Does the preoperative administration of tranexamic acid reduce perioperative blood loss and transfusion requirements after head neck cancer surgery? 
A randomized, controlled trial

Das, Anjan; Chattopadhyay, Surajit; Mandal, Debabrata; Chhaule, Subinay; Mitra, Tapobrata; Mukherjee, Anindya; Mandal, Subrata Kumar; Chattopadhyay, Sandip

doi:10.4103/0259-1162.161806

Cited by 20 publications

(32 citation statements)

References 29 publications

(32 reference statements)

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“…Tranexamic acid is "a synthetic antifibrinolytic agent that blocks the lysine-binding site of plasminogen, plasmin and tissue plasminogen activator which prevents their association with fibrin hence reducing bleeding. " 6 Previous studies 6,7 have already confirmed the favorable effect of tranexamic acid on bleeding tendency in major operations such as patients undergoing cardiac, major orthopaedic transplantation, and prostate surgeries as well as the efficacy of topical and oral forms of tranexamic acid in achieving hemostasis and improving the surgical field in functional endoscopic sinus surgery. Two previous studies to determine the efficacy of intravenous tranexamic acid in functional endoscopic sinus surgery showed favorable effects.…”

Section: Discussionmentioning

confidence: 95%

Endoscopic Sinus Surgery Perioperative Outcome after Intravenous Tranexamic Acid:

Quiroga

Jarin

2018

Philipp J Otolaryngol Head Neck Surg

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Objectives: To determine the effect of a single intravenous dose of tranexamic acid on intraoperative bleeding, duration of surgery, and surgical field visualization during endoscopic sinus surgery. Methods: Study Design: Double-blind, randomized, placebo-controlled trial. Setting: Tertiary Government Hospital in Quezon City Participants: 10 patients aged 18-75 years old diagnosed with chronic rhinosinusitis with or without nasal polyposis and unresponsive to medical treatment, who underwent endoscopic sinus surgery from September 2016 to August 2017, were randomly allocated to treatment group and control group respectively. The “odd” numbers were assigned to the treatment group (intravenous Tranexamic acid) given 1 dose of 100mg/ml (500mg tranexamic acid per 5 ml) tranexamic acid slow intravenous drip 1 hour prior to the procedure, while the “even” numbers assigned to the control group received the same amount of normal saline solution. Results: The mean duration of surgery of the tranexamic group was 185 minutes (standard deviation, SD 55.23) and the control group was 122.6 minutes (SD 42.03) showing no significant difference (p=.08). The mean blood loss of the tranexamic group was less at 240ml (SD 108.39) compared with the control group at 290ml (SD 74.16), although there was no statistically significant difference (p=.42). Intraoperative surgical field assessed by the surgeon based on the Boezart grading scale showed that 2 (40%) of the tranexamic group had higher bleeding score compared with the placebo group. However, this was not found to be statistically significant (p=.460). Due to the small sample size, a type II error occurred with alpha level of 0.05 and estimated power of 0.0885, with not enough basis to refute that a single dose of intravenous tranexamic acid has no effect in improving surgical field visualization during endoscopic sinus surgery. No drug side effects were noted after administration until after surgery. Conclusion: Single dose intravenous tranexamic acid in functional endoscopic sinus surgery decreased mean intraoperative blood loss (but this was statistically insignificant), but its effect on surgical field visualization cannot totally be assessed due to small sample size. There was also no change in the observed duration of surgery. No untoward side effects associated were noted from administration of the drug until after the surgery finished. Keywords: Functional endoscopic sinus surgery, intravenous tranexamic acid, chronic rhinosinusitis

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“…Das et al . 10 conducted a randomised, double-blind, case–control study on 80 patients with head and neck cancer who underwent various neck dissections. They found a highly significant difference in haemoglobin level, with an associated highly significant difference in transfused blood volume.…”

