Understanding the Mechanism and Chemical Properties of Tranexamic Acid and Its Applications in Orthopedics, Specifically Trauma Patients

Transcription

1 Understanding the Mechanism and Chemical Properties of Tranexamic Acid and Its Applications in Orthopedics, Specifically Trauma Patients Temple University Hospital Anastassia Newbury M.D. Christopher Haydel M.D. Chava Blivaiss B.A.

2 <Understanding the Mechanism and Chemical Properties of Tranexamic Acid and Its Applications in Orthopedics, Specifically Trauma Patients > <Anastassia Newbury> My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Background Tranexamic acid (TXA) is a safe and cost effective antifibrinolytic agent Utilized for decades during surgical procedures to minimize blood loss Early administration of TXA in trauma patients have decreased mortality rates and need for blood product transfusion No increase in thrombolytic events TXA well documented in the orthopaedic literature as being efficacious in decreasing blood loss during total knee arthroplasty.

4 Mechanism

5 Materials + Methods: CRASH-2

6 Materials + Methods: MATTERs

7 Materials + Methods: Meta-analysis review reduction in blood loss w/ TXA

8 Results TXA is most efficacious when given within an hour of injury and to those patients with more severe injuries with the highest concern for hemorrhage and hyperfibrinolysis

9 Conclusion XA leads to statistically significant decrease in blood loss in both trauma and orthopedic settings and could be beneficial in the field of trauma orthopedic

10 References 1. Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: A randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013;17(10):1-79. doi: /hta17100 [doi]. 2. Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. Br J Surg. 2013;100(10): doi: /bjs.9193 [doi]. 3. Napolitano LM, Cohen MJ, Cotton BA, Schreiber MA, Moore EE. Tranexamic acid in trauma: How should we use it? J Trauma Acute Care Surg. 2013;74(6): doi: /TA.0b013e318292cc54 [doi]. 4. McCormack PL. Tranexamic acid. Drugs [drug info]. 2012;72(5): Jimenez JJ, Iribarren JL, Lorente L, Rodriguez JM, Hernandez D, Nassar I, Perez R, Brouard M, Milena A, Martinez R, Mora ML. Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: A case control study followed by a randomized double-blind controlled trial.. Crit Care. 2007;11(6). 6. Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg. 2012;147(2): doi: /archsurg [doi]. 7. Roberts I, Shakur H, Ker K, Coats T, CRASH-2 Trial collaborators. Antifibrinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev. 2011;(1):CD doi(1):cd doi: / CD pub3 [doi]. 8. Gandhi R, Evans HM, Mahomed SR, Mahomed NN. Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: A meta-analysis. BMC Res Notes. 2013;6: doi: / [doi]. 9. Lemaire R. Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg Br. 2008;90(9): doi: / X.90B [doi]. 10. Sukeik M, Alshryda S, Haddad FS, Mason JM. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br. 2011;93(1): doi: / X.93B [doi]. 11. Zhou XD, Tao LJ, Li J, Wu LD. Do we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen randomized controlled trials. Arch Orthop Trauma Surg. 2013;133(7): doi: /s [doi]. 12. Development, concepts and doctrine centre. Transfusion medicine leaflet : Management of massive haemorrhage on operations. In:. Swindon, england: Development, concepts and doctrine centre. Joint Service Publication 950: Medical Policy Part 2: Clinical Policy Zhi-Gao Yang M, Wei-Ping Chen M, Li-Dong Wu P, MD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: A meta-analysis. J.Bone Joint Surg.Am. 2012;94(13): Huang F, Wu D, Ma G, Yin Z, Wang Q. The use of tranexamic acid to reduce blood loss and transfusion in major orthopedic surgery: A meta-analysis. J Surg Res. 2014;186(1): doi: /j.jss [doi]. 15. Mitra B, Mazur S, Cameron PA, et al. Tranexamic acid for trauma: Filling the 'GAP' in evidence. Emerg Med Australas. 2014;26(2): doi: / [doi].