Role of Tranexamic Acid (TXA) in Preventing Bleeding Following Sleeve Gastrectomy: a Systematic Review and Meta-analysis
Mocanu V, Wilson H, Verhoeff K, Kung J, Walsh C, Koloszvari N, Neville A, Karmali S
Obesity surgery. 2023
BACKGROUND Tranexamic acid (TXA) has drawn growing interest over the last decade for its benefit in optimizing post-operative bleeding, yet its role in bariatric surgery is poorly understood. METHODS The medical librarian developed and executed comprehensive searches on September 28, 2022. The population of interest included adults who underwent elective bariatric surgery. The intervention was tranexamic acid administration while the comparison was placebo or standard peri-operative therapy. The primary outcome of interest was post-operative bleeding which was defined a priori. RESULTS A total of four studies were identified comprising of 475 patients. Of those, 207 (50%) received TXA at induction and all underwent laparoscopic sleeve gastrectomy (LSG). The majority of patients were female (n = 343, 80.7%) with ages ranging from 17 to 70 years of age and mean BMIs ranging from 37 to 56 kg/m(2). Post-operative bleeding after LSG ranged from 0 to 28% depending on bleed definition and TXA administration with no differences in venous thromboembolic events or mortality between groups. Meta-analysis of post-operative bleeding demonstrated a statistically significant benefit with TXA administration (OR 0.40; 95% CI 0.23-0.70; p = 0.001) for patients undergoing elective LSG. CONCLUSIONS Intravenous tranexamic acid at the time of laparoscopic sleeve gastrectomy is associated with a significant reduction of post-operative bleeding with no observed differences in thromboembolic events or mortality. Further high-quality studies are needed to better delineate the ideal bariatric population to receives TXA in addition to the optimal timing, dose, and duration of TXA therapy.
Evaluation of efficacy and safety of a single dose Tranexamic acid in reducing blood loss during colorectal cancer surgery. A randomised, placebo controlled, double-blinded study
Shaker EH, Fayek ES, Elrawas MM
Indian journal of anaesthesia. 2023;67(2):194-200
BACKGROUND AND AIMS Colorectal cancer surgeries are commonly performed nowadays. They are considered as extensive procedures requiring perioperative blood transfusion in 32% to 68% of cases. The objective of this study was to evaluate the anti-haemorrhagic effects and safety of a single dose of tranexamic acid in such surgeries. METHODS Sixty patients scheduled for colorectal cancer surgeries were randomly assigned (TA) into two equal groups. Group TA received 10 mg/kg tranexamic acid in 100 ml of 0.9% NaCl immediately following induction of anaesthesia and control group received 100 ml 0.9% NaCl. The primary outcome was total blood loss reduction. The secondary outcomes were total number of patients requiring blood transfusion and occurrence of any thromboembolic events within 30 days after surgery. RESULTS Intraoperative and total blood loss were lower in TA group compared to the control group (P = 0.010, 0.003, respectively) while postoperative blood loss was comparable between both groups. The need for blood transfusion was lower in TA group (P = 0.038). Number of blood units transfused was also lower in TA group. Mean arterial blood pressure, serum creatinine and urine output in first 24 h postoperatively were comparable between both groups. Haemoglobin level in the first postoperative day was higher in TA group (P = 0.002), but was comparable between the groups at 2 weeks preoperative and from second up to fifth day postoperatively. CONCLUSION A single dose of TA administered between induction and start of surgical procedure may reduce total blood loss and need of transfusion in colorectal cancer surgeries without any serious adverse effects.
Is tranexamic acid associated with decreased need for blood transfusion in percutaneous nephrolithotomy: a systematic review and meta-analysis
Prasad, S., Sharma, G., Devana, S. K., Kumar, S., Sharma, S.
Annals of the Royal College of Surgeons of England. 2023;105(2):99-106
INTRODUCTION Bleeding is a common complication after percutaneous nephrolithotomy (PNL) for renal stone disease. Tranexamic acid (TXA) has been found to reduce mortality and blood transfusion in surgical and trauma patients. This review aimed to assess the safety and efficacy of TXA in patients undergoing PNL. METHODS A systematic literature review was performed to recognise all randomised controlled trials (RCTs) comparing the use of TXA in PNL. The primary outcome of the study was to compare the need for blood transfusion with and without TXA. FINDINGS Six RCTs with 1,323 patients were included in this review. Haemoglobin fall was lower in the TXA group compared with the control group, and the need for blood transfusion was reduced by 67% (odds ratio (OR) 0.33, confidence interval (CI) (0.21, 0.52), p<0.00001). However, blood loss was comparable for the two groups (mean difference -116.9, CI (-244.5,10.7) p=0.07). Length of stay and duration of surgery was significantly shorter with TXA. Furthermore, both minor and major complications were lower in the TXA group. Stone-free rate was higher with the TXA group. No thromboembolic complications were noted in the TXA group. CONCLUSIONS TXA is safe and efficacious for PNL with a reduction in need for blood transfusion and without an attending increase in complication rates.
