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Clinical efficacy of the topical application of tranexamic acid in tendon release in the hand:A randomized controlled trial

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Chinese Journal of Traumatology 2024年第3期27卷 163-167页

作者： Hao Liu Jun Liu Yong-Wei Wu Ming Zhou Yong-Jun Rui Suzhou Medical College of Soochow University Suzhou215000Jiangsu provinceChina Department of Traumatic Orthopedics Wuxi Ninth People's Hospital Affiliated to Soochow UniversityWuxi214000Jiangsu provinceChina

Purpose:To study the clinical effectiveness of the topical application of tranexamic acid in hand tendon ***:This was a randomized controlled trial conducted after receiving approval from the local ethics committee according to guidelines from the Helsinki *** patients who underwent hand tendon release operation in our hospital from January 2021 to December 2022 were included and randomly divided into 2 *** in the tranexamic acid group(40 cases)received intraoperative topical application of 2 g of tranexamic acid after tendon release,while patients in the conventional group(40 cases)did not receive topical application of tranexamic acid during *** operation time,perioperative hemoglobin changes,total blood loss,incidence of early postoperative complications,and total active movement(TAM)before surgery and 6 months after surgery were compared between the 2 *** continuous variable which follows normal distribution expressed by mean±SD and used t-test to compare between ***,categorical variables were used by Chi-square test,and a ptranexamic acid group than in the conventional group(t=7.611,ptranexamic acid group(74.33±20.50)mL was less than that in the conventional group(83.05±17.73)mL,and the difference was statistically significant(ptranexamic acid group(87.68°±10.44°)than in the conventional group(80.47°±10.93°)at 6 months after surgery,with a statistically significant difference(t=3.013,p<0.0

关键词： tranexamic acid Tendon release Total active movement Tendon adhesion

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Safety of tranexamic acid in surgically treated isolated spine trauma

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World Journal of Orthopedics 2024年第4期15卷 346-354页

作者： Wajiha Zahra Sandeep Krishan Nayar Ashwin Bhadresha Vinay Jasani Syed Aftab Trauma and Orthopedics Department University Hospital of North Midlands NHS TrustStoke-on-Trent ST46QGUnited Kingdom Trauma and Orthopedics Department Royal London HospitalBarts Health InstituteLondon E11BBUnited Kingdom Craniospinal Services University Hospital of North Midlands NHS TrustStokeon-Trent ST46QGUnited Kingdom Spine Department Royal London HospitalBarts Health InstituteLondon E11BBUnited Kingdom

BACKGROUND tranexamic acid(TXA),a synthetic antifibrinolytic drug,effectively reduces blood loss by inhibiting plasmin-induced fibrin *** is the first study in the United Kingdom to investigate the effectiveness of TXA in the surgical management of isolated spine *** To assess the safety of TXA in isolated spine *** primary and secondary outcomes are to assess the rate of thromboembolic events and to evaluate blood loss and the incidence of blood transfusion,*** This prospective observational study included patients aged≥17 years with isolated spine trauma requiring surgical intervention over a 6-month period at two major trauma centers in the United *** We identified 67 patients:26(39%)and 41(61%)received and did not receive TXA,*** groups were matched in terms of age,gender,American Society of Anesthesiologists grade,and mechanism of injury.A higher proportion of patients who received TXA had a subaxial cervical spine injury classification or thoracolumbar injury classification score>4(74%vs 56%).All patients in the TXA group underwent an open approach with a mean of 5 spinal levels involved and an average operative time of 203 min,compared with 24 patients(58%)in the non TXA group who underwent an open approach with an average of 3 spinal levels involved and a mean operative time of 159 *** patients who received TXA,blood loss was<150 and 150–300 mL in 8(31%)and 15(58%)patients,*** were no cases of thromboembolic events in any patient who received *** Our study demonstrated that TXA is safe for isolated spine *** is challenging to determine whether TXA effectively reduces blood loss because most surgeons prefer TXA for open or multilevel ***,larger studies are necessary to explore the rate,dosage,and mode of administration of TXA.

