Mostrando entradas con la etiqueta hemorragia. Mostrar todas las entradas
Mostrando entradas con la etiqueta hemorragia. Mostrar todas las entradas

jueves, 22 de julio de 2021

La eficacia y seguridad del tratamiento con ácido tranexámico en la cirugía de traumatismos ortopédicos

 https://www.ortopedia-traumatologia.mx/academia/la-eficacia-y-seguridad-del-tratamiento-con-acido-tranexamico-en-la-cirugia-de-traumatismos-ortopedicos/


La eficacia y seguridad del tratamiento con ácido tranexámico en la cirugía de traumatismos ortopédicos





  • »: El ácido tranexámico (TXA) es un fármaco que se utiliza para controlar la hemorragia al prevenir la degradación de la fibrina.
  • »: TXA es un tratamiento rentable para pacientes traumatizados en una variedad de entornos económicos.
  • »: Las preocupaciones sobre el ATX que causa eventos tromboembólicos (ETE) en pacientes con traumatismos ortopédicos no están respaldadas por pruebas.
  • »: Se ha demostrado que el ATX reduce la pérdida de sangre en la cirugía de fractura de cadera.

https://pubmed.ncbi.nlm.nih.gov/34270510/

https://journals.lww.com/jbjsreviews/Abstract/2021/07000/The_Efficacy_and_Safety_of_Tranexamic_Acid.9.aspx

https://jbjs.org/reader.php?id=209444&rsuite_id=2957501&native=1&topics=ta+bs&source=JBJS_Reviews%2F9%2F7%2Fe20.00292%2Fabstract#info

Perskin CR, Littlefield CP, Wang C, Umeh U, Egol KA. The Efficacy and Safety of Tranexamic Acid Treatment in Orthopaedic Trauma Surgery. JBJS Rev. 2021 Jul 16;9(7). doi: 10.2106/JBJS.RVW.20.00292. PMID: 34270510.

Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.




miércoles, 24 de mayo de 2017

Hemorragia postparto / Postpartum hemorrhage

Mayo 24, 2017. No. 2698






Efecto de la administración temprana de ácido tranexámico sobre la mortalidad, histerectomía, y otras morbilidades en mujeres con hemorragia postparto (WOMEN). Estudio internacional, aleatorizado, doble ciego controlado.
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial
Lancet. 2017 Apr 26. pii: S0140-6736(17)30638-4. doi: 10.1016/S0140-6736(17)30638-4. [Epub ahead of print]
 Summary
Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15000 to 20000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10051) or placebo (n=10 009), of whom 10036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65-1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52-0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88-1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.

El estudio WOMAN (World Maternal Antifibrinolytic Trial). Ácido tranexámico en el manejo de la hemorragia postparto. Estudio internacional, aleatorizado, doble ciego controlado.
The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial.
Trials. 2010 Apr 16;11:40. doi: 10.1186/1745-6215-11-40.
Abstract
BACKGROUND: Each year, worldwide about 530,000 women die from causes related to pregnancy and childbirth. Of the deaths 99% are in low and middle income countries. Obstetric haemorrhage is the leading cause of maternal mortality, most occurring in the postpartum period. Systemic antifibrinolytic agents are widely used in surgery to prevent clot breakdown (fibrinolysis) in order to reduce surgical blood loss. At present there is little reliable evidence from randomised trials on the effectiveness of tranexamic acid in the treatment of postpartum haemorrhage. METHODS: The Trial aims to determine the effect of early administration of tranexamic acid on mortality, hysterectomy and othermorbidities (surgical interventions, blood transfusion, risk of non-fatal vascular events) in women with clinically diagnosed postpartumhaemorrhage. The use of health services and safety, especially thromboembolic effect, on breastfed babies will also be assessed. The trial will be a large, pragmatic, randomised, double blind, placebo controlled trial among 15,000 women with a clinical diagnosis of postpartum haemorrhage. All legally adult women with clinically diagnosed postpartum haemorrhage following vaginal delivery of a baby or caesarean section will potentially be eligible. The fundamental eligibility criterion is the responsible clinician's 'uncertainty' as to whether or not to use an antifibrinolytic agent in a particular woman with postpartum haemorrhage. Treatment will entail a dose of tranexamic acid (1 gram by intravenous injection) or placebo (sodium chloride 0.9%) will be given as soon as possible after randomisation. A second dose may be given if after 30 minutes bleeding continues, or if it stops and restarts within 24 hours after the first dose. The main analyses will be on an 'intention to treat' basis, irrespective of whether the allocated treatment was received or not. Subgroup analyses for the primary outcome will be based on type of delivery; administration or not of prophylactic uterotonics; and on whether the clinical decision to consider trial entry was based primarily on estimated blood loss alone or on haemodynamic instability. A study with 15,000 women will have over 90% power to detect a 25% reduction from 4% to 3% in the primary endpoint of mortality or hysterectomy.
TRIAL REGISTRATION: ClinicalTrials.gov NCT00872469.

