You Must Know about TXA Before Your Next Operation

A new study out of Baylor College of Medicine in Houston shows that use of effective anti-bleeding drugs during surgery is up. That's good. But it is not up enough. 

Dr. Henry Huang says:

“There is a growing body of literature to support the use of antifibrinolytics to decrease perioperative blood loss, so the hope was that utilization rate would come up, and it did so in our study. But nearly 30% of centers have still decided not to use antifibrinolytics despite the increasing evidence.”

Antifibrinolytics are drugs such as TXA (tranexamic acid) that promote clotting.

A huge study of TXA in 2012 called CRASH-2 looked at 20,000 patients (half given TXA, half a placebo). It proved beyond all doubt that doctors' most common fear about TXA - that it would cause patients to throw a dangerous clot - were absolutely groundless. (Remember that term - CRASH-2. Ask your doctor if he is familiar with the CRASH-2 study.)

30% of surgical teams not using TXA, or something similar, is a concern. What has inhibited the adoption of what is essentially a miracle drug?

Of the centers that did not use antifibrinolytics, two factors were predominantly cited: 1., surgeon preference, and 2., concerns about side effects.

Since CRASH-2 proved beyond doubt that the side effects were minimal, what's the remaining hold up? "Surgeon preference."

Really????

Take a card, write "TXA" on it in large letters, and keep it in your wallet. If you need surgery, pull it out. If your surgeon has a "preference" for blood transfusion instead of preventing blood loss, perhaps you should "prefer" another surgeon.

I've written quite a bit about blood medicine. To read my other columns on this subject, click here.

Please feel free to leave a comment. 

Bill K. Underwood is the author of several novels and one non-fiction self-help book, all available at Amazon.com.You can help support this site by purchasing one of his books.

TXA drug found to dramatically reduce blood loss

A DRUG that prevents ­patients from losing excessive amounts of blood during and after surgery dramatically reduces complications, a global trial led by The Alfred hospital has revealed.

In a study out of Australia, about 40 per cent of patients who have open-heart ­surgery need blood transfusions and emergency surgery to stem the bleeding, putting them at risk of worse outcomes.

But giving them the drug tranexamic acid (TXA) cut those complications nearly in half.

Anaesthetists and surgeons leading the study say the drug can be used safely for everything from heart surgery to hip replacement.

Melbourne researchers are also hopeful it will prove to be an effective “roadside drug” that reduces bleeding in trauma patients while they are being transported to hospital.

Doctors were concerned the drug’s tendency to promote clotting might raise the risk of heart attack or stroke. But Associate Professor Silvana Marasco, a cardiothoracic surgeon at The Alfred and co-author of the study,­ said the findings of the 10-year trial of more than 4000 patients found no evidence to support these fears.

She said excessive bleeding in surgery could reduce the ­patient’s recovery and increase costs to the health system because of blood transfusions and emergency surgery.

“Bleeding during a surgery prolongs it, but it also causes a problem when the patient continues to bleed after you close the chest,” she said.

“If they have ongoing bleeding, you have to give them a blood transfusion, and sometimes the amount of blood they lose can collect around the heart and actually compress the heart and stop it from working ­properly. In that situation, they ­become quite unstable and you are rushing them back to the operating theatre for emergency surgery and we have to reopen them, find where the bleeding is coming from and give them drugs to reduce it.”

Professor Paul Myles, director of anaesthesia and perioperative medicine at The Alfred, said the findings meant almost every heart surgery patient could be treated with TXA.

“Use of TXA can also be safely expanded to prevent bleeding with other kinds of major surgery, such as knee and hip replacements, trauma surgery and spinal surgery — operations where TXA is not much used at present,” he said.

The study, published in the New England Journal of Medicine, was funded by the Australian and New Zealand College of Anaesthetists and the ­National Health and Medical Research Council. [Read more here…]

To read another of my columns on blood medicine, click here.
Please leave a polite comment.

Bill K. Underwood is the author of several novels and one non-fiction self-help book, all available at Amazon.com. You can help support this site by purchasing one of his books.

Blood Medicine, Part Two

If the American Medical Association says blood transfusions do more harm than good, as we noted in Part One, why are so many doctors still doing them?