Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

Karanicolas, Paul J.; Lin, Yulia; Tarshis, Jordan; Law, Calvin; Coburn, Natalie; Hallet, Julie; Nascimento, Barto; Pawliszyn, Janusz; McCluskey, Stuart A.

doi:10.1016/j.hpb.2016.09.005

Cited by 22 publications

(29 citation statements)

References 48 publications

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“…A previous open-labelled phase II trial demonstrated that the doses that will be used in our study (loading dose: 1 g; maintenance dose: 1 g/8 hours) provided stable and therapeutic serum concentrations of TXA during major hepatectomy. 25 Furthermore, previous large international RCTs have shown that this dose is safe. 12 13 Despite the potential dose-dependent effect in vitro, higher doses were not adopted because of safety concerns, mainly about seizure.…”

Section: Methods and Analysismentioning

confidence: 96%

Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD): study protocol for a multicentre randomised, blind, placebo-controlled trial

2020

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IntroductionPancreaticoduodenectomy (PD) is a major gastroenterological surgery that results in a substantial amount of blood loss. Several studies have demonstrated that major blood loss during PD is associated with both short-term and long-term poor outcomes. Administration of perioperative tranexamic acid (TXA) has been reported to reduce intraoperative blood loss in various surgeries, including cardiovascular surgery and orthopaedic surgery. Nevertheless, the effect of perioperative TXA use in patients undergoing PD has not been investigated. This study aims to investigate the effect of TXA on blood loss during PD.Methods and analysisA multicentre (six hospitals), randomised, blind (patient-blinded, surgeon-blinded, anaesthesiologist-blinded, monitor-blinded), placebo-controlled trial of TXA during PD was started in September 2019. Patients undergoing PD for biliary, duodenal or pancreatic diseases are randomly assigned to the TXA or placebo group. The stratification factors are the institutions and preoperative clinical diagnosis. Before skin incision, the participants in TXA group are administrated 1 g TXA as a loading infusion followed by a maintenance infusion of 125 mg/hour TXA until the end of surgery or 8 hours from the incision. Participants in the placebo group are administrated the same volume of saline that is indistinguishable from the TXA. The primary outcome is blood loss during PD. The secondary outcomes are intraoperative and postoperative (up to day 2) blood transfusions, operation time, anaesthesia time, postoperative laboratory variables, length of hospital stay, in-hospital and 90-day mortality and postoperative complications occurring within 28 days of surgery or requiring readmission. To date, 115 patients of a planned 220 have been enrolled in the study.Ethics and disseminationThis protocol was approved by the Nagoya University Clinical Research Review Board and is registered with Japan Registry of Clinical Trials on 15 August 2019. The results of this trial will be disseminated through peer-reviewed journals.Trial registration numberjRCTs041190062.

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Section: Methods and Analysismentioning

confidence: 96%

Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD): study protocol for a multicentre randomised, blind, placebo-controlled trial

2020

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“…Secondly, we assessed PAI-1 and t-PA plasma concentrations during surgery, before initiation of the Pringle maneuver (T2), in order to evaluate the influence of surgically created tissue damage. Thirdly, we determined the markers at the end of surgery (T3) to assess the impact of liver hypoperfusion on fibrinolytic activity, and fourthly, 24 h after surgery (T4), to detect postoperative fibrinolytic activity, which commonly stays enhanced a few days after liver resection ( 19 ).…”

