Effects of intravenous tranexamic acid on bleeding during burn surgery: A double-blinded randomized clinical trial

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns Pub Date : 2024-09-21 DOI:10.1016/j.burns.2024.09.009

Mohsen Abaspour Naderi , Anoush Dehnadi Moghadam , Mohammadreza Mobayen , Siamak Rimaz , Zahra Haghani-Dogahe , Sajjad Roudsarabi , Mohammad Tolouei , Reza Zarei

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引用次数: 0

Abstract

Blood loss during burn surgery significantly contributes to morbidity and mortality. Tranexamic acid (TXA), an antifibrinolytic agent, is hypothesized to reduce intraoperative bleeding. This double-blinded, randomized clinical trial aimed to assess the efficacy of systemic TXA in severe burn patients (total body surface area [TBSA] > 20 %) undergoing surgery. The study evaluated the impact of TXA on surgical bleeding, operating room (OR) time, intravenous (IV) fluid requirements, length of hospital stay (LOS), and overall patient outcomes. A total of 94 patients, with equal distribution in age, sex, and TBSA, were randomly assigned into two groups (47 each). We administered TXA as a 10 mg/kg loading dose followed by a 1 mg/kg/h infusion during surgery. Results demonstrated significant reductions in blood loss (P = 0.043), total IV fluid volume (P = 0.021), OR time (P = 0.002), LOS (P = 0.0001), and transfusions (P = 0.024) in the TXA group. Notably, women and patients without inhalation injuries exhibited better responses to TXA treatment, and graft survival was lower in the TXA group. The study concludes that IV TXA administration during burn surgery can reduce bleeding, minimize IV fluid and blood transfusion needs, and shorten surgery duration, enhancing overall surgical outcomes.

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静脉注射氨甲环酸对烧伤手术出血的影响：双盲随机临床试验。

烧伤手术中的失血是导致发病率和死亡率的重要原因。氨甲环酸（TXA）是一种抗纤维蛋白溶解剂，被认为可以减少术中出血。这项双盲随机临床试验旨在评估全身使用氨甲环酸对接受手术的重度烧伤患者（总体表面积 [TBSA] > 20%）的疗效。研究评估了TXA对手术出血、手术室（OR）时间、静脉注射液（IV）需求、住院时间（LOS）和患者总体预后的影响。共有 94 名患者被随机分配到两组（每组 47 人），他们的年龄、性别和 TBSA 分布均等。我们在手术期间以 10 毫克/千克的负荷剂量输注 TXA，然后每小时输注 1 毫克/千克。结果显示，TXA 组患者的失血量（P = 0.043）、静脉输液总量（P = 0.021）、手术时间（P = 0.002）、LOS（P = 0.0001）和输血量（P = 0.024）均明显减少。值得注意的是，女性和没有吸入性损伤的患者对 TXA 治疗的反应更好，而 TXA 组的移植物存活率较低。研究得出结论：在烧伤手术中静脉注射 TXA 可以减少出血，最大限度地减少静脉输液和输血需求，缩短手术时间，从而提高整体手术效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Burns 医学-皮肤病学

CiteScore

4.50

自引率

18.50%

发文量

304

审稿时长

72 days

期刊介绍： Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice. Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.