The prophylactic role of tranexamic acid to reduce blood loss during radical surgery: A prospective study

Kumkum Gupta, Bhawna Rastogi, Atul Krishan, Amit Gupta, V P Singh, Salony Agarwal, Kumkum Gupta, Bhawna Rastogi, Atul Krishan, Amit Gupta, V P Singh, Salony Agarwal

Abstract

Background: The radical surgical procedures are associated with perioperative blood loss. This study was aimed to evaluate the clinical efficacy and safety of tranexamic acid in reducing perioperative blood loss in patients undergoing radical surgery.

Materials and methods: Sixty ASA class I and II adult consented female patients, scheduled for elective radical surgery and met the inclusion criterion, were blindly randomized into two groups to receive either intravenous 1 g tranexamic acid 20 min before skin incision or an equivalent volume of normal saline as placebo (P). All patient's total blood loss was measured and recorded perioperatively at the 12(th)h postoperatively. The preoperative and postoperative hemoglobin, hematocrit values, serum creatinine, activated thromboplastin time, prothombin time, thrombocyte count, fibrinogen, D-dimer, and symptoms of pulmonary embolism were comparatively evaluated.

Results: The tranexamic acid significantly reduced the quantity of total blood loss, 576 ± 53 mL in study group as compared to 823 ± 74 mL in the control group (P<0.01). Postoperatively hematocrit values were higher in the tranexamic acid group. The coagulation profile did not differ between the groups, but D-dimer concentrations were increased in the control group. No complications or adverse effects were reported in the either group.

Conclusion: The prophylactic administration of tranexamic acid has effectively reduced theblood loss and transfusion needs during radical surgery without any adverse effects or complication of thrombosis.

Keywords: Antifibrinolytic agent; coagulation profile; hematocrit values; tranexamic acid.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Murphy WG, Davies MJ, Eduardo A. The haemostatic response to surgery and trauma. Br J Anaesth. 1993;70:205–13.
    1. Amar D, Grant FM, Zhang H, Boland PJ, Leung DH, Healey JA. Antifibrinolytic therapy and perioperative blood loss in cancer patients undergoing major orthopedic surgery. Anesthesiology. 2003;98:337–42.
    1. Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs. 1985;29:236–61.
    1. Wells PJ. Safety and efficacy of methods for reducing perioperative allogenic transfusion: A critical review of the literature. Am J Ther. 2002;9:37788.
    1. Mongan PD, Brown RS, Thwaites BG. Tranexamic acid and aprotinin reduce postoperative bleeding transfusions during primary coronary revascularization. Anesth Analg. 1998;87:258–65.
    1. Casati V, Bellotti F, Gerli C, Franco A, Oppizzi M, Cossolini M, et al. Tranexamic acid administration after cardiac surgery: A prospective, randomized, double blind placebo controlled study. Anaesthesiology. 2001;94:8–14.
    1. Wu CC, Ho WN, Cheng SB, Yeh DC, Wen Mc, Liu TJ, et al. Perioperative parenteral tranexamic acid in liver tumor resection. Ann Surg. 2006;243:173–80.
    1. Makwana J, Paranjape S, Goswami J. Antifibrinolytics in liver surgery. Indian J Anaesth. 2010;54:489–95.
    1. Dalmau A, Sabate A, Acosta F, Garcia-Huete L, Koo M, Sansano T, et al. Tranexamic acid reduces red cell transfusion better than aminocaproic acid or placebo in liver transplantation. Anesth Analg. 2000;91:29–34.
    1. Mahdy AM, Webster NR. Perioperative systemic haemostatic agents. Br J Anaesth. 2004;93:842–58.
    1. Dunn CJ, Goa KL. Tranexamic acid: A review of its use in surgery and other indications. Drugs. 1999;57:1005–32.
    1. Ekback G, Axelsson K, Ryttberg L, Bror E, Zill KL, Johan W, et al. Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg. 2000;91:1124–30.
    1. Lemay E, Guay J, Cote C, Roy A. Tranexamic acid reduces the need for allogenic red blood cell transfusions in patients undergoing total hip replacement. Can J Anesth. 2004;51:31–7.
    1. Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty. A prospective, randomized, double blind study of 86 patients. J Bone Joint Surg Br. 1996;78:434–40.
    1. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90:596–9.
    1. Hippala S, Strid L, Wennerstrand M, Arvela V, Mantyla S, Ylmen J, et al. Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth. 1995;74:534–7.
    1. Gohel M, Patel P, Gupta A, Desai P. Efficacy of tranexamic acid in decreasing blood loss during and after cesarean section: A randomized case controlled prospective study. J Obstet Gynecol Reprod Biol. 2004;112:154–7.
    1. Ming-ying G, Lian-fang W, Qi-feng S, Karin T. Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: A multi-center, randomized trial. Eur J Obstet Gynecol Reprod Biol. 2004;112:154–7.
    1. Gohel M, Patel P, Gupta A, Desai P. Efficacy of tranexamic acid in decreasing blood loss during and after cesarean section: A randomized case controlled prospective study. J Obstet Gynecol India. 2007;57:227–30.
    1. Celebi N, Celebioglu B, Selcuk M, Canbay O, Karagoz AH, Aypar U. The role of antifibrinolytic agents in gynecological cancer surgery. Saudi Med J. 2006;27:637–41.
    1. Chauhan S, Das SN, Bisoi A, Kale S, Kiran U. Comparison of epsilon aminocaproic acid and tranexamic acid in pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18:141–3.
    1. Jansen AJ, Andreica S, Claeys M, Haese JD, Camu F, Jochmans K. Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth. 1999;83:596–601.
    1. Benoni G, Lethagen S, Neilson P, Fredin H. Tranexamic acid given at the end of the operation, does not reduce postoperative blood loss in hip arthroplasty. Acta Orthop Scand. 2000;71:250–4.
    1. Bekassy Z, Astedt B. Treatment with the fibrinolytic inhibitor tranexamic acid-risk for thrombosis? Acta Obstet Gynecol Scand. 1990;69:353–4.

Source: PubMed

3
订阅