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      Efficacy of topical vs intravenous tranexamic acid in reducing blood loss and promoting wound healing in bone surgery: A systematic review and meta-analysis

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          Abstract

          BACKGROUND

          Tranexamic acid (TXA) has been used as an anti-fibrinolytic drug for over half a century and has received much attention in recent decades.

          AIM

          To evaluate the efficacy of topical vs intravenous TXA in reducing blood loss and promoting wound healing in bone surgery.

          METHODS

          From the electronic resources, PubMed, Cochrane Library, Embase, ISI, and Scopus were used to perform a literature search over the last 10 years between 2010 and 2020. EndNote™ X8 was used for managing the electronic resource. Searches were performed with mesh terms. The data were retracted blindly by two independent reviewers. Random effects were used to deal with potential heterogeneity and I 2 showed heterogeneity. Chi-square ( I 2) tests were used to quantify the extent of heterogeneity ( P < 0.01 was considered statistically significant). The efficacy of topical TXA in reducing blood loss and promoting wound healing in bone surgery was compared with intravenous TXA and placebo.

          RESULTS

          According to the research design, 1360 potentially important research abstracts and titles were discovered in our electronic searches, and 18 papers remained in agreement with our inclusion criteria. It was found that TXA reduced 277.51 mL of blood loss compared to placebo, and there was no significant difference between topical TXA and IV TXA in reducing blood loss in bone surgery. Our analyses also showed that TXA significantly reduced blood transfusion compared to placebo and there was no significant difference between topical TXA and IV TXA.

          CONCLUSION

          The use of both topical and intravenous TXA are equally effective in reducing blood loss in bone surgery, which might be beneficial for wound healing after surgery.

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          Most cited references44

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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            Factors affecting wound healing.

            Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutaneous wound healing and the potential cellular and/or molecular mechanisms involved. The factors discussed include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds.
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              Wound Healing: A Cellular Perspective

              Wound healing is one of the most complex processes in the human body. It involves the spatial and temporal synchronization of a variety of cell types with distinct roles in the phases of hemostasis, inflammation, growth, re-epithelialization, and remodeling. With the evolution of single cell technologies, it has been possible to uncover phenotypic and functional heterogeneity within several of these cell types. There have also been discoveries of rare, stem cell subsets within the skin, which are unipotent in the uninjured state, but become multipotent following skin injury. Unraveling the roles of each of these cell types and their interactions with each other is important in understanding the mechanisms of normal wound closure. Changes in the microenvironment including alterations in mechanical forces, oxygen levels, chemokines, extracellular matrix and growth factor synthesis directly impact cellular recruitment and activation, leading to impaired states of wound healing. Single cell technologies can be used to decipher these cellular alterations in diseased states such as in chronic wounds and hypertrophic scarring so that effective therapeutic solutions for healing wounds can be developed.
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                Author and article information

                Contributors
                Journal
                World J Clin Cases
                WJCC
                World Journal of Clinical Cases
                Baishideng Publishing Group Inc
                2307-8960
                16 June 2021
                16 June 2021
                : 9
                : 17
                : 4210-4220
                Affiliations
                Nursing Department, Yangpu District Shidong Hospital, Shanghai 200438, China
                Nursing Department, Yangpu District Shidong Hospital, Shanghai 200438, China
                Nursing Department, Yangpu District Shidong Hospital, Shanghai 200438, China
                Emergency Services Department, Yangpu District Shidong Hospital, Shanghai 200438, China
                Nursing Department, Yangpu District Shidong Hospital, Shanghai 200438, China
                The Second Neurological Department, Yangpu District Shidong Hospital, Shanghai 200438, China. lifeimedicine@ 123456163.com
                Author notes

                Author contributions: Xu JW and Li F conceptualized this study; Xu JW, Qiang H, and Li F collected the data; Xu JW, Wang Y, and Wei XX performed the formal analysis; Xu JW and Wang Y drafted the manuscript; Li F edited and reviewed the manuscript.

                Corresponding author: Fei Li, MD, Chief Doctor, The Second Neurological Department, Yangpu District Shidong Hospital, No. 999 Shiguang Road, Yangpu District, Shanghai 200438, China. lifeimedicine@ 123456163.com

                Article
                jWJCC.v9.i17.pg4210
                10.12998/wjcc.v9.i17.4210
                8173404
                34141783
                6c49686a-3331-49c3-95d8-a5316c42cf16
                ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/

                History
                : 24 December 2020
                : 24 February 2021
                : 29 March 2021
                Categories
                Meta-Analysis

                tranexamic acid,blood loss,wound healing,bone surgery,meta-analysis

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