Prophylactic tranexamic acid use in non‐cardiac surgeries at high risk for transfusion

Abstract

Background Tranexamic acid (TXA) reduces transfusion in a wide range of surgical populations, although its real‐world use in non‐cardiac surgeries has not been well described. The objective of this study was to describe prophylactic TXA use in non‐cardiac surgeries at high risk for transfusion. Methods This is a retrospective cohort study of all adult patients undergoing major non‐cardiac surgery at ≥5% risk of perioperative transfusion at five Canadian hospitals between January 2014 and December 2016. Canadian Classification of Health Interventions procedure codes within the Discharge Abstract Database were linked to transfusion and laboratory databases. TXA use was ascertained electronically from The Ottawa Hospital Data Warehouse and via manual chart review for Winnipeg hospitals. For each surgery, we evaluated the percentage of patients who received TXA as well as the specifics of TXA dosing and administration. Results TXA use was evaluable in 14 300 patients. Overall, 17% of surgeries received TXA, ranging from 0% to 68% among individual surgeries. TXA use was more common in orthopaedic (n = 2043/4942; 41%) and spine surgeries (n = 239/1322; 18%) compared to other surgical domains (n = 109/8036; 1%). TXA was commonly administered as a bolus (n = 2097/2391; 88%). The median TXA dose was 1000 mg (IQR 1000–1000 mg). Conclusion TXA is predominantly used in orthopaedic and spine surgeries, with little uptake in other non‐cardiac surgeries at high risk for red blood cell transfusion. Further studies are needed to evaluate the effectiveness and safety of TXA and to understand the barriers to TXA administration in a broad range of non‐cardiac surgeries.

A physiology‐based trigger score to guide perioperative transfusion of allogeneic red blood cells: A multicentre randomised controlled trial

“…The PBM strategy has since been incorporated in other parts of the world, including the USA, Austria, Australia and Netherlands 42 . Tranexamic acid has also been shown to consistently reduce RBCs transfusion in a wide range of surgical populations 43 . Despite of these advances, Hb at a level between 7 and 10 g/dl represent an area for further refinement in perioperative blood transfusion.…”

“…42 Tranexamic acid has also been shown to consistently reduce RBCs transfusion in a wide range of surgical populations. 43 Despite of these advances, Hb at a level between 7 and 10 g/dl represent an area for further refinement in perioperative blood transfusion. The POTTS system included four variables that are readily available during routine practice.…”

Update on Applications and Limitations of Perioperative Tranexamic Acid

“…13 The results of small randomized-controlled trials, as well as subsequent systematic reviews and meta-analyses, demonstrate that perioperative TXA is effective at reducing surgical blood loss and allogeneic transfusion in orthopedic surgery. [97][98][99][100] A recent retrospective analysis assessed prophylactic TXA use in noncardiac surgeries at high risk for blood transfusion in 14,300 patients between 2014 and 2016. 98 The results demonstrated that TXA was most frequently used in patients undergoing orthopedic surgery (~41%) with a higher utilization for pelvic surgery (~68%) and hip arthroplasty (~67%).…”

“…[97][98][99][100] A recent retrospective analysis assessed prophylactic TXA use in noncardiac surgeries at high risk for blood transfusion in 14,300 patients between 2014 and 2016. 98 The results demonstrated that TXA was most frequently used in patients undergoing orthopedic surgery (~41%) with a higher utilization for pelvic surgery (~68%) and hip arthroplasty (~67%). This degree of TXA utilization was much higher than was observed for other types of noncardiac surgery.…”

“…107 TXA Method of Administration and Drug Dose Pharmacokinetic studies have established that the optimal serum TXA concentration in orthopedic surgery is >10 µg/mL. 98,108,109 Therapeutic levels can be achieved via oral, topical, or IV administration by different pharmacokinetic profiles. 108,110,111 Current evidence demonstrates that there is no difference in the effect of TXA on reduced blood loss, transfusion, or incidence of thrombotic complications when assessing studies that utilized different routes of TXA administration for major joint arthroplasty.…”