Does tranexamic acid reduce blood loss during head and neck cancer surgery?

Abstract

Background and Aims:Transfusion of blood and blood products poses several hazards. Antifibrinolytic agents are used to reduce perioperative blood loss. We decided to assess the effect of tranexamic acid (TA) on blood loss and the need for transfusion in head and neck cancer surgery.Methods:After Institutional Review Board approval, 240 patients undergoing supramajor head and neck cancer surgeries were prospectively randomised to either TA (10 mg/kg) group or placebo (P) group. After induction, the drug was infused by the anaesthesiologist, who was blinded to allocation, over 20 min. The dose was repeated every 3 h. Perioperative (up to 24 h) blood loss, need for transfusion and fluid therapy was recorded. Thromboelastography (TEG) was performed at fixed intervals in the first 100 patients. Patients were watched for post-operative complications.Results:Two hundred and nineteen records were evaluable. We found no difference in intraoperative blood loss (TA - 750 [600–1000] ml vs. P - 780 [150–2600] ml, P = 0.22). Post-operative blood loss was significantly more in the placebo group at 24 h (P - 200 [120–250] ml vs. TA - 250 [50–1050] ml, P = 0.009), but this did not result in higher number of patients needing transfusions (TA - 22/108 and P - 27/111 patients, P = 0.51). TEG revealed faster clot formation and minimal fibrinolysis. Two patients died of causes unrelated to study drug. Incidence of wound complications and deep venous thrombosis was similar.Conclusion:In head and neck cancer surgery, TA did not reduce intraoperative blood loss or need for transfusions. Perioperative TEG variables were similar. This may be attributed to pre-existing hypercoagulable state and minimal fibrinolysis in cancer patients.

The Effectiveness of Tranexamic Acid in Patients With Proximal Femoral Tumor Resection Prosthesis

“…There are few studies in the literature about the use of TXA to reduce bleeding in malignant tumor surgical procedures [5][6][7][8]. Montroy et al published a meta-analysis in which lysine analogues examined the efficacy and safety of cancer patients.…”

“…When some other cancer-related studies were examined, in a review investigating the effect of TXA administered during radical cystectomy for bladder cancer, TXA did not provide significant benefit compared to placebo [6]. In another study, it was reported that the use of TXA in head and neck cancers was not beneficial in reducing bleeding rates [7]. In another study examining the effect of TXA use in vertebral metastasis surgery, no significant benefit was reported in the amount of bleeding.…”

“…In another study, it was reported that TXA reduced bleeding rates in Complex Skull Base Neurosurgical Procedures including malignant tumor surgeries. When all these studies were evaluated, it was stated that TXA did not increase thromboembolic events [6,7,11,12].…”

“…In the literature, there are many studies reporting the decrease in postoperative blood loss in patients receiving TXA. In addition, it has been reported in the literature that TXA is used in malignancies [5][6][7][8]. In a study performed in patients with malignant bleeding, there was no evidence that the use of TXA increased the risk of thrombosis [8].…”

Tranexamic acid has no advantage in head and neck surgical procedures: a randomised, double-blind, controlled clinical trial

“…Kulkarni et al . 9 conducted a double-blind, randomised study on 240 patients with head and neck cancers. They infused tranexamic acid or saline before the incision and repeated the infusion 3-hourly until wound closure commenced.…”