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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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.

Why Blood is Bad Emergency Medicine

While more and more hospitals are jumping on the bloodless medicine bandwagon, emergency medicine seems to be going the other direction. Paramedics in some locations are beginning to carry blood in their ambulances and helicopters. 

Nearly every medical benefit – or supposed benefit – of transfused blood can now be achieved by some other treatment, at less cost, and with fewer negative effects. So why is blood still being used?

I’m not a doctor. But I’ve written a lot about blood, and in the process I’ve learned a lot about blood medicine. The more I learn, the more appalled I am that doctors continue to consider blood transfusion an effective treatment – for anything. This brief column is intended to summarize what I’ve written previously.

You can read some of my other columns on the subject here: 

• Advances in Blood Medicine
• Blood Medicine, Part Two
• Blood Medicine, Part Three
• Real Advances in Blood Technology
• Blood, Medical Ethics, and the Bible
• Hyperbaric Oxygen Therapy for Massive Blood Loss

 As we discussed in the column Blood Medicine Part Two, it isn’t enough for the hemoglobin inside your red blood cells to absorb oxygen in the lungs. It also must let go of the oxygen when it gets to where it’s needed. Since oxygen is attracted to the iron molecules in hemoglobin, releasing it is easier said than done. One ingredient that plays a key role in the release of oxygen from hemoglobin is a blood chemical called DPG. Lowering of DPG makes oxygen ‘stick’ to the hemoglobin – not good.

Your blood pH must stay between 7.35 and 7.45 - always. A number outside that range will cause your body to stop all other functions until it has corrected its blood pH. Blood pH begins to fall in storage. Donated red blood cells are stored in a solution called ACD – acid-citrate-dextrose. ACD acidifies – lowers the pH of – the blood even more. The lower the pH, the ‘stickier’ the hemoglobin becomes. At 14 days, the pH of stored blood has fallen to 6.9. Since blood pH below 7.35 is considered an urgent problem, why does an emergency room doctor wants to give it to you?  

In one study of patients who received 3 units of blood in emergency operations, the conclusion was:

“In [an] acute situation, when the organism (that’s you) needs restoration of the oxygen releasing capacity within minutes, the resynthesis [of DPG in stored blood] is obviously insufficient.”

Put simply, a transfusion of stored blood is the last thing you want entering your body in an emergency.

Stored blood:

• Carries antigens unique to the donor that can kill the recipient.
• Potentially carries Zika, malaria, hepatitis, HIV, Covid and a dozen other diseases.
• Has a low pH, forcing the patient’s body to work to raise it back above 7.35.
• Contains a high percentage of dead and dying cells that add to the workload of the patient’s organs.
• Contains inflexible red blood cells that cause clots.
• Contains potassium at levels 4 times higher than are considered healthy
• Contains ammonia at up to 10 times the upper limit of what is considered safe.
• Contains free hemoglobin that steals oxygen from the patient and adds to the workload of the liver.
• Is deficient in DPG, lowering the patient’s cellular oxygenation.
• Is deficient in nitric oxide, lowering capillary dilation, causing reduced cellular oxygenation as well as clots.
• Contains anti-coagulants - something not needed by an already bleeding patient.
• Raises blood pressure, straining and destroying fragile clots the body is trying to form at the wound site, increasing bleeding.
• Suppresses the patient’s immune system for, at best, days; at worst, permanently.  
  

 

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 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 a book.

Blood Medicine, part three

 

 An operating room nurse responded to Part Two of this series:

“So you’re saying, if a woman in our birthing center is bleeding out, we should just let her die rather than give her blood?”

Are those really the only two options – blood transfusion or death?