A study suggests that patients who received tranexamic acid during liver surgery were three times less likely to develop post-hepatectomy liver failure than those who received a placebo.
The findings were published in Blood.
Post-hepatectomy liver failure is one of the most serious complications after liver surgery and remains a leading cause of death after liver resection.
Currently, there are no approved medications specifically designed to prevent this complication.
Findings from the multicentre study, co-led by researchers at Mayo Clinic and Michigan State University, provide evidence that targeting the body’s fibrinolytic system may support liver regeneration and reduce the risk of post-surgical liver failure.
Tranexamic acid is a medication that prevents the breakdown of blood clots. It is widely used to manage or prevent excessive bleeding in trauma, heavy menstrual periods, childbirth, and during dental or surgical procedures.
Patrick Starlinger, a hepatobiliary and pancreatic surgeon at Mayo Clinic in Rochester and co-senior author of the study, said: ‘The possibility that a widely available, low-cost medication could substantially reduce this risk is exciting because it has the potential to improve outcomes for patients undergoing surgery for liver cancer and other serious liver diseases.’
Researchers first found in pre-clinical models that temporarily reducing plasminogen, a protein involved in the fibrinolytic system, enhanced liver regeneration after resection. They then analysed data from the HeLiX trial, a large international clinical study in which patients undergoing liver resection received either tranexamic acid or a placebo.
The protective effect of tranexamic acid was greatest among patients with impaired liver function before surgery, a group at particularly high risk of post-hepatectomy liver failure.
The findings also challenge a long-standing assumption about liver regeneration.
Dr Starlinger added: ‘For decades, the field believed that plasminogen was necessary for liver regeneration, based on pre-clinical models. Using a more precise and reversible approach, we observed the opposite effect. Our findings open a new avenue for understanding how the body’s clotting and fibrinolytic systems influence liver recovery after surgery.’
The findings support further studies to determine whether tranexamic acid could be part of a strategy to prevent post-hepatectomy liver failure in patients at highest risk.
Dr Starlinger said: ‘While these findings need to be confirmed in a dedicated clinical trial, they provide a strong rationale for evaluating whether tranexamic acid can help protect patients from one of the most feared complications in liver surgery.’
