Evaluation of local intra-pleural application of tranexamic acid on postoperative blood loss in lung decortication surgery, a prospective, randomized, double-blind, placebo-controlled study

Abstract

Background:During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding.Patients and Methods:A total of 70 patients underwent lung decortication surgery in Cardiothoracic Surgery Department at Tanta University Hospital from January 2015 to May 2017. Patients were randomly allocated into two groups, Group I (35 patients) receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II (35 patients) receiving 100 ml of saline solution as placebo. At the end of the operation and before closing the chest, in both groups, drug or placebo solution was distributed locally all over the pleural cavity. Comparison between the groups was done regarding the amount of postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and hospital stay.Results:Both groups were comparable regarding demographic and surgical data. Group I patients had the significantly lesser amount of postoperative blood loss than Group II during the first postoperative 48 h, and hence, the need of postoperative blood transfusion was significantly lower in Group I with better postoperative hemoglobin level than Group II. However, there was no difference in overall ICU and hospital stay.Conclusion:The local intrapleural use of tranexamic acid after decortication surgery of the lung is safe and significantly reduces the amount of postoperative blood loss and in consequence reduces the amount of postoperative blood transfusion.

Safety and Efficacy of Local Tranexamic Acid for the Prevention of Surgical Bleeding in Soft-Tissue Surgery: A Review of the Literature and Recommendations for Plastic Surgery

“…31,[57][58][59][60][61][62] One study was excluded because of nonstandardized drug preparation. 62 Eight studies addressed inner organs, four of which were performed in open surgery (Table 3) [63][64][65][66] and four in minimally invasive surgery (Table 4). [67][68][69][70] Thus, 14 studies from soft-tissue surgery, including a total of 1923 patients, were included.…”

“…Randomized controlled trials from open surgery on inner organs find both reduced bleeding volumes and transfusion needs from topical use of tranexamic acid (Table 3). Sabry et al 64 performed lung decortication surgery, which may be comparable to capsule/scar tissue excisions. They applied 100 ml of 30 mg/ml tranexamic acid into the thoracic cavity.…”

Efficacy and safety of tranexamic acid in patients undergoing thoracic surgery: a systematic review and PRISMA-compliant meta-analysis

“…According to the results shown in Table 1 , among the five trials, one included patients receiving pulmonary resection [ 15 ], one included patients undergoing lung decortication surgery [ 16 ], one included patients undergoing bronchoscopy and transbronchial lung biopsies (TBLB) [ 17 ], one included only patients undergoing lobectomy [ 18 ], and one included patients undergoing lobectomy and esophagectomy [ 19 ]. The 5 eligible trials involved 307 patients, of whom 165 were allocated to the TXA group and 142 to the control group (placebo).…”

Tranexamic Acid Prevention of Hemorrhagic Complications Following Interpolated Flap Repair: A Single-Center, Retrospective, Cohort Study

“…Localized TXA has previously been shown to be useful in reducing bleeding during surgical procedures in a variety of subspecialties, particularly among patients on antithrombotic therapy. 13,14,[16][17][18] Localized TXA has also been found to be effective in dermatologic surgery specifically. 15 Hemorrhagic complication rates vary by repair type, as active bleeding requiring a physician's intervention has been reported to occur in 5.3% to 8.4% of interpolated flaps.…”

“…Local administration of TXA has been used as a method of controlling bleeding in a variety of surgical subspecialties. [13][14][15][16][17][18] A randomized controlled trial evaluating subcutaneous TXA use during MMS found that TXA was safe, reduced bleeding, and was particularly effective for patients receiving anticoagulation or antiplatelet therapy. 15 However, data on the association between subcutaneous TXA use during interpolated flap repair and postoperative bleeding events and other complications are lacking.…”