Impact of Obesity on Tranexamic Acid Efficacy in Adult Patients With Major Bleeding

Abstract

Background: Tranexamic acid (TXA) is an antifibrinolytic used for prophylaxis and treatment of acute bleeding. Although fixed dosing is often used in practice, weight-based dosing is sometimes used in the operating room (OR). The efficacy and safety of fixed-dose TXA is not well established in patients with above average weight or body mass index. Objective: To characterize the efficacy and safety of intravenous TXA in obese patients with major bleeding. Methods: This was a retrospective review of 165 patients receiving fixed-dose TXA for acute bleeding outside the OR. Blood product administration (BPA) before and after TXA was collected, along with demographic and bleed-related information. Thrombotic events were the major safety end point. A prespecified subgroup analysis was conducted in patients weighing at least 100 kg compared with a lower weight. Logistic regression was performed to determine whether an association exists between body weight and blood product requirement after TXA administration. Results: In the 24 hours after TXA, patients received an average of 4.17 units of blood product. Patients weighing at least 100 kg averaged 4.04 total units, compared with 4.19 units in the lower weight group ( P = 0.603). Administration of individual blood products did not differ between groups, and thrombotic events were similar. Regression analysis did not associate weight with total BPA. Conclusion and Relevance: In patients receiving fixed-dose TXA, weight does not appear to alter blood product requirements or rates of adverse thrombotic events. These data support continued use of fixed-dose TXA for treatment of acute major bleeding in obese patients.

Appraising the use of tranexamic acid in traumatic and non‐traumatic intracranial hemorrhage: A narrative review

“… 63 They found that there were no differences in blood product administration or other secondary clinical outcomes between patients <100 kg or ≥100 kg who received fixed‐dose TXA. 63 Taken together, it likely remains appropriate to give fixed‐dose TXA for indications other than surgical‐related bleeding.…”

“…Franz et al sought to address this gap by collecting data on 165 patients who received fixed‐dose TXA for non‐operative indications (≈20% with trauma listed as bleed type) 63 . They found that there were no differences in blood product administration or other secondary clinical outcomes between patients <100 kg or ≥100 kg who received fixed‐dose TXA 63 . Taken together, it likely remains appropriate to give fixed‐dose TXA for indications other than surgical‐related bleeding.…”

“…However, there is a paucity of literature examining the differences in outcomes in obese versus non‐obese patients with fixed‐dose TXA in non‐operative indications, and major trials did not report differences based on patient weight subgroups. Franz et al sought to address this gap by collecting data on 165 patients who received fixed‐dose TXA for non‐operative indications (≈20% with trauma listed as bleed type) 63 . They found that there were no differences in blood product administration or other secondary clinical outcomes between patients <100 kg or ≥100 kg who received fixed‐dose TXA 63 .…”

Effect of intraoperative cell salvage on coagulation function outcomes in patients with massive post-Cesarean section hemorrhage

“…Postpartum hemorrhage, characterized by rapid and substantial blood loss, can lead to a sudden decrease in blood volume, resulting in acidosis and deterioration of maternal coagulation function, and possibly leading to hemor-rhagic shock [1]. Moreover, cesarean section procedures themselves can induce changes in hemorheology and increase coagulation factors and platelet activity, predisposing pregnant women to thrombosis after delivery and posing serious risks to maternal safety [2]. Therefore, prompt intervention is crucial to restore coagulation function.…”