关键词： tranexamic acid Infection Trauma Thromboembolic disease Minimally invasive Percutaneous

tranexamic acid for major trauma patients in Ireland

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World Journal of Emergency Medicine 2022年第1期13卷 11-17页

作者： Kieran Walsh Francis O’Keeff e Louise Brent Biswadev Mitra National Trauma Research Institute the Alfred HospitalMelbourne 3004Australia Critical Care Research School of Public Health and Preventive MedicineMonash UniversityMelbourne 3004Australia Emergency&Trauma Centre Alfred HealthMelbourne 3004Australia Emergency Department Mater Misericordiae University HospitalDublin D07 R2WYIreland National Offi ce for Clinical Audit Ardilaun HouseDublin D02 VN51Ireland

BACKGROUND:The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2(CRASH-2)is the largest randomized control trial(RCT)examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid(TXA)within 3 hours of *** the publication of CRASH-2,significant geographical variance in the use of TXA for trauma patients *** study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of ***:A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network(TARN).All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation(as defined by systolic blood pressure[SBP]1(70.68%vs.57.43%)and higher Injury Severity Score(ISS>25;49.62%vs.23.76%).Administration of TXA was not associated with mortality at hospital discharge(odds ratio[OR]0.86,95%CI 0.31–2.38).CONCLUSIONS:Among injured Irish patients presenting with hemorrhagic shock,TXA was administered to 56.8%of *** administered with TXA were on average more severely ***,a mortality benefit could not be demonstrated.

关键词： tranexamic acid Shock Ireland Hemorrhage

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tranexamic acid may be a useful pharmacotherapy for endoscopically resistant small bowel angiodysplasia

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World Journal of Gastroenterology 2023年第7期29卷 1131-1138页

作者： Shunji Fujimori Department of Gastroenterology Chiba Hokusoh HospitalNippon Medical SchoolChiba 270-1694Japan

Small bowel angiodysplasia(SBAD)is reported to account for nearly 50%of cases of small bowel *** SBAD occurs frequently,it is difficult to treat all the angiodysplasias endoscopically,and gastrointestinal bleeding often *** therapy,somatostatin analogs,thalidomide and vascular endothelial growth factor(VEGF)-neutralizing antibodies have been reported to reduce gastrointestinal angiodysplasia(GIAD)***,there is no strong evidence to recommend ***,there are no guidelines for their *** hemorrhagic telangiectasia(HHT)is a hereditary disease caused by abnormalities in VEGF,resulting in multiple GIADs.A treatment guideline has been created for GIAD in HHT,and the use of tranexamic acid,an antifibrinolytic agent,is the first recommendation pharmacotherapy for GIAD with gastrointestinal bleeding that is difficult to treat *** has been reported that fibrinolysis is accelerated in GIAD patients who are not HHT,similar to HHT *** use of tranexamic acid for gastric antral vascular ectasia in GIAD has been reported to be ***,there are very few reports of its use for *** are concerns with tranexamic acid use regarding the development of thrombosis/embolism,but there are few reports of such side *** clinical trials including tranexamic acid for SBAD are desired.

关键词： Angiodysplasia Intestine Hereditary hemorrhagic telangiectasia tranexamic acid Endoscopic treatment Pharmacotherapy

Application of tranexamic acid in Shoulder Arthroscopic Surgery:A Randomised Controlled Trial

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Chinese Medical Sciences Journal 2023年第4期38卷 273-278页

作者： Tian-Ci Wang Jia-Liang Guo Qiu-Ping Tian He-Ping Deng Bing Yin Zeng Xiao Bo Lu Department of Orthopedic Trauma Hebei Medical University Third Affiliated HospitalShijiazhuang 050051China Medical Services Section Hebei Medical University Third Affiliated HospitalShijiazhuang 050051China Department of Ultrasonography Hebei Medical University Third Affiliated HospitalShijiazhuang 050051China Graduate School of Hebei Medical University Shijiazhuang 050011China

