Dose of tranexamic acid

RE: Dose of tranexamic acid

Julie Innes — Thu, 28 Sep 2017 08:47:47 GMT

Thanks Rob!

RE: Dose of tranexamic acid

Rob Loxley — Wed, 27 Sep 2017 19:42:03 GMT

[quote user="Julie Innes"]where are you getting your tranexamic acid from?[/quote]

Munro Vet Supplies:

Tranexamic acid 500mg tabs	Tran60	60 tabs	£16.50
Tranexamic acid Inj 500mg/5ml	Tran50	5x5ml	£9.35

RE: Dose of tranexamic acid

Lindsey Edwards — Wed, 27 Sep 2017 18:28:18 GMT

I use cyklokapron (i/v or oral prep) - cheap and worth considering given history. I do not use routinely but always add in if any concern (would rather add a small amount than blood transfusions!). Maybe US genetic profile is different - I don't see that high a prevalence either but do encounter some mild/moderate surgical site bleeding in 1/30; resolved with cyclokapron

RE: Dose of tranexamic acid

Julie Innes — Wed, 27 Sep 2017 16:07:23 GMT

Just as a slight aside, where are you getting your tranexamic acid from? I've used it once in a greyhound with a very keen owner- I think we gave her a prescription for the oral form.

I do a LOT of greyhound neuterings/ amputations/ dentals (we work with RGT dogs, have 4 in for neutering this week alone!) and have never had any issues without it, but I have a dog coming in today for a clotting profile which is to be neutered next week (apparently he develops bruises easily after racing), so it may be worth considering, but I can't see it from our wholesaler.

TIA

RE: Dose of tranexamic acid

gerard mclauchlan — Tue, 26 Sep 2017 22:35:05 GMT

Hi,

Typically the vomiting associated with tranexamic acid is dose dependent and normally seen in IV doses > 15mg/kg when given rapidly (some people are even using high doses as an emetic when apomorphine fails). We use it relatively commonly in our pre surgical sighthounds at 10mg/kg IV BID and not seen vomiting as a problem yet but who knows. Ultimately prospective studies are lacking and there is some suggestions that dogs require much higher doses than we currently give

I tend to use it at time of surgery or just prior based on the paper below looking at epsilon-aminocaproic acid (EACA)

Retrospective evaluation of the effectiveness of epsilon aminocaproic acid for the prevention of postamputation bleeding in retired racing Greyhounds with appendicular bone tumors: 46 cases (2003–2008)

Liliana M. Mar ́ın, DVM, MSc; M. Cristina Iazbik, DVM; Sara Zaldivar-Lopez, DVM, MSc; Linda K. Lord, DVM, MSc, PhD; Nicole Stingle, RVT; Paulo Vilar, DVM, MSc; Ana Lara-Garcia, DVM, MSc, PhD, DACVIM, MRCVS; Francisco Alvarez, DVM, MSc, DACVIM; Kenji Hosoya, DVM, MSc, DACVR; Laura Nelson, DVM, DACVS; Antonio Pozzi, DVM, MS, DACVS; Edward Cooper, VMD, MSc, DACVECC; Mary A. McLoughlin, DVM, MSc, DACVS; Rebecca Ball, DVM, MSc, DACVS; William C. Kisseberth, DVM, MSc, PhD, DACVIM; Cheryl A. London, DVM, PhD, DACVIM; Robert Dudley, DVM, MS, DACVS; Jonathan Dyce, MA, VetMB, MRCVS, DSAO, DACVS; Melanie McMahon, DVM, MSc, DACVIM; Phillip Lerche, BVSc, PhD, DACVA; Richard Bednarski, VM, MSc, DACVA and C. Guillermo Couto, DVM, DACVIM

Abstract

Objectives – To determine the frequency of delayed postoperative bleeding in retired racing Greyhounds with appendicular bone tumors undergoing limb amputations. To identify if administration of epsilon-aminocaproic acid (EACA) was effective on the prevention of postoperative bleeding.

Design – Retrospective study from December 2003 to December 2008.

Setting – Veterinary university teaching hospital.

Animals – Forty-six retired racing Greyhounds (RRGs) diagnosed with primary appendicular bone tumors that underwent limb amputation were included in the study.

Measurements and Main Results – Thirteen of 46 RRGs (28%) included in the study had delayed postoperative bleeding starting 48–72 h after surgery. Bleeding episodes included cutaneous, subcutaneous, and external bleeding that extended from the area of the surgical site that became widespread within hours, and that required administration of blood components. A paired t-test suggests that there was a significant decrease in PCV postoperatively for both dogs that bled and dogs that did not bleed (P < 0.0001). Forty of 46 RRGs (86%) received either fresh frozen plasma (FFP) or EACA or both, for the prevention of postoperative bleeding. A logistic regression model determined that dogs that did not receive EACA were 5.7 times more likely to bleed than dogs that did receive EACA, when controlling for whether or not they received FFP (95% CI: 1.02–32.15, P = 0.047).

Conclusion – This retrospective study suggests that preemptive postoperative administration of EACA appears to be efficacious in decreasing the frequency of bleeding in RRGs undergoing limb amputation; however, a prospective study is warranted to corroborate its effectiveness.

RE: Dose of tranexamic acid

Lindsey Edwards — Tue, 26 Sep 2017 20:33:09 GMT

I tend to give orally at ~15mg/kg q8hours x3days; generally start at recovery if any concerns or if any patient/familial history of bleeding episodes. Anecdotally bleeding tends to occur 36-48hours post surgery as the clot dissolves so prefer to focus treatment on post-op window as preferred to pre-op. IV admin associated with vomiting, seems to be less with oral admin. Operate on many greys including amputations and rescue spays at all stages of heat cycle and do not encounter many bleeding crises and none where treated as above.

To OP - I would not generally administer for toe amputation/foot surgery as haemostasis should be easily achieved surgically followed by 48hours of bandage (I would expect no more than 5ml /1 swab in bandage of bleeding following such procedure)

RE: Dose of tranexamic acid

gerard mclauchlan — Mon, 25 Sep 2017 13:06:06 GMT

Hi,

I give 10mg/kg IV BID. I normally recommend starting the day before surgery in elective cases and continue for 3-4 days afterwards.

Gerard