Secondary Hemorrhage after Myomectomy
Rooma Sinha, Arnold P. Advincula, Kurian Joseph in FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
As a dictum, when a patient presents with severe bleeding, management includes hemodynamic resuscitation, stabilization, and control of the source of bleeding. Tranexamic acid can be tried initially for control of bleeding. If bleeding does not respond to conservative approaches, conventional surgery and pelvic angioembolization must be kept in mind. As evidence suggests, for any patient with secondary hemorrhage after myomectomy (hysteroscopic, laparotomy, or laparoscopic), a high index of suspicion for a pseudoaneurysm must be kept in mind. On ultrasonography, a pseudoaneurysm appears like a well-defined hypoechoic/anechoic cystic structure which may be associated with a hematoma at the previous myomectomy site [16] with turbulent blood flow on color Doppler. However, 3D computed tomography (CT) angiography is the preferred modality for a more accurate diagnosis of a pseudoaneurysm [17]. Once the diagnosis of a pseudoaneurysm has been established, management by transarterial embolization of the pseudoaneurysm should be discussed in detail with the patient [15–20]. Even in the absence of a pseudoaneurysm, if there is an obvious bleeder on angiography, embolization of the uterine artery has been shown to be a safe and effective method in stopping hemorrhage from its pseudoaneurysm/bleeding branch, as shown in various past studies. At the time of embolization, it is important that along with all the major feeding vessels, collateral supply from the opposite uterine artery is also taken care of to prevent a recurrence and rebleed. The first report of transarterial embolization for secondary hemorrhage after myomectomy was made by Zorlu et al. [18], where the patient was embolized on postoperative day 7. On angiography, the authors found bilaterally dilated uterine arteries with complex dispersion of distal parts of the artery on the side of removal of myoma.
Effects of Tranexamic Acid on Death, Vascular Occlusive Events, and Blood Transfusion in Trauma Patients with Significant Hemorrhage (CRASH-2): A Randomized, Placebo-Controlled Trial
Stephen M Cohn, Ara J. Feinstein in 50 Landmark Papers every Trauma Surgeon Should Know, 2019
Background Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients. Methods This randomized controlled trial was undertaken in 274 hospitals in 40 countries. 20,211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 hours of injury to either tranexamic acid (loading dose 1 gram over 10 minutes then infusion of 1 gram over 8 hours) or matching placebo. Randomization was balanced by center, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial coordinating center staff) were masked to treatment allocation. The primary outcome was death in the hospital within 4 weeks of injury, and was described with the following categories: bleeding, vascular occlusion (myocardial infarction, stroke, and pulmonary embolism), multiorgan failure, head injury, and other. All analyses were by intention to treat. This study is registered as ISRCTN86750102 clinicaltrials.gov NCT00375258 and South African Clinical Trial Register DOH-27-0607-1919. Findings 10,096 patients were allocated to tranexamic acid, and 10,115 to placebo, of whom 10,060 and 10,067, respectively, were analyzed. All-cause mortality was significantly reduced with tranexamic acid (1463 [14.5%] tranexamic
Shock Management
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
Tranexamic acid is an anti-fibrinolytic agent and reduces bleeding by inhibiting the breakdown of fibrin clots. Administration of tranexamic acid within 3 hours of bleeding reduces deaths from bleeding in patients with trauma and post-partum haemorrhage. – Recent meta-analysis has confirmed that tranexamic acid improves survival, but treatment delay reduces the benefit. Every 15 minutes of treatment delay appears to decrease the treatment benefit by about 10% with no benefit after 3 hours.
Skin permeation and retention of topical bead formulation containing tranexamic acid
Published in Journal of Cosmetic and Laser Therapy, 2017
Ajay Vijayakumar, Rengarajan Baskaran, Bong Kyu Yoo
The objective of this study is to develop a topical bead formulation of tranexamic acid (TA) which can be used concomitantly with laser treatment. The bead formulation of TA (TAB) was successfully prepared by fluidized bed drying method. Physicochemical properties of the TAB were evaluated in terms of chemical stability of TA and differential scanning calorimetry. TA in the bead was stable up to six months at 25°C and existed as amorphous state. In vitro skin permeation and in vivo skin retention of TA in the beads were significantly higher compared to a commercial product. When the bead was dissolved into distilled water and applied concomitantly with laser treatment, the amount of TA retained in the skin in the in vivo study was inversely proportional to the energy levels of laser treatment, indicating absorption into subcutaneous tissue and drainage to systemic circulation. Therefore, when laser treatment is used concomitantly with TAB, energy level should be very carefully monitored to avoid possible adverse events associated with systemic side effects of TA.
Efficacy of tranexamic acid in reducing blood loss after cesarean section
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2009
Leila Sekhavat, Afsar Tabatabaii, Maryam Dalili, Tahminah Farajkhoda, Atefah Dehghani Tafti
Aim. To assess the efficacy and safety of tranexamic acid in reducing blood loss at caesarian section (CS). Method. A prospective randomised study conducted on 90 primiparas divided into two groups who underwent CS. The study group, 45 women, received tranexamic acid immediately before CS, whereas the control group, 45 women received placebo. Blood loss volume was measured from the end of CS to 2 h postpartum and compared between the two groups. Hemoglobin (Hb) and hematocrit (Hct) were tested 24 h after CS and compared between the two groups. Results. Tranexamic acid significantly reduced the blood loss from the end of CS to 2 h postpartum; 28.02 ± 5.53 mL in the tranexamic group versus 37.12 ± 8.97 mL in the control group (p = 0.000). Hb 24 h after CS was significantly greater in tranexamic group than control group (12.57 ± 1.33 in the tranexamic group and 11.74 ± 1.14 in the control group, p = 0.002). No complications or side effects were reported in either group. Conclusions. Tranexamic acid statistically reduces blood loss from end to 2 h after CS and its use was not associated with any side effects or complications. Consequently, tranexamic acid can be used safely and effectively to reduce bleeding resulting from CS.
Role of oral tranexamic acid in melasma patients treated with IPL and low fluence QS Nd:YAG laser
Published in Journal of Dermatological Treatment, 2013
Hyun Hee Cho, Mira Choi, Soyun Cho, Jong Hee Lee
Background: Recently, tranexamic acid (TNA) containing oral medication has gained public attention, claiming for whitening effects. Objective: This study was performed to evaluate the clinical efficacy and safety of oral TNA as an adjuvant to intense pulsed light (IPL) and laser treatment in melasma. Methods: A total of 51 patients were included in the study. Patients who have been on oral TNA during IPL and laser treatments (group A) and those who were treated with only IPL and laser (group B) were analyzed (from winter to summer). Modified melasma area and severity index (mMASI) scores were blindly evaluated by two investigators using digital photographs taken at each visit. Results: The mean modified MASI score decreased from 11.33 ± 7.07 to 6.21 ± 5.04 in group A and from 11.70 ± 6.72 to 8.93 ± 5.89 in group B (baseline vs. 2 weeks after the last treatment, p = 0.005). Modified MASI score right before and after IPL were more reduced in group A. No serious adverse effects were reported up to 8 months of oral TNA medication. Conclusion: Oral TNA may improve clinical efficacy in light- or laser-based melasma treatment especially during the period of relative high sun exposure without serious adverse effects.
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