PMID- 37864195
OWN - NLM
STAT- MEDLINE
DCOM- 20231101
LR  - 20231122
IS  - 2047-783X (Electronic)
IS  - 0949-2321 (Print)
IS  - 0949-2321 (Linking)
VI  - 28
IP  - 1
DP  - 2023 Oct 20
TI  - Role of tranexamic acid-soaked gelatin sponge in minimizing rectus sheath 
      hematoma after cesarean section in women treated with warfarin, a simple tool for 
      high-risk cases, a randomized controlled trial.
PG  - 448
LID - 10.1186/s40001-023-01434-7 [doi]
LID - 448
AB  - BACKGROUND: This study aims to illustrate the impact of applying the tranexamic 
      acid impregnated in a gelatin sponge between the anterior rectus sheath and the 
      Rectus Abdominis muscle during Cesarean section (CS) in minimizing rectus sheath 
      hematoma (RHS) in women treated with Warfarin. METHODS: A clinical trial was 
      carried out on 63 pregnant women attended for elective CS, who on antenatal 
      warfarin anticoagulation started from 13 weeks gestation to 36 weeks then shifted 
      to low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH), and with 
      an indication for postnatal warfarin anticoagulation. They were randomly assigned 
      on the day of the scheduled CS into three equal groups (21 women for each). Group 
      1 had two pieces of gelatin sponges soaked with one ampoule of tranexamic acid. 
      Group 2 had two pieces of gelatin sponges not soaked with tranexamic acid. Group 
      3 (control group) had no gelatin sponge applied. All patients underwent 
      postoperative assessment done for hemoglobin (Hb), hematocrit (HCT), estimated 
      blood loss (EBL), amount and nature of discharge collected from the sub-rectus 
      drain, complications (RHS, wound infection, thromboembolism), need for 
      re-operation, and need for blood transfusion. RESULTS: Statistically significant 
      differences were found between Group 1 and Group 2 regarding the postoperative Hb 
      (10.66 +/- 1.13 vs. 9.77 +/- 0.69, P = 0.009), between Group 1 and Group 2 regarding 
      the postoperative HCT (31.87 +/- 3.59 vs. 28.54 +/- 1.85, P = 0.001), between Group 1 
      and Group 2 regarding EBL (442.19 +/- 244.46 vs. 744.38 +/- 267.05, P = 0.003), 
      between Group 1 and Group 3 regarding EBL (442.19 +/- 244.46 vs. 664.29 +/- 343.97, 
      P = 0.040), and between Group 1 and Group 3 regarding the discharge amount from 
      the sub rectus drain (190.48 +/- 100.77 vs. 307.14 +/- 127.76, P = 0.004). 
      CONCLUSION: Tranexamic acid-soaked gelatin sponges are safe and effective in 
      reducing postoperative drainage and EBL. CLINICAL TRIAL REGISTRATION: At 
      ClinicalTrials.gov in June 2022 (NCT05439694).
CI  - (c) 2023. BioMed Central Ltd., part of Springer Nature.
FAU - Hany, Ayman
AU  - Hany A
AD  - Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, 
      Alkasr Alainy St, Cairo, 11562, Egypt.
FAU - Mansour, Ayman
AU  - Mansour A
AD  - Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, 
      Alkasr Alainy St, Cairo, 11562, Egypt. mansouraymanraed@gmail.com.
FAU - Sediek, Mona
AU  - Sediek M
AD  - Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, 
      Alkasr Alainy St, Cairo, 11562, Egypt.
FAU - Nabil, Mohamed
AU  - Nabil M
AD  - Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, 
      Alkasr Alainy St, Cairo, 11562, Egypt.
LA  - eng
SI  - ClinicalTrials.gov/NCT05439694
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20231020
PL  - England
TA  - Eur J Med Res
JT  - European journal of medical research
JID - 9517857
RN  - 6T84R30KC1 (Tranexamic Acid)
RN  - 9000-70-8 (Gelatin)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Humans
MH  - Female
MH  - Pregnancy
MH  - *Tranexamic Acid/adverse effects
MH  - Gelatin
MH  - Warfarin
MH  - Heparin
MH  - Heparin, Low-Molecular-Weight
MH  - Cesarean Section/adverse effects
MH  - Anticoagulants
MH  - Hematoma/etiology/prevention & control
PMC - PMC10588007
OTO - NOTNLM
OT  - Anticoagulants
OT  - Gelatin sponge
OT  - Rectus sheath hematoma
OT  - Tranexamic acid
COIS- None of the authors has financial or other competing interest.
EDAT- 2023/10/21 05:41
MHDA- 2023/11/01 12:44
PMCR- 2023/10/20
CRDT- 2023/10/20 23:48
PHST- 2023/04/13 00:00 [received]
PHST- 2023/10/06 00:00 [accepted]
PHST- 2023/11/01 12:44 [medline]
PHST- 2023/10/21 05:41 [pubmed]
PHST- 2023/10/20 23:48 [entrez]
PHST- 2023/10/20 00:00 [pmc-release]
AID - 10.1186/s40001-023-01434-7 [pii]
AID - 1434 [pii]
AID - 10.1186/s40001-023-01434-7 [doi]
PST - epublish
SO  - Eur J Med Res. 2023 Oct 20;28(1):448. doi: 10.1186/s40001-023-01434-7.