MedicalResearch.com Interview with:Shawn Anthony, MD, MBA
Assistant Professor of Orthopaedics
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Rates of total shoulder arthroplasty are increasing, especially with an aging population. Blood loss requiring transfusion is less common than in total hip or knee replacements but still required in some patients. Tranexamic acid (TXA) is increasingly used to reduce blood loss in lower extremity arthroplasty but limited data exists for its effectiveness and safety in patients undergoing shoulder arthroplasty. We aimed to utilize national data to assess frequency of use and effectiveness of TXA in shoulder arthroplasty patients.
While utilization of TXA has become very common in total hip and knee arthroplasty, TXA is still used in less than 50% of patients undergoing shoulder arthroplasty as of 2016. TXA use was associated with a 36% decrease in transfusion risk and a 35% decreased risk for combined complications. Moreover, TXA use was associated with 6.2% shorter hospital stay.
MedicalResearch.com Interview with:
Mary A.M. Rogers, PhD, MS
Research Associate Professor
Research Director, Patient Safety Enhancement Program
Department of Internal Medicine
University of Michigan
Ann Arbor, MI
MedicalResearch.com: What is the background for this study? Response: Peripherally inserted central catheters (PICCs) are commonly used for vascular access in hospitalized patients. Previous studies have shown that PICCs of larger gauge (diameter) increase the risk of developing venous thromboembolism (blood clots in the deep veins that sometimes travel to the lung). Red blood cell transfusion is also known to increase the risk of venous thromboembolism. Because PICCs are often used to transfuse blood, we designed a study to investigate whether the method of transfusion delivery influences the risk of developing venous thromboembolism.
MedicalResearch.com Interview with:
Dr. Walter H. Dzik MD
Associate Pathologist, Massachusetts General Hospital
Associate Professor of Pathology
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Dzik: Millions of Red Blood Cell transfusions are given each year. To maintain adequate blood inventories worldwide, Red Blood Cell units are stored under refrigerated conditions. Previous animal and laboratory research has highlighted the fact that red cells undergo biochemical, morphologic, and biophysical changes during prolonged refrigerated blood storage. Researchers and clnicians have questioned whether the changes that occur during storage would impair the ability of transfused Red Cells to delivery oxygen to tissues.
Our study was a randomized controlled trial conducted in patients with extreme anemia and insufficient global tissue oxygenation. We randomly assigned children with severe anemia and lactic acidosis to receive Red Blood Cells stored 1-10 days versus Red Blood Cells stored 25-35 days. We measured the recovery from lactic acidosis in response to transfusion in the two groups. We also measured cerebral tissue oxygenation using a non-invasive tissue oximeter. We found that the proportion of patients who achieved reversal of lactic acidosis was the same in the two RBC storage-duration groups. The rate of decline of lactic acidosis was also equal. There was also no difference in cerebral oxygenation, resolution of acidosis, correction of vital signs, clinical recovery, survival and 30-day followup. (more…)
MedicalResearch.com Interview with:David T. Gilbertson, Ph.D.
Chronic Disease Research Group
Center for Observational Research, Amgen, Inc, Thousand Oaks, CA
MedicalResearch: What were the main findings of the study?Dr. Gilbertson: Since transfusion avoidance is important in patients receiving maintenance hemodialysis, development of a measure of red blood cell transfusion use to assess dialysis facility anemia management is reasonable. Because dialysis facility size varies widely, calculation of a standardized transfusion ratio (STfR) using standard methods is possible, but these methods result in significant instability in estimates for small dialysis facilities. Use of more advanced statistical methods results in standardized transfusion ratio estimates that are considerably more stable and more consistently precise across dialysis facilities of all sizes.
MedicalResearch.com eInterview with Luca Weltert, MD
Cardiac Surgery Department of the European Hospital in Rome,
Presentation during the Plenary Scientific Session of the
93rd AATS Annual Meeting in Minneapolis.
MedicalResearch.com: What are the main findings of the study?Dr. Luca Weltert:This study illustrates the efficacy of Human Recombinant Erythropoietin (HRE) in avoiding blood transfusions in the heart surgery setting. And aside from complicated number, tables and statistics tells that HRE can reduce Blood Transfusions as much as 65%, while at the same time not exposing patients to any substantial added risk.
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