From the Guidelines
Tranexamic acid (TXA) prophylaxis is not explicitly recommended for liver resection surgery in the provided guidelines. The guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations 2022, do not mention TXA as a recommended prophylaxis for liver resection surgery 1. However, the use of antifibrinolytic agents such as TXA has been recommended in other contexts, such as trauma patients who are bleeding or at risk of significant hemorrhage, with a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 h 1.
Considerations for TXA Prophylaxis
- The ERAS guidelines do recommend anti-thrombotic prophylaxis, such as low molecular weight heparin or unfragmented heparin, to reduce the risk of thromboembolic events, which should be started postoperatively unless exceptional circumstances make this unsafe 1.
- The guidelines also recommend intermittent pneumatic compression devices to further reduce the risk of thromboembolic events 1.
- TXA has been shown to reduce intraoperative blood loss and decrease transfusion requirements in other surgical contexts, but its use in liver resection surgery is not explicitly recommended in the provided guidelines.
Clinical Decision Making
In the absence of explicit recommendations for TXA prophylaxis in liver resection surgery, clinicians should consider the individual patient's risk factors for bleeding and thrombosis, as well as the potential benefits and risks of TXA administration. The decision to use TXA prophylaxis should be made on a case-by-case basis, taking into account the patient's medical history, the type and extent of the surgical procedure, and the potential for bleeding and thromboembolic complications.
Key Points
- TXA prophylaxis is not explicitly recommended for liver resection surgery in the provided guidelines.
- Anti-thrombotic prophylaxis and intermittent pneumatic compression devices are recommended to reduce the risk of thromboembolic events.
- Clinicians should consider individual patient risk factors and make decisions on a case-by-case basis.
From the Research
Tranexamic Acid Prophylaxis in Liver Resection Surgery
- The use of tranexamic acid (TXA) in liver resection surgery has been studied to determine its effectiveness in reducing bleeding and transfusion requirements 2, 3, 4, 5.
- A prospective, phase II trial found that TXA does not influence the change in systemic fibrinolysis, but may reduce bleeding through a different mechanism of action 2.
- A systematic review and meta-analysis found that TXA reduces the need for perioperative blood transfusion in liver resection and transplantation, without increasing the incidence of thromboembolic events or mortality 3.
- However, a retrospective cohort study found that TXA administration during liver transplantation was not associated with reduced blood loss or reduced utilization of red blood cell transfusion 4.
- Another study found that prophylactic administration of TXA reduces total packed red blood cell usage during orthotopic liver transplantation 5.
- The efficacy and safety of TXA vary according to the clinical context, timing of administration, and dose, and its use has the potential to improve surgical safety and avoid unnecessary blood use 6.
Key Findings
- TXA may reduce bleeding in liver resection surgery, but its mechanism of action is not fully understood 2.
- TXA reduces the need for perioperative blood transfusion in liver resection and transplantation 3.
- TXA does not increase the incidence of thromboembolic events or mortality in liver resection and transplantation 3.
- The use of TXA in liver transplantation is not universally recommended, and its effectiveness may depend on individual patient factors 4.