The effects of tranexamic acid on blood loss and transfusion rate in colorectal surgery

Grass, Fabian; Braafladt, Signe; Alabbad, Jasim; Lovely, Jenna K.; Kelley, Scott R.; Mathis, Kellie L.; Huebner, Marianne; Larson, David W.

doi:10.1016/j.amjsurg.2019.03.013

Cited by 4 publications

(21 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More recently, Grass et al 49 carried out a retrospective study in patients (n=213) who underwent elective colorectal surgery for cancer and received 1 g of TXA intravenously as induction therapy and before anesthesia emergence. Despite their study failed to prove a significant reduction of post-operative transfusions rate, the authors provided insight into the potential benefits of perioperative TXA administration in this surgical setting.…”

Section: Clinical Usage and Efficacy Of Tranexamic Acid In Oncologic ...mentioning

confidence: 99%

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Zec¹,

Napoli²,

Fiévez³

et al. 2022

JMDH

View full text Add to dashboard Cite

In cancer patients undergoing surgery, tumor biology and anticancer treatments can increase the risk of perioperative bleeding and blood transfusions. Notably, blood transfusions can be potentially associated with an increased risk of life-threatening immune responses, acute lung injury, postoperative infections, and thromboembolism. Moreover, the link between perioperative transfusion and increased risk of cancer recurrence cannot be excluded. On the other hand, cancer patients have an increased risk of thromboembolism due to cancer itself and antineoplastic systemic treatments including chemotherapy and anti-angiogenic drugs. In this complex scenario, effective and safe strategies aimed at the prevention of blood transfusions are warranted. This narrative review addresses the efficacy, and the safety of the synthetic antifibrinolytic agent tranexamic acid (TXA) when used perioperatively in cancer surgery. Although in not oncologic surgery the use of TXA has been extensively studied, in the setting of cancer patients requiring surgery, the evidence is scarce. An overview of the ongoing clinical research is also provided.

show abstract

Section: Clinical Usage and Efficacy Of Tranexamic Acid In Oncologic ...mentioning

confidence: 99%

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Zec¹,

Napoli²,

Fiévez³

et al. 2022

JMDH

View full text Add to dashboard Cite

show abstract

“…This was statistically significant in gastrointestinal and gynaecological surgeries ( p = 0.04, MD –0.47 mmol/L, 95% CI [−0.93, −0.01]), ( p = 0.03, MD −0.70 mmol/L, 95% CI [−1.33, 0.07]). There was variation in the studies as to when the samples for the reported postoperative haemoglobin values were taken; one study reported 3‐h and Day 1 postoperative haemoglobin, 29 one reported 12‐h values, 31 three reported 24‐h values, 30–32 one reported 48‐h values 36 and one reported Day‐5 postoperative haemoglobin as this was when the blood volume was assumed to have normalised 35 . Heterogeneity in the subgroup analyses varied from 0% to 71%.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies reported postoperative complication rates 29,32,35,37–40 . There were 88/466 patients (18.9%) who experienced a complication and received TXA vs 124/606 patients (20.5%) in the control group.…”

Section: Resultsmentioning

confidence: 99%

“…The literature search, following the removal of duplicates, revealed 1366 potential studies. Following screening and subsequent full-text review, a total of 12 studies were included for quantitative synthesis [29][30][31][32][33][34][35][36][37][38][39][40] (Figure 1).…”

Section: Literature Searchmentioning

confidence: 99%

“…33 Another study offered all patients ultrasound assessment for DVT, of which 56% participated, although it was not reported when the screening took place. 35 Eleven studies reported the rate of pulmonary embolism (PE) [29][30][31][32][33][34][35][36][37]39,40 ; five patients developed a PE in the TXA group and five in the control group. These were all diagnosed in symptomatic patients.…”

Section: Venous Thromboembolismmentioning

confidence: 99%

See 2 more Smart Citations

Impact on blood loss and transfusion rates following administration of tranexamic acid in major oncological abdominal and pelvic surgery: A systematic review and meta‐analysis