Section: Methodsmentioning

confidence: 99%

Fibrinolytic System Changes in Liver Surgery: A Pilot Observational Study

et al. 2018

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Introduction: Bleeding occurs frequently in liver surgery. Unbalance between tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) concentrations might increase bleeding. Our aim was to analyze perioperative fibrinolytic changes during liver surgery.Materials and Methods: We evaluated 15 patients for inclusion into a prospective pilot study of liver surgery. We assessed fibrinolysis by plasma PAI-1 and t-PA: before surgery (T1), before Pringle maneuver (PM;T2), at the end of surgery (T3) and 24 h postoperatively (T4), and registered demographic and laboratory data, extent and duration of surgery, hemodynamic parameters, blood loss, and transfused volumes of blood products. Data presented as mean ± SD. Significance at P < 0.05.Results: After exclusion of six patients only undergoing biopsies, we included six women and three men aged 49.1 ± 19.6 years; two patients with liver metastases of colorectal cancer and hepatocellular carcinoma, respectively, two with focal nodular hyperplasia, two with hepatic hemangioma, and one with angiomyolipoma. Six patients underwent PM. PAI-1 plasma concentration (n = 9) rose from 6.25 ± 2.25 at T1 through 17.30 ± 14.59 ng/ml at T2 and 28.74 ± 20.4 (p = 0.007) and 22.5 ± 16.0 ng/ml (p = 0.04), respectively, at T3 and T4. Correspondingly, t-PA plasma concentration (n = 9) increased from 4.76 ± 3.08 ng/ml at T1 through 8.00 ± 5.10 ng/ml (p = 0.012) at T2 and decreased to 4.25 ± 2.29 ng/ml and 3.04 ± 3.09 at T3 and T4, respectively. Plasma t-PA level at T2 was significantly different from those at T1, T3, and T4 (p < 0.004). In PM patients, t-PA levels increased from T1, peaked at T2 (p = 0.001), and subsequently decreased at T3 and T4 (p = 0.011 and p = 0.037), respectively. Mean blood loss was 1,377.7 ± 1,062.8 ml; seven patients received blood products. Patients with higher PAI-1 levels at T3 received more fresh frozen plasma (r = 0.79; p = 0.01) and red blood cells (r = 0.88; p = 0.002).Conclusions: During liver surgery, fibrinolysis increased, as evidenced by rises in plasma PAI-1and t-PA, especially after start of surgery and following PM. Transfused volumes of blood products correlated with higher plasma concentrations of PAI-1. Confirming this tendency requires a larger cohort of patients.

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“…на 5-10 кг массы тела, или 10-15 мл/кг. Свежезамороженная плазма применяется при коагулопатии разведения (и при других состояниях, сопровождающихся дефицитом факторов свертывания) и рекомендуемая доза составляет 1 ед./10 кг, или 10-15 мл/кг [72,73].…”

Section: оригинальные исследованияunclassified

Modern aspects of correction of disturbances arising from extended hemihepatectomy in children

Белоусова¹,

Сотников²,

Matinyan³

2018

Anesteziologiya I Reanimatologiya

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В последнее время в мире участились случаи выявления опухолевых образований печени. Наиболее распространенной опухолью печени у детей является гепатобластома (ГБЛ). Она выявляется чаще всего в течение первых 3 лет жизни. Заболеваемость составляет около 10,5 случая на 1 млн детей в возрасте до 1 года и 5,2 случая на 1 млн в возрасте от 1 до 4 лет, согласно данным SEER [1]. С 1992 по 2004 г. заболеваемость ГБЛ в США выросла на 4% [2], а в Европе в период с 1978 по 1997 г.-на 1%. ГБЛ часто ассоциируется с низкой массой тела при рождении, синдромом семейного аденоматозного полипоза, синдромом Беквит или генетическими аномалиями [3], такими как трисомия по 18-й хромосоме и синдром Беквит-Видеманна [4]. К негативным прогностическим факторам долгосрочной выживаемости при ГБЛ относятся наличие метастати

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Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

Abstract: Background: Hyperfibrinolysis may occur due to systemic inflammation or hepatic injury that occurs

Cited by 22 publications

References 48 publications

Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD): study protocol for a multicentre randomised, blind, placebo-controlled trial

Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD): study protocol for a multicentre randomised, blind, placebo-controlled trial

Fibrinolytic System Changes in Liver Surgery: A Pilot Observational Study

Modern aspects of correction of disturbances arising from extended hemihepatectomy in children

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