Section: Discussionmentioning

confidence: 99%

“…There have only been three randomised case–control studies 8–10 on head and neck surgical procedures. Chen et al .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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ObjectiveTo assess the effect of tranexamic acid in head and neck surgical procedures.MethodsA prospective, double-blind and randomised, parallel group, placebo-controlled clinical trial was conducted. Ninety-two patients undergoing various head and neck surgical procedures were randomised. Subjects received seven infusions of coded drugs (tranexamic acid or normal saline) starting at the time of skin closure. Haematological, biochemical, blood loss and other parameters were observed by the staff, who were blinded to patients’ group allocation (case or control).ResultsPatients were analysed on the basis of type of surgery. Fifty patients who had undergone surgical procedures, including total thyroidectomy, total parotidectomy, and various neck dissections with or without primary tumour excision, were included in the first group. The second group comprised 41 patients who had undergone hemithyroidectomy, lobectomy or superficial parotidectomy. There was no statistical difference in blood parameters between both groups. There was a reduction in post-operative drain volume, but this was not significant.ConclusionAlthough this prospective, randomised, placebo-controlled clinical trial found a reduction in post-operative drain volume in tranexamic acid groups, the difference was not statistically significant between the various head and neck surgical procedure groups.

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“…A number of small RCTs and retrospective cohort studies were performed to assess the effect of perioperative antifibrinolytics on bleeding during and after cancer surgery, in a variety of solid malignancies. The studies including patients with liver, prostate and gynecological cancer found a reduction in blood transfusion requirements during and after surgery in the TXA arms [ 36 , 37 , 38 , 39 , 40 , 41 ]. In contrast, antifibrinolytics did not influence bleeding outcomes in major orthopedic cancer surgery or in oncologic spinal canal, head and neck and neurosurgeries [ 42 , 43 , 44 , 45 ].…”

Section: Managing Thrombocytopenia In Cancermentioning

confidence: 99%

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Leader

Hofstetter

Spectre

2021

JCM

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Cancer patients have varying incidence, depth and duration of thrombocytopenia. The mainstay of managing severe chemotherapy-induced thrombocytopenia (CIT) in cancer is the use of platelet transfusions. While prophylactic platelet transfusions reduce the bleeding rate, multiple unmet needs remain, such as high residual rates of bleeding, and anticancer treatment dose reductions/delays. Accordingly, the following promising results in other settings, antifibrinolytic drugs have been evaluated for prevention and treatment of bleeding in patients with hematological malignancies and solid tumors. In addition, Thrombopoeitin receptor agonists have been studied for two major implications in cancer: treatment of severe thrombocytopenia associated with myelodysplastic syndrome and acute myeloid leukemia; primary and secondary prevention of CIT in solid tumors in order to maintain dose density and intensity of anti-cancer treatment. Furthermore, thrombocytopenic cancer patients are often prescribed antithrombotic medication for indications arising prior or post cancer diagnosis. Balancing the bleeding and thrombotic risks in such patients represents a unique clinical challenge. This review focuses upon non-transfusion-based approaches to managing thrombocytopenia and the associated bleeding risk in cancer, and also addresses the management of antithrombotic therapy in thrombocytopenic cancer patients.

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“…The original article titled “Does the preoperative administration of tranexamic acid reduce perioperative blood loss and transfusion requirements after head neck cancer surgery? A randomized, controlled trial” published in Anesthesia: Essays and Researches, on pages 384-390, Issue 3, Volume 9, 2015[ 1 ], is being retracted because the article was found to have unattributed sections of content with high rate of similarity from other articles along with evidence of data fabrication. The corresponding author was contacted and asked to provide the journal with the raw data for these studies but there has been no response within a reasonable timeframe.…”

mentioning

confidence: 99%

Retraction: Does the preoperative administration of tranexamic acid reduce perioperative blood loss and transfusion requirements after head neck cancer surgery? A randomized, controlled trial

2020

Anesth Essays Res

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Does the preoperative administration of tranexamic acid reduce perioperative blood loss and transfusion requirements after head neck cancer surgery? A randomized, controlled trial

Cited by 20 publications

References 29 publications

Endoscopic Sinus Surgery Perioperative Outcome after Intravenous Tranexamic Acid:

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

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Retraction: Does the preoperative administration of tranexamic acid reduce perioperative blood loss and transfusion requirements after head neck cancer surgery? A randomized, controlled trial

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