The impact of tranexamic acid on administration of red blood cell transfusions for resection of colorectal liver metastases

Jaffer, Alisha; Karanicolas, Paul J.; Davis, Laura; Behman, Ramy; Hanna, Sherif S.; Law, Calvin; Coburn, Natalie; Roke, Rachel; Lemke, Madeline; Beyfuss, Kaitlyn; Hallet, Julie

doi:10.1016/j.hpb.2020.06.004

Cited by 11 publications

(9 citation statements)

References 46 publications

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“…Whilst case control and cohort studies have since been published, the lack of randomisation and blinding can introduce confounders and are at a higher risk of bias, and therefore not included in this review. Nonetheless, the findings [34–36] seem to support those of the RCTs. Of the 6 RCTs identified in this study, only 1 [29] was performed in the liver resection population.…”

Section: Limitationsmentioning

confidence: 64%

Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Hepatic Surgery: A Systematic Review and Meta‐Analysis

et al. 2021

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Introduction Perioperative bleeding poses a major risk during liver surgery, which can result in increased transfusion requirements, morbidity, and mortality. Tranexamic acid (TXA) effectively reduces perioperative bleeding and transfusion requirements in trauma patients. However, there remains a lack of evidence of its use in liver surgery. This meta-analysis of randomised controlled trials evaluated the efficacy and safety of TXA in liver resection and transplantation. Method A comprehensive search of Medline, Embase, CENTRAL and Clinicaltrials.gov databases was undertaken to identify studies from January 1947 to September 2021. The outcomes of the need for blood transfusion, thromboembolic events and mortality were extracted from the included studies. Quantitative pooling of data was based on the random effects model. Results Six studies reporting on 429 patients were included. TXA reduced the need for perioperative blood transfusion in liver resection and transplantation (OR 0.09; 95% CI 0.01 to 0.72). More importantly, TXA did not increase the incidence of thromboembolic events (OR 2.22; 95% CI 0.47 to 10.43) and mortality (OR 0.60; 95% CI 0.13 to 2.76). Conclusion TXA safely reduces the need for blood transfusion in patients undergoing liver resection and transplantation.

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Section: Limitationsmentioning

confidence: 64%

Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Hepatic Surgery: A Systematic Review and Meta‐Analysis

et al. 2021

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“…It should be noted that while TA is not currently approved for use as an anticancer agent, TA is employed with increasing frequency in various aspects of clinical cancer management. TA is often used to limit bleeding during surgical tumor resections ( Wu et al, 2006 ; Longo et al, 2018 ; Jaffer et al, 2021 ). TA treatment is associated with a reduction in the number of malignant cells and decreased generation of ascites fluid in patients with disseminated ovarian cancer ( Soma et al, 1980 ; Kikuchi et al, 1986 ).…”

Section: Discussionmentioning

confidence: 99%

“…While TA has been used to manage cancer and cancer treatment-associated sequela in patients ( Soma et al, 1980 ; Kikuchi et al, 1986 ; Oertli et al, 1994 ; Wu et al, 2006 ; Longo et al, 2018 ; Lohani et al, 2020 ; Jaffer et al, 2021 ; Lohani et al, 2021 ), it has never been used clinically as an anti-cancer therapeutic, and considerations of TA anticancer actions have focused on its blockade of Plasmin production. The goals of the studies carried out herein were three-fold: 1.…”