Objective To explore the optimal administration route of tranexamic acid(TXA)in shoulder arthroscopic *** Patients undergoing arthroscopic rotator cuff repair were randomly divided into four groups:control group(without TXA treatment),intravenous group(TXA was intravenously administered 10 minutes before surgery),irrigation group(TXA was added to the irrigation fluid during subacromial decompression and acromioplasty),and intravenous plus irrigation group(TXA was applied both intravenously and via intra-articular irrigation).The primary outcome was visual clarity assessed with visual analog scale(VAS)score,and the secondary outcomes included irrigation fluid consumption and time to subacromial decompression and acromioplasty *** There were 134 patients enrolled in the study,including 33 in the control group,35 in the intravenous group,32 in the irrigation group,and 34 in the intravenous plus irrigation *** median and interquartile range of VAS scores for the intravenous,irrigation,and intravenous plus irrigation groups were 2.70(2.50,2.86)(Z=-3.677,P=0.002),2.67(2.50,2.77)(Z=-3.058,P<0.001),and 2.91(2.75,3.00)(Z=-6.634,P<0.001),respectively,significantly higher than that of the control group[2.44(2.37,2.53)].Moreover,the control group consumed more irrigation fluid than the intravenous group,irrigation group,and intravenous plus irrigation group(all P<0.05).The intravenous plus irrigation group consumed less irrigation fluid than either the intravenous group or the irrigation group(both P<0.001).There was no difference in subacromial decompression and acromioplasty operative time among the four *** TXA applied both topically and systematically can improve intraoperative visual clarity,and the combined application is more effective.

关键词： tranexamic acid shoulder arthroscopic surgery visual clarity rotator cuff tear administration route

Efficacy and safety of intravenous tranexamic acid in total shoulder arthroplasty:A meta-analysis

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World Journal of Clinical Cases 2023年第13期11卷 2992-3001页

作者： Hua-Mei Deng The Second Affiliated Hospital Guangzhou University of Chinese MedicineGuangzhou 510120Guangdong ProvinceChina

BACKGROUND Total shoulder arthroplasty(TSA)results in a large amount of perioperative blood loss due to severe *** To investigate the safety and efficacy of intravenous tranexamic acid(TXA)in *** We searched the PubMed,Cochrane Library,Embase and Web of Science databases for randomized controlled trials(RCTs)on the use of TXA in *** all the results were checked and assessed by Reference Citation Analysis(https://***/).A meta-analysis was performed with Review Manager 5.3 to calculate the odds ratio(OR)or weighted mean difference(WMD)of related outcome *** A total of 5 RCTs with level 1 evidence were *** were 369 cases,with 186 in the TXA group and 183 in the placebo *** meta-analysis showed that TXA can significantly reduce total blood loss during the perioperative period[WMD=-249.56,95%confidence interval(CI):-347.6 to-151.52,P<0.0001],and the incidence of adverse reactions was low(OR=0.36,95%CI:0.16-0.83,P=0.02).Compared with the placebo group,the TXA group had significantly less total haemoglobin loss(WMD=-34.39,95%CI:-50.56 to-18.22),less haemoglobin fluctuation before and after the operation(WMD=-0.6,95%CI:-0.93 to-0.27)and less 24-h drain output(WMD=-136.87,95%CI:-165.87 to-106.49).There were no significant differences in the operation time(P=0.11)or hospital length of stay(P=0.30)between the two *** The application of intravenous TXA in the perioperative period of TSA can significantly reduce the total volume of perioperative blood loss and reduce the incidence of adverse reactions,so TXA is worthy of widespread clinical use.

关键词： Intravenous tranexamic acid Total shoulder arthroplasty Placebo Meta-analysis

Topical use of tranexamic acid:Are there concerns for cytotoxicity?

