A topical application of tranexamic acid (TXA) after surgery is a simple, effective way to reduce blood loss, transfusions and the risk for systemic side effects, researchers have found.
Normally given orally or intravenously, TXA has been used successfully in a variety of surgeries to prevent the dissolution of blood clots, but some clinicians are still hesitant about administering the drug.
Fonte: AnesthesiologyNews
“There was a big fear in the orthopedic community about the side effects of TXA increasing the risk for thromboembolic complications, namely venous thrombosis and pulmonary embolism,” study leader Sattar Alshryda, MBChB, consultant trauma and orthopedic surgeon at Royal Manchester Children’s Hospital, in Manchester, United Kingdom, told Anesthesiology News.
Dr. Alshryda and his colleagues conducted a double-blind, randomized controlled trial with 157 patients to test for blood loss. According to the study, approximately one-third of patients undergoing knee replacement procedures in England and Wales in 2008 required one to three units of blood.
“Joint replacement necessitates allogeneic blood transfusion, which remains a concern for patients and health care providers due to the potentially serious complications of transfusion and cost implications,” Dr. Alshryda said.
Patients had either a 50-mL saline solution containing 1 g of TXA or a placebo sprayed into their wounds after surgery. The researchers found that topical TXA reduced the absolute risk for blood transfusion by 15.4%. One patient in the TXA group received two units of blood; 32 units were given to 13 patients in the placebo group.
Patients who received TXA lost less blood and had shorter hospital stays—1.2 days shorter, on average—than those in the placebo group, according to the researchers. Their care cost an average of $561 less, as well. The TXA cost $3.70.
Knee replacement surgery is becoming increasingly common in the United States, with costs mirroring its growth. In 2000, surgeons performed 328,122 total knee procedures, according to data from the Agency for Healthcare Research and Quality. That number jumped to 719,000 in 2010. During that decade, the mean length of stay decreased from 4.2 to 3.3 days, whereas mean costs increased from $23,315 to $49,558.
But Stavros G. Memtsoudis, MD, an attending anesthesiologist at the Hospital for Special Surgery, in New York City, said reducing costs should not be the driving factor for increasing the use of topical TXA.
He said studies have shown—and some clinicians have bought into the idea—that TXA is effective in reducing blood transfusions, but the drug is not given to all patients due to safety issues.
“The big question, really, is why doesn’t everyone get it? And the answer to that would be because the safety data are still really difficult to come by. Because to determine safety, you require much bigger studies,” Dr. Memtsoudis said.
He said the Hospital for Special Surgery administers TXA topically and intravenously, and that topical use has become more popular in recent years because it is believed “to reduce the dosage that the patient gets exposed to systemically that could cause clotting compared to giving it through the IV.”
Dr. Memtsoudis said while he has not seen any side effects so far, any use of the drug might increase the risk for clotting—bringing into question whether the benefits outweigh the risks. Blood loss is important to consider, he said, because of its associated complications.
Use of TXA, despite the potential side effects, can prevent these problems. “While you may have an increase on one side, you’re also going to have a decrease on the other side through a reduction of blood loss,” he said.
—Martin Leung
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