Tranexamic acid applied topically to achieve haemostasis
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".