The use of a common drug could reduce blood loss, the need for transfusions, and save money, a new study suggests.
A landmark clinical trial published in the New England Journal of Medicine found that tranexamic acid reduced transfusions across major surgeries without increasing the risk of dangerous blood clots.
Tranexamic acid has been used in cardiac and some orthopaedic surgeries for over 30 years, but doctors have been uncertain whether it can safely be used in other major surgeries, especially cancer surgeries.
This Canadian clinical trial studied over 8,000 major surgeries to determine if tranexamic acid reduced bleeding and blood transfusion without increasing the risk of clots. The results of the trial support expanding its use to all major surgeries where patients face a high risk of blood loss.
Dr Brett Houston, co-first author and haematologist and clinician-scientist at the University of Manitoba and CancerCare Manitoba, said: ‘This is transformative to patient care and globally has the potential to save millions of units of red blood cells each year.’
Daniel McIsaac, co-first author and anaesthesiologist and senior scientist at The Ottawa Hospital and Clinical Research Chair in Perioperative Innovation at the University of Ottawa, said: ‘If tranexamic acid is universally adopted across major surgeries, it will improve surgical safety for millions of patients around the world. In Canada alone, adopting this drug across the board could reduce the number of patients needing a transfusion by 25% annually and the number of blood units required by 10%.
Universal adoption of the drug also has the potential to save significant money.
For every 100 patients treated with tranexamic acid, 10 units of blood could be saved. Importantly, the researchers found that tranexamic acid did not increase the risk of venous blood clots 90 days after surgery.
The rate of blood clotting in both the treatment and placebo groups was the same, at 2.1%.
One unique aspect of the study was that 60%, or about 5,000 participants, had surgery to remove cancer.
The trial found that tranexamic acid during major surgery was safe and effective even for cancer patients, who are at a higher risk of blood clots due to cancer.
Dr Dean Fergusson, co-senior author and Deputy Scientific Director, Clinical Research and senior scientist at The Ottawa Hospital and professor at the University of Ottawa, said: We hope our findings will reassure care providers that this drug is safe and effective at reducing bleeding and remove a barrier to its use in most major surgeries," said
The trial was sponsored and coordinated by the University of Manitoba (UM) and co-led by researchers at UM and The Ottawa Hospital.