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World Journal of Orthopedics 2022年第6期13卷 555-563页

作者： Ioannis Gkiatas Aristeidis-Panagiotis Kontokostopoulos Spyridon E Tsirigkakis Ioannis Kostas-Agnantis Ioannis Gelalis Anastasios Korompilias Emilios Pakos Department of Orthopaedic Surgery University of IoanninaIoannina 45500EpirusGreece

tranexamic acid(TXA)has revolutionized modern blood management in orthopaedic surgery,especially in total joint arthroplasty,by significantly reducing blood loss and transfusion *** is an antifibrinolytic agent and a synthetic derivative of the amino acid lysine,which can inhibit the activation of plasminogen and the fibrin breakdown *** administration of TXA can be intravenous(IV),topical,and *** patients where the IV administration is contraindicated,topical use is *** administration of the drug theoretically increases concentration at the operative site with reduced systemic exposure,reduces cost,and gives the surgeon the control of the *** to recent studies,topical administration of TXA is not inferior compared to IV administration,in terms of safety and ***,there are concerns regarding the possible toxicity in the cartilage tissue with the topical use of TXA mainly in hemiarthroplasty operations of the hip,unilateral knee arthroplasties,total knee arthroplasties where the patella is not resurfaced,and other intraarticular procedures,like anterior cruciate ligament *** purpose of the present review is to present all the recent updates on the use of TXA focusing on the toxicity on chondrocytes and the articular cartilage that may or may not be provoked by the topical use of TXA.

关键词： tranexamic acid Topical use Cytotoxicity Orthopaedic surgery

Efficacy,effectiveness,and safety of combination laser and tranexamic acid treatment for melasma:A meta-analysis

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中国整形与重建外科(英文) 2023年第3期5卷 154-158页

作者： Arika Latashia Adelia Sri Adila Nurainiwati Probo Yudha Pratama Putra Aulia Sita Hapsari Medical Faculty University of BrawijayaMalang 65145East JavaIndonesia Department of Dermatology and Venereology Medical FacultyUniversity of Muhammadiyah MalangMalang 65144East JavaIndonesia Medical Faculty University of Muhammadiyah MalangMalang 65144East JavaIndonesia

Background: Melasma is an acquired pigmentation condition characterized by its refractory nature and a high risk of recurrence. Treatment of melasma is challenging owing to its unclear etiology, stubborn resistance to treatment, and frequent relapses. Therefore, this study aimed to compare the efficacy, effectiveness, and safety of monotherapy and combination therapy(combination of laser and tranexamic acid(TXA)) for the treatment of melasma using a network ***: The PRISMA guidelines were used in this meta-analysis, with a literature search conducted in reputable sources, such as Cochrane, Science Direct, Pub Med, and Google ***: From the initial search, 1 504 relevant studies were identified. After careful analysis, three studies were included in the meta-analysis. The results showed no significant differences in the Melasma Area and Severity Index(MASI) score between monotherapy(control group) and a combination therapy of laser and TXA. The mean difference in MASI score was 1.87(95% confidence interval(CI),-0.78–4.52;P=0.17), indicating no significant difference between the two treatment approaches. Side effects were more common in the combination treatment group than in the control group. The odds ratio for experiencing side effects was 8.85(95% CI, 1.57–50.01;P=0.01).Conclusion: Both the monotherapy and combination therapy groups showed therapeutic improvement;however,the combination therapy group showed a higher incidence of side effects.

关键词： Laser Melasma tranexamic acid

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tranexamic acid in otorhinolaryngology - A contemporary review

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世界耳鼻咽喉头颈外科杂志英文版 2021年第4期7卷 328-337页

作者： Fuzi Jordan Budiono Gideon R. Meller Catherine Jacobson Ian Department of Otolaryngology Head and Neck Surgery Prince of Wales Hospital New South Wales Australia Faculty of Medicine University of New South Wales

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.

关键词： tranexamic acid Otorhinolaryngology Surgery Bleeding