A Single Preoperative Dose of Tranexamic Acid Reduces Perioperative Blood Loss

Abstract

Objective: To review the efficacy and safety of a single dose of intravenous tranexamic acid (TXA) given preoperatively. Summary Background Data: TXA is a synthetic antifibrinolytic that has been used in various surgical disciplines to reduce blood loss, blood transfusions, ecchymosis, and hematoma formation. However, there is no universal standard on the most effective dose and route of TXA administration, limiting its routine use in many centers. This study evaluates the current evidence for the efficacy and safety of a single preoperative dose of TXA on surgical blood loss in all surgical disciplines. Methods: With the guidance of a research librarian, in accordance with the Cochrane Handbook Medline, Cochrane Central and Embase were searched in November 2018. Search terms included “Tranexamic Acid” AND “Intravenous,” with studies limited to randomized controlled trails in adult humans. Two independent reviewers and an arbitrator assessed articles for inclusion. Criteria included a single preoperative bolus dose of intravenous TXA, surgical patients, and intraoperative blood loss measurement or perioperative blood loss up to 24 hours postsurgery. Quality assessment was done using the Cochrane Collaboration risk-of-bias tool by 2 reviewers. Statistical analysis was carried out using Cochrane Review Manager 5.3. The primary outcome was surgical blood loss. Secondary outcomes included venous thromboembolic complications, transfusion requirements, and dosing. Results: A total of 1906 articles were screened, 57 met inclusion criteria. The majority of included studies were orthopedic (27), followed by obstetric and gynecological (16), oral maxillofacial and otolaryngology (10), cardiac (3), and 1 plastic surgery study focusing on acute burn reconstruction. Across all surgical specialties (n = 5698), the perioperative estimated blood loss was lower in patients receiving TXA, with a standard mean difference of −153.33 mL (95% CI = −187.79 to −118.87). Overall, surgical patients with TXA had a 72% reduced odds of transfusion (odds ratio = 0.28 [95% CI = 0.22–0.36]). The most frequently used dose of TXA was 15 mg/kg. There was no difference in the incidence of venous thromboembolic events between TXA and control groups. Conclusions: While there is a growing body of evidence to support benefits of perioperative TXA use, this is the first meta-analysis to identify the efficacy and safety of a single preoperative dose of IV TXA. The potential implications for expanding the use of preoperative TXA for elective day surgery procedures is substantial. Preoperative intravenous TXA reduced perioperative blood loss and transfusion requirements in a variety of surgical disciplines without increasing the risk of thromboembolic events. Therefore, it should be considered for prophylactic use in surgery to reduce operative bleeding.

Effects of intravenous tranexamic acid on ovarian reserve and intra-operative blood loss during laparoscopic cystectomy of endometriotic cyst: a pilot randomized controlled trial

“…The dosage of TXA for local fibrinolysis treatment is 0.5 to 1 g (equivalent to 15 mg/kg) by intravenous injection every 6 to 8 h while the dosage for general fibrinolysis treatment is a single dose of 1 g or 10 mg/kg by intravenous injection [ 38 ]. The meta-analysis by Heyns et al suggested that the most frequently used single dose for a reduction of perioperative estimated blood loss in several types of operation was 15 mg/kg [ 39 ]. A study by Abbasi et al compared two doses of TXA, i.e., 5 and 15 mg/kg during sinus endoscopy surgery [ 40 ].…”

Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis

“…Tranexamic acid (TXA) is an antifibrinolytic that inhibits fibrin’s plasmin-mediated degradation and is used to stabilize clots and reduce active bleeding. In orthopaedic surgery, tranexamic acid is most notably involved in the elective orthopaedic procedures necessitating transfusion [ 1 , 2 ]. The use of tranexamic acid has become widely accepted in total knee and hip arthroplasty to prevent extensive blood loss and lower transfusion rates, but it can be also beneficial for patients who undergo total shoulder arthroplasty [ 3 ].…”

A Single Preoperative Dose and an Additional Dose of Tranexamic Acid in Total Knee Arthroplasty: a Meta-analysis

“…No signi cant difference was found in terms of DVT incidence (P 0.05). There was no signi cant publication bias for postoperative blood loss, transfusion rate, and DVT incidence.Conclusion: When it comes to IV TXA in TKA, a single preoperative dose and an additional dose of TXA may be a better and more feasible way for blood control than a single preoperative dose.Recently, a meta-analysis [15] assessed the e cacy and safety of the e cacy and safety of a single dose of IV TXA given preoperatively. and it showed that preoperative IV TXA reduced perioperative blood loss and transfusion requirements in a variety of surgical disciplines without increasing the risk of thromboembolic events.One RCT[7] showed that with the same total dose of TXA, the preoperative dose and an additional dose of TXA (IV TXA twice) were superior to a single preoperative dose of TXA (IV TXA once) in reducing blood loss in TKA.…”

“…Recently, a meta-analysis [15] assessed the e cacy and safety of the e cacy and safety of a single dose of IV TXA given preoperatively. and it showed that preoperative IV TXA reduced perioperative blood loss and transfusion requirements in a variety of surgical disciplines without increasing the risk of thromboembolic events.…”