Intravenous Tranexamic Acid in Percutaneous Kidney Biopsy: A Randomized Controlled Trial
Izawa J, Matsuzaki K, Raita Y, Uehara G, Nishioka N, Yano H, Sudo K, Katsuren M, Ohigashi T, Sozu T, et al
BACKGROUND Tranexamic acid is frequently reported to reduce bleeding-related complications in major surgery and trauma. We aimed to investigate whether tranexamic acid reduced hematoma size after percutaneous kidney biopsy. METHODS We conducted a double-blind, parallel three-group, randomized placebo-controlled trial at a teaching hospital in Japan between January 2016 and July 2018. Adult patients with clinical indication for ultrasound-guided percutaneous biopsy of a native kidney were included. Participants were randomly assigned into three groups: high-dose tranexamic acid (1,000 mg in total), low-dose tranexamic acid (500 mg in total), or placebo (counterpart saline). Intervention drugs were intravenously administered twice, as a bolus just before the biopsy and as a continuous infusion initiated just after the biopsy. Primary outcome was post-biopsy perirenal hematoma size as measured by ultrasound on the morning after the biopsy. RESULTS We assessed 90 adult patients for study eligibility, of whom 56 were randomly allocated into the three groups: 20 for high-dose tranexamic acid, 19 for low-dose tranexamic acid, and 17 for placebo. The median size of perirenal hematoma was 200 mm2 (interquartile range, 21-650) in the high-dose tranexamic acid group, 52 mm2 (0-139) in the low-dose tranexamic acid group, and 0 mm2 (0-339) in the placebo group (p = 0.048 for high-dose tranexamic acid vs. placebo). CONCLUSION In this trial, the median size of post-kidney biopsy hematoma was unexpectedly larger in the high-dose tranexamic acid group than in the placebo group. Although our results do not support the routine use of tranexamic acid in percutaneous kidney biopsy at present, further studies are needed to confirm the results.
Tranexamic Acid Use for Hemorrhagic Events Prevention in Percutaneous Nephrolithotomy: Systematic Review and Meta-analysis
Baccaglini W, Rodrigues AFS, Glina FP, Dall'Aqua V, Glina S, Lopes Neto AC
Journal of endourology. 2022
PURPOSE Analyze the impact of Tranexamic acid (TA) use after percutaneous nephrolithotomy (PNL) on blood loss and transfusion rate (TR), and secondary outcomes, complications rate and stone free rates (SFR), Operative time (OT) and length of hospital stay (LOS). MATERIALS AND METHODS Search made in the Medline (PubMed), Embase, and Central Cochrane for studies published up to August 2021. The study protocol was registered at PROSPERO (CRD42020182197). Eligibility criteria were defined based on PICOS. Articles included were those who assessed the effect of intravenous TA in patients submitted to PNL. Only randomized placebo-controlled trial which included patients with and without TA perioperatively. Results: A total of 1,151 patients were included in 7 studies. Six studies presented a lower blood TR for the TA group (P<0.00001). Four studies presented similar results in relation a lower stone free rate (SFR) (P=0.004), and similar results regarding overall complication rate for the control group (P=0.03). Regarding the 'major complication rate' (Clavien-Dindo ≥3), no difference was found (P=0.07). Four studies showed a higher mean OT for the control group (159 x 151 minutes, respectively, P=0.003). Six studies found a lower mean LOS in the TA group (4.0 x 3.5 days, respectively, P=0.03). CONCLUSIONS The benefit of TXA use in the setting of PCNL perioperative is clear. Our study showed favorable results to TXA use in relation to TR, SFR, complication rate, OT and LOS, but these results did not translate into a lower major complication rate. Further studies evaluating the complexity of the calculi and events unrelated to PCNL may help us to select which patients will benefit from the use of TXA.
