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.
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