Tranexamic acid applied topically to achieve haemostasis
Notice bibliographique
Résumé
Tranexamic acid is an antifibrinolytic agent that may be administered orally or by intravenous injection to reduce bleeding following procedures such as prostatectomy and dental extraction. Use of this agent is, however, contraindicated in patients with a history of thromboembolic disease. We report a case in which tranexamic acid was used topically to stop bleeding in a patient in whom such a contraindication prevented its intravenous use. A 75-year-old male patient presented for excision of a large left-sided parotid pleomorphic adenoma. His past medical history included hypertension, a gait and balance disorder (believed to be a variant of Parkinson's disease) and transient ischaemic attacks. As a result of the latter he was prescribed aspirin 75 mg and dipyridamole 25 mg daily. One hour after an uneventful excision of the tumour, bleeding and swelling around the neck and face were noted and re-exploration was required. Following an awake fibreoptic intubation, general anaesthesia was re-established and surgical exploration revealed brisk oozing that persisted despite diathermy. The use of intravenous tranexamic acid (Cyclokapron) was considered but because of the patient's history of thromboembolic disease we decided instead to soak gauze swabs with 1000 mg of this agent and apply it directly into the wound. Following this manoeuvre, bleeding ceased and there were no further complications. We have been unable to find any other reports describing the topical use of tranexamic acid as a means of treating intra-operative haemorrhage. There are, however, reports confirming effective topical application when combined with another haemostatic agent (carbazochrome sodium sulphonate) to reduce bleeding following total knee arthroplasty [1] and also as an enema to stop rectal bleeding [2]. The prompt response to direct application of the drug in our patient suggests a beneficial local effect but we were unable to measure the plasma level to determine the degree of systemic absorption. There is, however, one study (in rabbits) that compares systemic levels of tranexamic acid following topical and intravenous administration [3]. This reported significantly lower serum concentrations following topical application (to the eye) than after intravenous administration. We would therefore suggest that topical administration of tranexamic acid may be of benefit in reducing bleeding from surgical wounds and be associated with less risk of thromboembolism than may occur with intravenous administration.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».