Tranexamic acid and blood loss in pancreaticoduodenectomy: TAC-PD randomized clinical trial
Ishii K, Yokoyama Y, Yonekawa Y, Hayashi D, Kinoshita F, Kuwatsuka Y, Okuno M, Natsume S, Minami T, Sugawara G, et al
The British journal of surgery. 2022
BACKGROUND Tranexamic acid (TXA) may reduce intraoperative blood loss, but it has not been investigated in pancreaticoduodenectomy (PD). METHODS A pragmatic, multicentre, randomized, blinded, placebo-controlled trial was conducted. Adult patients undergoing planned PD for biliary, duodenal, or pancreatic diseases were randomly assigned to TXA or placebo groups. Patients in the TXA group were administered 1 g TXA before incision, followed by a maintenance infusion of 125 mg/h TXA. Patients in the placebo group were administered the same volume of saline as those in the placebo group. The primary outcome was blood loss during PD. The secondary outcomes included perioperative blood transfusions, operating time, morbidity, and mortality. RESULTS Between September 2019 and May 2021, 218 patients were randomly assigned and underwent surgery (108 in the TXA group and 110 in the placebo group). Mean intraoperative blood loss was 659 ml in the TXA group and 701 ml in the placebo group (mean difference -42 ml, 95 per cent c.i. -191 to 106). Of the 218 patients, 202 received the intervention and underwent PD, and the mean blood loss during PD was 667 ml in the TXA group and 744 ml in the placebo group (mean difference -77 ml, 95 per cent c.i. -226 to 72). The secondary outcomes were comparable between the two groups. CONCLUSION Perioperative TXA use did not reduce blood loss during PD. REGISTRATION NUMBER jRCTs041190062 (https://jrct.niph.go.jp).
Tranexamic acid vs placebo and its impact on bleeding, transfusions and stone-free rates in percutaneous nephrolithotomy: a systematic review and meta-analysis
Hinojosa-Gonzalez DE, Flores-Villalba E, Eisner BH, Olvera-Posada D
Central European journal of urology. 2022;75(1):81-89
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is the standard of care for the treatment of large renal stones. Bleeding-related complications remain a major concern when performing this procedure. Tranexamic acid (TXA) has recently been studied in both urologic and non-urologic procedures to reduce bleeding, transfusions and complications. MATERIAL AND METHODS In June 2021 a systematic review was conducted following PRISMA guidelines on randomized prospective studies comparing the effects of TXA on bleeding complications during PCNL. Data was analyzed using Review Manager 5.3. RESULTS Eight studies were included with a total 1,201 patients, of which 598 received TXA and 603 received placebo. TXA was associated with less bleeding (decreased change in hemoglobin) -0.79 Hb g/dl [-1.09, -0.65] p <.00001 and decreased transfusion rates (OR 0.31 [0.18, 0.52] p <0.0001). This was also associated with lower complication rates, both minor, major and overall, OR 0.59[0.41, .85] p = 0.005, OR 0.31 [0.17, 0.56] p = 0.0001 and OR 0.40 [0.29, 0.56] p <0.00001 respectively. TXA was also associated with improved stone-free rates as compared with placebo (OR 1.79 [1.23, 2.62] p = 0.003). TXA resulted in shorter operative times (11.51 minutes [-16.25, -6.77] p =.001) and length of stay (-0.74 days [-1.13 -0.34] p = 0.0006). Two pulmonary embolisms were registered in a single study in the TXA group. CONCLUSIONS In this meta-analysis, the use of TXA during PCNL was associated with a statistically significant reduction in the following parameters when compared with placebo: change in hemoglobin, transfusion rates, complication rates, operative time, and length of stay. It was also associated with improvement in stone-free rates. These data should be considered by surgeons performing PCNL.
Effect of tranexamic acid on bleeding outcomes after percutaneous nephrolithotomy: A systematic review and meta-analysis of randomized controlled trials
MacDonald MM, Ilie G, Power LS, Whalen S, Parker R, Skinner TA, Lantz Powers AG
Journal of endourology. 2021
PURPOSE We performed a systematic review and meta-analysis of the literature to evaluate the efficacy of the routine use of tranexamic acid during percutaneous nephrolithotomy. METHODS This systematic review was conducted following best practices from Cochrane and the Institute of Medicine [Cochrane Handbook and IOM citations]. We followed the updated reporting guidelines from PRISMA 2020. RESULTS In total 275 titles and abstracts were reviewed, of which 20 were screened to be eligible for full text review. Of these 20 articles, 11 were selected for inclusion after full article evaluations. Seven of these 11 studies were seen as having a low risk of bias with a Jadad score of ≥3. These studies were included for data extraction. Once data was extracted, 964 patients were included. The primary outcome, blood transfusion rate, showed significant reduction with a ratio for transfusion rate of 0.34 [ 95% CI (0.19 to 0.61), z= 3.61, p=0.0003]. Mean Hemoglobin (Hgb) drop, and operative time were both shown to be reduced with the use of TXA. The mean difference for Hgb drop was -0.86 [ 95% CI (-1.26 to -0.46), z= 4.23, p< 0.0001]. Reduction in operative time showed a mean difference of -8.45 min [ 95% CI (-15.04 to -1.86), z= 2.51, p= 0.01]. Stone clearance was not shown to differ significantly between experimental and control groups, with a risk ratio of 1.28 [ 95% CI (0.89 to 1.84), z= 1.31, p= 0.19]. CONCLUSIONS This meta-analysis revealed that the routine use of TXA at time of PCNL reduces the rates of blood transfusion, mean Hgb drop, and operative time. With the low cost of TXA and strong safety profile, stronger consideration should be given to the routine use of TXA during PCNL by endoscopic surgeons.
