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Effects of low‐dose epinephrine on perioperative hemostasis and inflammatory reaction in major surgical operations: a randomized clinical trial
Author(s) -
Liu J. L.,
Zeng W. N.,
Wang F. Y.,
Chen C.,
Gong X. Y.,
Yang H.,
Tan Z. J.,
Jia X. L.,
Yang L.
Publication year - 2018
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13896
Subject(s) - medicine , tranexamic acid , perioperative , anesthesia , epinephrine , hemostasis , randomized controlled trial , fibrinolysis , surgery , thrombosis , blood transfusion , blood loss
Essentials Blood loss and immune reaction are closely related to morbidity and recovery after surgery. We studied the effect of epinephrine plus tranexamic acid on blood loss and immune reaction. Epinephrine plus tranexamic acid reduced postoperative total blood loss and immune reaction. Epinephrine plus tranexamic acid did not increase the incidence of complications.Summary Background Hemostasis, thrombosis and surgical stress‐induced immune reactions are important for perioperative morbidity and recovery after major surgical operations. Objectives To evaluate the effects of combined administration of low‐dose epinephrine ( LDEPI ) and tranexamic acid ( TXA ) on perioperative blood loss, thromboembolic complications and inflammatory responses in patients undergoing total hip arthroplasty ( THA ). Patients/Methods Patients scheduled for THA ( n = 195) were randomized into three interventions: intravenous LDEPI plus TXA (group IV ); topical diluted epinephrine plus TXA (group TP ); and TXA alone as control (group CT ). The primary outcome was perioperative blood loss on postoperative day ( POD ) 1. Secondary outcomes included perioperative blood loss on POD 3, intraoperative blood loss, volume of drainage, transfusion values, coagulation and fibrinolysis parameters, inflammatory cytokine levels, cases of thrombosis, intravenous fluid on the operation day, and length of hospital stay. Results The mean calculated amounts of total blood loss in groups IV , TP and CT were 631.2 m L , 760.5 m L , and 825.6 m L , respectively, on POD 1; treatment effects (differences) were 194.4 m L (95% confidence interval [ CI ] 146.7–242.0) and 65.0 m L (95% CI 17.4–112.7). Groups IV and TP had lower levels of proinflammatory cytokines (tumor necrosis factor‐α and interleukin [ IL ]‐1β) and higher levels of the anti‐inflammatory cytokine IL ‐10, and showed faster development of coagulation and fibrinolysis (without change in peak levels), than group CT early postoperation. No differences were observed in transfusion, thromboembolic and other outcomes among the groups. Conclusion The combined administration of LDEPI and TXA was more effective in reducing perioperative blood loss and alleviating the inflammatory response than TXA alone, without increasing the incidence of thromboembolic and other complications.