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Evaluation of Local Intra-Pleural Application of Tranexamic Acid on Postoperative Blood Loss in Lung Decortication Surgery, A Prospective, Randomized, Double-Blind, Placebo-controlled Study

BACKGROUND: During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tra...

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Autores principales: Sabry, Mohab M, Sallam, Ayman A, Elgebaly, Ahmed Said, Abdelwahab, Amr A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206794/
https://www.ncbi.nlm.nih.gov/pubmed/30333336
http://dx.doi.org/10.4103/aca.ACA_231_17
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author Sabry, Mohab M
Sallam, Ayman A
Elgebaly, Ahmed Said
Abdelwahab, Amr A
author_facet Sabry, Mohab M
Sallam, Ayman A
Elgebaly, Ahmed Said
Abdelwahab, Amr A
author_sort Sabry, Mohab M
collection PubMed
description BACKGROUND: During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding. PATIENTS AND METHODS: A total of 70 patients underwent lung decortication surgery in Cardiothoracic Surgery Department at Tanta University Hospital from January 2015 to May 2017. Patients were randomly allocated into two groups, Group I (35 patients) receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II (35 patients) receiving 100 ml of saline solution as placebo. At the end of the operation and before closing the chest, in both groups, drug or placebo solution was distributed locally all over the pleural cavity. Comparison between the groups was done regarding the amount of postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and hospital stay. RESULTS: Both groups were comparable regarding demographic and surgical data. Group I patients had the significantly lesser amount of postoperative blood loss than Group II during the first postoperative 48 h, and hence, the need of postoperative blood transfusion was significantly lower in Group I with better postoperative hemoglobin level than Group II. However, there was no difference in overall ICU and hospital stay. CONCLUSION: The local intrapleural use of tranexamic acid after decortication surgery of the lung is safe and significantly reduces the amount of postoperative blood loss and in consequence reduces the amount of postoperative blood transfusion.
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spelling pubmed-62067942018-11-21 Evaluation of Local Intra-Pleural Application of Tranexamic Acid on Postoperative Blood Loss in Lung Decortication Surgery, A Prospective, Randomized, Double-Blind, Placebo-controlled Study Sabry, Mohab M Sallam, Ayman A Elgebaly, Ahmed Said Abdelwahab, Amr A Ann Card Anaesth Original Article BACKGROUND: During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding. PATIENTS AND METHODS: A total of 70 patients underwent lung decortication surgery in Cardiothoracic Surgery Department at Tanta University Hospital from January 2015 to May 2017. Patients were randomly allocated into two groups, Group I (35 patients) receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II (35 patients) receiving 100 ml of saline solution as placebo. At the end of the operation and before closing the chest, in both groups, drug or placebo solution was distributed locally all over the pleural cavity. Comparison between the groups was done regarding the amount of postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and hospital stay. RESULTS: Both groups were comparable regarding demographic and surgical data. Group I patients had the significantly lesser amount of postoperative blood loss than Group II during the first postoperative 48 h, and hence, the need of postoperative blood transfusion was significantly lower in Group I with better postoperative hemoglobin level than Group II. However, there was no difference in overall ICU and hospital stay. CONCLUSION: The local intrapleural use of tranexamic acid after decortication surgery of the lung is safe and significantly reduces the amount of postoperative blood loss and in consequence reduces the amount of postoperative blood transfusion. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC6206794/ /pubmed/30333336 http://dx.doi.org/10.4103/aca.ACA_231_17 Text en Copyright: © 2018 Annals of Cardiac Anaesthesia http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Sabry, Mohab M
Sallam, Ayman A
Elgebaly, Ahmed Said
Abdelwahab, Amr A
Evaluation of Local Intra-Pleural Application of Tranexamic Acid on Postoperative Blood Loss in Lung Decortication Surgery, A Prospective, Randomized, Double-Blind, Placebo-controlled Study
title Evaluation of Local Intra-Pleural Application of Tranexamic Acid on Postoperative Blood Loss in Lung Decortication Surgery, A Prospective, Randomized, Double-Blind, Placebo-controlled Study
title_full Evaluation of Local Intra-Pleural Application of Tranexamic Acid on Postoperative Blood Loss in Lung Decortication Surgery, A Prospective, Randomized, Double-Blind, Placebo-controlled Study
title_fullStr Evaluation of Local Intra-Pleural Application of Tranexamic Acid on Postoperative Blood Loss in Lung Decortication Surgery, A Prospective, Randomized, Double-Blind, Placebo-controlled Study
title_full_unstemmed Evaluation of Local Intra-Pleural Application of Tranexamic Acid on Postoperative Blood Loss in Lung Decortication Surgery, A Prospective, Randomized, Double-Blind, Placebo-controlled Study
title_short Evaluation of Local Intra-Pleural Application of Tranexamic Acid on Postoperative Blood Loss in Lung Decortication Surgery, A Prospective, Randomized, Double-Blind, Placebo-controlled Study
title_sort evaluation of local intra-pleural application of tranexamic acid on postoperative blood loss in lung decortication surgery, a prospective, randomized, double-blind, placebo-controlled study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206794/
https://www.ncbi.nlm.nih.gov/pubmed/30333336
http://dx.doi.org/10.4103/aca.ACA_231_17
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