The Effects of Tranexamic Acid on Bleeding Control During and after Percutaneous Nephrolithotomy (PCNL): A Randomized Clinical Trial
Mokhtari MR, Farshid S, Modresi P, Abedi F
Urology journal. 2021;:6505
PURPOSE Tranexamic acid is a fibrinolysis suppressor that is used for a variety of bleeding control procedures such as hematuria, surgery bleeding, and trauma caused bleeding. The advantages of using the tranexamic acid are bleeding control and less need for blood transfusion. MATERIALS AND METHODS This double blind clinical trial was conducted on 108 patients in Imam Khomeni Hospital, Urmia, Iran 2013-14. The control and intervention groups consisted of 54 randomly selected participants each. The intervention group received 1gr of intravenous tranexamic acid with initiation of surgery and 500mg orally each 8hrs afterwards up to three days. The control group received placebo capsules containing starch of the same form. RESULTS The mean term of hospitalization in the intervention group was significantly shorter than that of the control group (P<0.001). The difference between the two groups in terms of preoperative hemoglobin was not significant. However, the decrease in postoperative hemoglobin, intraoperative hemoglobin count in washing liquid, and hemoglobin count in the intervention group were significantly different from those of the control group (P<0.001). CONCLUSION The findings showed that tranexamic acid decreased bleeding during PCNL and the need for blood transfusion. It also decreased the hospitalization term.
The efficacy and safety of tranexamic acid in the management of perioperative bleeding after percutaneous nephrolithotomy: A systematic review and meta-analysis of comparative studies
Lee MJ, Kim JK, Tang J, Ming JM, Chua M
Journal of endourology. 2021
INTRODUCTION We performed a systematic review and meta-analysis of the current literature to assess the efficacy and safety of tranexamic acid (TXA) in the management of postoperative bleeding after percutaneous nephrolithotomy (PCNL). METHODS A systematic literature review was performed in March 2021. Two reviewers independently screened, identified, and evaluated comparative studies assessing the effectiveness of TXA in preventing bleeding following PCNL when compared to placebo or no intervention. The incidence of transfusion, complete stone clearance, and complications were extracted among TXA and control groups to generate the Risk Ratio (RR) and corresponding 95% confidence interval (CI). Blood loss, hemoglobin (Hb) drop, length of hospital stays, and operative (OR) time were analysed using standard mean difference (SMD) with corresponding 95% CI. Effect estimates were pooled using the inverse-variance approach with a random-effect model. RESULTS A total of 11 studies (8 randomized controlled trial, 1 prospective cohort, 2 retrospective cohort studies; total 1842 patients) of low-to-moderate-quality were included in the meta-analysis. Overall pooled effect estimates demonstrated a decreased transfusion rate (RR 0.36; 95% CI 0.25 to 0.51), blood loss (SMD -0.74; 95% CI -1.14 to -0.34) and Hb drop (SMD -0.95; 95% CI -1.51 to -0.39) among patients in the TXA group when compared to those in the control. The number needed to treat was 11 to prevent one transfusion. Patients who received TXA also had improved stone clearance (RR 1.08; 95% CI 1.02 to 1.14), lower minor (RR 0.72; 95% CI 0.58 to 0.89) and major (RR 0.38; 95% CI 0.21 to 0.69) complications, shorter hospital stays (SMD -0.52; 95% CI -1.01 to -0.04) and decreased OR time (SMD -0.89; 95% CI -1.46 to -0.31). CONCLUSIONS TXA can effectively reduce postoperative bleeding following PCNL. Future studies should identify a subset of patients who may benefit from preoperative TXA administration for PCNL.