Bajo presión: Presiones de llenado intraluminal de los globos de taponamiento en hemorragia postparto.
Under Pressure: Intraluminal Filling Pressures of Postpartum Hemorrhage Tamponade Balloons.
AJP Rep. 2017 Apr;7(2):e86-e92. doi: 10.1055/s-0037-1602657.
Postpartum hemorrhage (PPH) affects 2.9 to 4.3% of deliveries in North America with 0.3% characterized as severe,1-3 and it consistently ranks among the leading causes of pregnancy-related deaths in both developed and low-resource countries.....





IX Foro Internacional de Medicina del Dolor y Paliativa
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 8 al 10 de Junio
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miércoles, 10 de mayo de 2017

Hemorragia obstétrica / Obstetric hemorrhage

Abril 21, 2017. No. 2666







Manejo del sangrado masivo en pacientes obstétricas Testigos de Jehova. La abrumadora importancia de un protocolo multidisciplinario preestablecido.
Management of massive bleeding in a Jehovah's Witness obstetric patient: the overwhelming importance of a pre-established multidisciplinary protocol.
Blood Transfus. 2016 Jul 12;14(6):541-544. doi: 10.2450/2016.0229-15. [Epub ahead of print]
Introduction
Life-threatening massive bleeding is doubtlessly one of the biggest challenges in health care, especially in patients who reject allogeneic transfusion, such as Jehovah's Witnesses. However, according to the principle of patients' autonomy, our job is to accept their decision and provide them with the best possible assistance. We present a protocol for the management of massive post-operative bleeding successfully applied in a Jehovah's Witness after a Caesarean section (CS).

Listas de verificación y desempeño multidisciplinario del equipo durante la hemorragia obstétrica simulada.
Checklists and multidisciplinary team performance during simulated obstetric hemorrhage.
Int J Obstet Anesth. 2016 Feb;25:9-16. doi: 10.1016/j.ijoa.2015.08.011. Epub 2015 Aug 21.
Abstract
BACKGROUND: Checklists can optimize team performance during medical crises. However, there has been limited examination of checklist use during obstetric crises. In this simulation study we exposed multidisciplinary teams to checklist training to evaluate checklist use and team performance during a severe postpartum hemorrhage. METHODS: Fourteen multidisciplinary teams participated in a postpartum hemorrhage simulation occurring after vaginal delivery. Before participating, each team received checklist training. The primary study outcome was whether each team used the checklist during the simulation. Secondary outcomes were the times taken to activate our institution-specific massive transfusion protocol and commence red blood cell transfusion, and whether a designated checklist reader was used. RESULTS: The majority of teams (12/14 (86%)) used the checklist. Red blood cell transfusion was administered by all teams. The median [IQR] times taken to activate the massive transfusion protocol and transfuse red blood cells were 5min 14s [3:23-6:43] and 14min 40s [12:56-17:28], respectively. A designated checklist reader was used by 7/12 (58%) teams that used the checklist. Among teams that used a checklist with versus without a designated reader, we observed no differences in the times to activate the massive transfusion protocol or to commence red blood cell transfusion (P>0.05). CONCLUSIONS: Although checklist training was effective in promoting checklist use, multidisciplinary teams varied in their scope of checklist use during a postpartum hemorrhage simulation. Future studies are required to determine whether structured checklist training can result in more standardized checklist use during a postpartum hemorrhage.
KEYWORDS: Checklist; Multidisciplinary; Obstetrics; Postpartum hemorrhage; Simulation
PDF 

Manejo transfusional y de la coagulación en hemorragia obstétrica severa
Transfusion and coagulation management in major obstetric hemorrhage.
Curr Opin Anaesthesiol. 2015 Jun;28(3):275-84. doi: 10.1097/ACO.0000000000000180.
Abstract
PURPOSE OF REVIEW: Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage. RECENT FINDINGS: Epidemiologic studies indicate that rates of severe postpartum hemorrhage (PPH) in well resourced countries are increasing. Despite these increases, rates of transfusion in obstetrics are low (0.9-2.3%), and investigators have questioned whether a predelivery 'type and screen' is cost-effective for all obstetric patients. Instead, blood ordering protocols specific to obstetric patients can reduce unnecessary antibody testing. When severe PPH occurs, a massive transfusion protocol has attracted interest as a key therapeutic resource by ensuring sustained availability of blood products to the labor and delivery unit. During early postpartum bleeding, recent studies have shown that hypofibrinogenemia is an important predictor for the later development of severe PPH. Point-of-care technologies, such as thromboelastography and rotational thromboelastometry, can identify decreased fibrin clot quality during PPH, which correlate with low fibrinogen levels.
SUMMARY: A massive transfusion protocol provides a key resource in the management of severe PPH. However, future studies are needed to assess whether formula-driven vs. goal-directed transfusion therapy improves maternal outcomes in women with severe PPH.

Foro Internacional de Medicina Crítica
Ciudad de México, Julio 13-15, 2017
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Anestesiología y Medicina del Dolor

52 664 6848905