What is the role of prophylactic tranexamic acid (TXA) in general surgery?

From the Guidelines

Prophylactic tranexamic acid (TXA) is recommended in general surgery to reduce bleeding and the need for transfusion.

Benefits of TXA

• TXA is a synthetic derivative of the amino acid lysine that inhibits plasminogen activation, thus preventing impairment of fibrinolysis 1
• It has been shown to reduce bleeding in trauma, cardiac surgery, and other major surgery 1
• The use of TXA is recommended during on-pump cardiac surgical procedures to reduce total blood products transfused and major hemorrhage or tamponade requiring reoperation 1
• TXA should be given to reduce blood loss and need for transfusion in hip fracture patients 1

Dosage and Administration

• A dose of 1 g bolus is recommended, and an additional infusion of 500 mg/h may also be considered 1
• A maximum total dose of 100 mg/kg is recommended to minimize the risk of seizures 1
• TXA can be administered orally, intravenously, or topically 1

Safety and Efficacy

• TXA has a low-risk profile and is cost-effective 1
• The risk of precipitated thrombosis with the use of TXA is low, and the rate of thrombosis, especially myocardial infarction, was lower with the use of TXA in the CRASH-2 trial 1
• High doses of TXA may be associated with seizures, but this is rare 1

From the Research

Role of Prophylactic Tranexamic Acid (TXA) in General Surgery

The use of prophylactic tranexamic acid (TXA) in general surgery has been studied in various clinical trials and meta-analyses. The evidence suggests that TXA can reduce perioperative blood loss and transfusion requirements in general surgery patients.

• Efficacy of TXA: Studies have shown that TXA can reduce major bleeding by 25% without a significant increase in thrombotic events 2. A meta-analysis found that a single preoperative dose of TXA reduced perioperative blood loss and transfusion requirements in a variety of surgical disciplines without increasing the risk of thromboembolic events 3.
• Safety of TXA: The safety of TXA has been evaluated in several studies, and the evidence suggests that it is generally safe and well-tolerated. A study found that TXA did not increase the risk of thromboembolic events or other adverse effects in patients undergoing general surgery 4.
• Specific Surgical Procedures: TXA has been studied in various specific surgical procedures, including hepatopancreaticobiliary surgery and colorectal surgery. The evidence suggests that TXA can reduce the risk of perioperative bleeding in these procedures 4.
• Dosing and Administration: The optimal dosing and administration of TXA in general surgery is not yet established, but studies suggest that a single preoperative dose of 1-2 grams may be effective 3, 4.
• Real-World Use: The real-world use of TXA in general surgery has been evaluated in several studies, and the evidence suggests that it is not yet widely used in many centers. A study found that TXA was used in only 17% of non-cardiac surgeries at high risk for transfusion 5.

Benefits and Risks of TXA

The benefits and risks of TXA in general surgery have been evaluated in several studies. The evidence suggests that TXA can reduce perioperative blood loss and transfusion requirements, but may also increase the risk of thromboembolic events in some patients.

• Benefits: TXA can reduce perioperative blood loss and transfusion requirements, which can improve patient outcomes and reduce healthcare costs 2, 3, 4.
• Risks: TXA may increase the risk of thromboembolic events, although the evidence suggests that this risk is generally low 2, 3, 4.