Section: Introductionmentioning

confidence: 99%

Repurposing Tranexamic Acid as an Anticancer Agent

et al. 2022

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Tranexamic Acid (TA) is a clinically used antifibrinolytic agent that acts as a Lys mimetic to block binding of Plasminogen with Plasminogen activators, preventing conversion of Plasminogen to its proteolytically activated form, Plasmin. Previous studies suggested that TA may exhibit anticancer activity by blockade of extracellular Plasmin formation. Plasmin-mediated cleavage of the CDCP1 protein may increase its oncogenic functions through several downstream pathways. Results presented herein demonstrate that TA blocks Plasmin-mediated excision of the extracellular domain of the oncoprotein CDCP1. In vitro studies indicate that TA reduces the viability of a broad array of human and murine cancer cell lines, and breast tumor growth studies demonstrate that TA reduces cancer growth in vivo. Based on the ability of TA to mimic Lys and Arg, we hypothesized that TA may perturb multiple processes that involve Lys/Arg-rich protein sequences, and that TA may alter intracellular signaling pathways in addition to blocking extracellular Plasmin production. Indeed, TA-mediated suppression of tumor cell viability is associated with multiple biochemical actions, including inhibition of protein synthesis, reduced activating phosphorylation of STAT3 and S6K1, decreased expression of the MYC oncoprotein, and suppression of Lys acetylation. Further, TA inhibited uptake of Lys and Arg by cancer cells. These findings suggest that TA or TA analogs may serve as lead compounds and inspire the production of new classes of anticancer agents that function by mimicking Lys and Arg.

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“…11 Recently, there have been notable changes in perioperative transfusion practice that includes a restrictive transfusion strategy 12,13 and prophylactic antifibrinolytic therapy. 14 These multimodal efforts might have impacted the pattern of perioperative RBC usage in hepatectomy, potentially modulating the risk of transfusion-related complications. Previous investigations have not clearly established the relationship of allogeneic RBC transfusion and VTE after hepatectomy.…”

Section: Introductionmentioning

confidence: 99%

“…According to a previous NSQIP study (2005–2010) on hepatectomy ( n = 7621), 10 the overall rate of VTE including deep vein thrombosis (DVT) and pulmonary embolism was 2.8% within 30 days of surgery; however, depending on the extent of hepatectomy and type of thromboprophylaxis, VTE rates vary widely between <1% and 13.8% 11 . Recently, there have been notable changes in perioperative transfusion practice that includes a restrictive transfusion strategy 12,13 and prophylactic antifibrinolytic therapy 14 . These multimodal efforts might have impacted the pattern of perioperative RBC usage in hepatectomy, potentially modulating the risk of transfusion‐related complications.…”

Section: Introductionmentioning

confidence: 99%

Trends and predictions of perioperative transfusion and venous thromboembolism in hepatectomy using a North American Registry

Ha,

Stewart,

Butt

et al. 2023

Transfusion

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BackgroundStudies indicate a link between allogeneic blood transfusion and venous thromboembolism (VTE) post‐major surgery. Analyzing trends and predictors of these outcomes after hepatectomy can inform risk management.MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was used for a retrospective analysis. Primary outcomes were perioperative red blood cell (RBC) transfusion and VTE events within 30 days of hepatectomy. Seven‐year trends and predictors were evaluated.ResultsAmong 29,131 hepatectomy patients, transfusion rates showed no statistically significant decreasing trends (p = .122) from 2014 to 2020 (18.13%–16.71%), while VTE rates showed a downward trend over the 7 years (p = .021); 17.2% received RBC transfusion, with higher rates in surgeries lasting ≥282 min (median: 220 min). Calculated RBC mass [hematocrit (%) × body weight (kg) × 10−5 × 70/(body mass index/22)] at or below 1.5 L substantially increased transfusion odds. VTE was reported postoperatively in 2.6% of cases more frequently in longer cases involving transfusions. The adjusted odds ratio (aOR) of VTE escalated from the shortest operative time to the longest (3.17; 95% confidence interval [CI], 2.37–4.22). The adjusted odds of VTE doubled for transfused patients compared to non‐transfused patients (aOR, 2.19; 95% CI, 1.86–2.57).ConclusionsRates of RBC transfusion and VTE rates hepatectomy have minimally changed in the recent years. VTE prevention is challenging in extended surgeries at increased risk of bleeding and RBC transfusions. Patient‐level data on coagulation and thromboprophylaxis can potentially refine risk assessment for postoperative VTE.

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The impact of tranexamic acid on administration of red blood cell transfusions for resection of colorectal liver metastases

Cited by 11 publications

References 46 publications

Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Hepatic Surgery: A Systematic Review and Meta‐Analysis

Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Hepatic Surgery: A Systematic Review and Meta‐Analysis

Repurposing Tranexamic Acid as an Anticancer Agent

Trends and predictions of perioperative transfusion and venous thromboembolism in hepatectomy using a North American Registry

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