At our place we have been using amicar in the cardiac room since I've been here....just recently we have adopted a total joint protocol using txa....just listened to a podcast out of duke and it seems they are using txa at a specific dose (lower, to avoid seizure). What are you guys using in joints? In cardiac? How much? Every case? What does the data say?
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Amicar vs txa
Started by bkell101
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We use txa 10mg/kg for totals, one dose intraop, and another bag of the same postop, left as a gtt
never had anyone have a seizure with that dose
never had anyone have a seizure with that dose
For Total Joints we use a 10 mg/kg dose of TXA upfront and a second dose 2-3 hours later with no complications after 500+ patients.
http://www.marcqi.org/_pdfs/SpectrumTXAProtocol.pdf
TXA has been shown to be most effective in the early post-operative period (first 3-4 hours) when the majority of blood loss occurs. The half life of TXA is 2-3 hours predominantly cleared by urinary excretion and less than 5% is metabolized. Therapeutic serum levels are maintained for 3 hours after administration with extra-vascular concentrations maintained for up to 17 hours
TXA has been shown to be most effective in the early post-operative period (first 3-4 hours) when the majority of blood loss occurs. The half life of TXA is 2-3 hours predominantly cleared by urinary excretion and less than 5% is metabolized. Therapeutic serum levels are maintained for 3 hours after administration with extra-vascular concentrations maintained for up to 17 hours
We use Amicar for hearts and txa for total joints. Amicar 5 grams before incision 5 on pump and 5 after protamine. We do most of our cabg off pump but they also get a total of 15 g Amicar in 3 doses.
Txa just before incision and second dose in PACU.
Txa just before incision and second dose in PACU.
Are you guys diluting? We use Txa 10mg/kg prior to incision and at the conclusion of the case. Never used anti-fibrinolytics for joints during residency.
We used to use Amicar for hearts. Then there was a manufacturing shortage, so we went to TXA. Then the orthopods started using TXA on joints and we started using TXA in trauma, and we've just kept with it.
I think they're equivalent with respect to antifibrinolytic action. We run ROTEMs on some of our hearts, and I pretty much never see any fibrinolysis.
There seems to be a (small) survival benefit of TXA in trauma independent of its antifibrinolytic action. More work being done on this out there.
http://emcrit.org/wp-content/uploads/2012/02/TXA-in-trauma-How-should-we-use-it.pdf
I think they're equivalent with respect to antifibrinolytic action. We run ROTEMs on some of our hearts, and I pretty much never see any fibrinolysis.
There seems to be a (small) survival benefit of TXA in trauma independent of its antifibrinolytic action. More work being done on this out there.
http://emcrit.org/wp-content/uploads/2012/02/TXA-in-trauma-How-should-we-use-it.pdf
Oh, and our doses would be considered small, but by ROTEM they're effective. We bolus 10mg/kg TXA and then run 2mg/kg/hr, less in renal failure. That's really all you need.
Thanks for the PDF...that is exactly what we are doing....knees with a tourniquet two divided doses 10 mg/kg and hips one dose of 20 mg/kg up front
In our cardiac room we are using 5 g prior to incision , running an infusion , and blousing another 5 when we go on pump.....usually end up with a total of 15 for the case....is there anything out there that says txa may have less renal failure post cardiac surgery?
