not establish the efficacy of the acid. On the other hand, Guatam et al. argue that tranexamic acid greatly decreases bleeding after operation and reduces the need for blood transfusion among patients after undergoing a total knee replacement (TKR). Thus, it can be noted that these studies acknowledged the effectiveness and safety of tranexamic acid in reducing post operative bleeding after total knee and hip surgery. The literature review has indicated that a good number of studies have been conducted to determine the safety and efficacy of tranexamic acid in reducing preoperative bleeding , post operative bleeding and the need for blood transfusion. It has been noted that tranexamic acid can be used as an antifibrinolytic agent in various surgical procedures. A good number of the articles have acknowledged the safety and efficacy of tranexamic acid. However, the findings have also raised concern on the methodology employed in some studies indicating the need for accuracy when conducting research. Thus, further research is needed to evaluate the safety, dose and dosage of tranexamic acid. Moreover, the literature has provided vital information regarding the topic under study. The findings in the literature have offered a remarkable boost to the topic under study. Works Cited Abul-AZM, A. and Abdullah, K. "Effects of topical tranexamic acid in open heart surgery." European Journal of Anesthesiology 23.5 (2006): 380-384. Print. Alvarez, J., Santiveri, F., Ramos, I., Vela, E., Puig, L. and Escolano, F. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied.Boston Blackwell publishing, 2008. Print. Dunn, C.and Goa, K. "Tranexamic acid: a review of its use in surgery and other indications." Journal of Drugs 57.6 (1999): 1005-1032.Print. Guatam, P., Katyal, S.,Yasmin, M. and Singh, A. "Effects of tranexamic acid on blood loss and transfusion required in total knee replacement in the Indian population: A case study series." Indian Journal of Anaesthesia 55.6 (2011): 590-593. Print. Jimenez, J. et al. "Safety and effectiveness of two regimes with tranexamic acid to reduce inflmmatory response in elective cardiopulmonary bypass patients: a randomized double blind,dose dependent, phase IV clinical trial." Journal of Cardiothoracic Surgery (2011): 10-20. Print. Kazemi, Z. et al. "The effects of tranexamic acid on reducing bllod loss in total hip arthroplasty under Epidural anesthesia." Orthopaedic Journal (2010): 10-20. Print. Krohn, C.,Sorensen, R., Lange, J., Riise, R.,Bjorsnen, S. and Brosstad,F. "Tranexamic acid given into the wound reduces post operative blood loss by halif orthopaedic surgery." European Journal of Surgery 168.12 (2002): 57-61. Print. Sekhavat, L., Tabatabaii, A., Dalili, M., Frajkhoda, T. and Tafti, A. The Journal of Maternal Fetal and Neonatal Medicine 22.1(2009): 72-75. Print. Waldow, T., Krutzsch, D.,Wills, M., Plotze, K. and Matschke, K. Low dose aprotonin and low dose tranexamic acidin elective cardiac surgery with cardiopulmonary bypass. Amstaderm: IOS Press, 2009. Print. Yamasaki, S., Masuhara, K., and Fuji, T. "Tranexamic acid reduces postoperative blood loss in cement less and total hip arthroplasty." The Journ of Bone and Joint Surgery 87.4(2005): 766-770. Print. Read More