Fowler

Law

Tham

et al. 2022

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and Objectives Major bleeding and receiving blood products in cancer surgery are associated with increased postoperative complications and worse outcomes. Tranexamic acid (TXA) reduces blood loss and improves outcomes in various surgical specialities. We performed a systematic review and meta‐analysis to investigate TXA use on blood loss in elective abdominal and pelvic cancer surgery. Methods A literature search was performed for studies comparing intravenous TXA versus placebo/no TXA in patients undergoing major elective abdominal or pelvic cancer surgery. Results Twelve articles met the inclusion criteria, consisting of 723 patients who received TXA and 659 controls. Patients receiving TXA were less likely to receive a red blood cell (RBC) transfusion (p < 0.001, OR 0.4 95% CI [0.25, 0.63]) and experienced less blood loss (p < 0.001, MD −197.8 ml, 95% CI [−275.69, −119.84]). The TXA group experienced a smaller reduction in haemoglobin (p = 0.001, MD –0.45 mmol/L, 95% CI [−0.73, −0.18]). There was no difference in venous thromboembolism (VTE) rates (p = 0.95, OR 0.98, 95% CI [0.46, 2.08]). Conclusions TXA use reduced blood loss and RBC transfusion requirements perioperatively, with no significant increased risk of VTE. However, further studies are required to assess its benefit for cancer surgery in some sub‐specialities.

show abstract

Tranexamic Acid for reduction of intra- and postoperative TRansfusion requirements in elective Abdominal surgery (TATRA): study protocol for an investigator-initiated, multicenter, double-blind, placebo-controlled, randomized superiority trial with two parallel groups

Ronellenfitsch,

Kestel,

Klose

et al. 2024

Trials

View full text Add to dashboard Cite

Background Intra- and postoperative hemorrhage is a relevant problem in major abdominal surgery, leading to acute anemia and necessitating transfusion of packed red blood cells. It is estimated that in 30% of abdominal surgeries, intra- or postoperative transfusion is required. Transfusion potentially has detrimental health effects and poses a considerable socioeconomic burden. Tranexamic acid, a lysine analog inhibiting plasminogen activation and providing clot stability, has been used to reduce hemorrhage. While there is ample evidence in other surgical disciplines, it is almost completely lacking in abdominal surgery. Methods This multicenter double-blind parallel group randomized superiority trial will compare tranexamic acid (loading dose 1000 mg over 10 min prior to skin incision, maintenance dose 125 mg/h continuously until skin closure or until 1000 mg have been administered) to placebo in patients ≥ 18 years undergoing elective esophagectomy, gastrectomy, colectomy, rectal resection, pancreatic resection, or hepatectomy. The primary efficacy endpoint is the intra- or postoperative transfusion of at least one unit of packed red blood cells. Key secondary endpoints are the number of transfused units per patient, estimated intraoperative blood loss, postoperative complications/mortality, length of hospital stay, operation/anesthesia time, D-dimer levels, and quality of life. Sample size calculation is based on the assumption that in the control group, 30% of patients require transfusion while the intervention achieves a risk reduction of 33%, reducing the probability to 20%. With a type one error of 5% and a power of 90%, using a two-sided χ2 test, this results in 412 patients per group. Accounting for non-compliance, 425 patients are to be randomized per group. The total trial duration will be 30 months with a recruitment period of 18 months. Discussion If the proposed trial yielded positive results, the routine use of tranexamic acid in major abdominal surgery would be supported. This would avoid acute anemia with detrimental effects such as tissue hypoxia and organ injury, as well as the negative immediate and delayed effects of transfusions. Trial registration EU CT Nr: 2023–509970-43–01, NCT06414031. Registered on 10 May 2024.

show abstract

The effects of tranexamic acid on blood loss and transfusion rate in colorectal surgery

Cited by 4 publications

References 27 publications

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Impact on blood loss and transfusion rates following administration of tranexamic acid in major oncological abdominal and pelvic surgery: A systematic review and meta‐analysis

Tranexamic Acid for reduction of intra- and postoperative TRansfusion requirements in elective Abdominal surgery (TATRA): study protocol for an investigator-initiated, multicenter, double-blind, placebo-controlled, randomized superiority trial with two parallel groups

Contact Info

Product

Resources

About