Incidence of Thromboembolic Events in Oncology Patients Receiving Intraoperative Tranexamic Acid During Orthopedic Surgery: A Retrospective Review at a Comprehensive Cancer Center

Ackerman, Robert S.; Hirschi, Michael; Trona, Nathaniel; Joyce, David M.; Evans, Trip; Patel, Sephalie Y.

doi:10.1213/xaa.0000000000001129

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…It should be noted that this study included 90 patients of heterogeneous age groups that were treated for either primary bone sarcoma or bone metastasis of the proximal femur, distal femur, and proximal tibia. Ackerman et al 20 investigated the effect of TXA on thromboembolic events in orthopaedic oncology surgery and concluded that TXA was safe to use in these patients. However, this study included both patients with primary sarcomas and metastases involving different anatomic regions.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Tranexamic Acid in Resection and Endoprosthetic Reconstruction of Distal Femoral Osteosarcomas in Children: A Retrospective Cohort Study

Sofulu

Ozturk²,

Polat³

et al. 2021

Journal of Pediatric Orthopaedics

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Background: This study aimed to investigate the effect of intravenous tranexamic acid (TXA) on blood loss and transfusion rates in children who underwent resection and endoprosthetic reconstruction of distal femoral osteosarcomas. Methods: The medical records of 56 patients who underwent resection and endoprosthetic reconstruction for distal femoral osteosarcomas between 2017 and 2019 were retrospectively reviewed. Patients were divided into 2 groups: group 1 consisted of 25 patients (11 male and 14 female, mean age 15.2 ± 3 y) who received preoperative 15 mg/kg intravenous TXA, and group 2 consisted of 31 control patients (18 male and 13 female, mean age 14.3 ± 2.6 y) who did not receive TXA. The groups were compared based on their total blood loss, intraoperative blood loss, hidden blood loss, postoperative drain output, transfusion requirements, preoperative and postoperative hemoglobin (Hb) and hematocrit (Htc) difference, length of hospital stays, operative time, and complications. Results: The mean total blood loss was lower in intravenous TXA group (1247.5 ± 300.9 mL) when compared with control group (1715.7 ± 857.0 mL) (P = 0.018). The mean intraoperative blood loss in intravenous TXA group (386 ± 109 mL) was lower than that in control group (977.4 ± 610.7 mL) (P < 0.001). Postoperative drain output at 24 and 48 hours was 198.0 ± 61.8 and 72.4 ± 27.4 mL in intravenous TXA group, respectively, and was low compared with 268.4 ± 118.2 and 117.1 ± 67.8 mL in control group (P = 0.028 and 0.006). The rate of patients requiring transfusion was significantly lower in intravenous TXA group (56%) than in control group (83.9%). Preoperative and postoperative 6, 24, and 72 hours Hb and Htc differences were significantly lower in intravenous TXA group [(−1.7 ± 1.8 g/dL P < 0.001; −2.0 ± 1.5 g/dL P < 0.001; −2.3 ± 1.7 g/dL P < 0.001, for Hb) (−5.7 ± 4.6, P < 0.001; −6.9 ± 4.0, P < 0.001; −9.6 ± 9.1, P < 0.001, for Htc)]. Intravenous TXA group had shorter hospital stay time in comparison to control group (P < 0.001). The operative time was significantly longer in the control group (P < 0.05). No increase in pulmonary embolism or venous thromboembolism rate was observed with intravenous TXA use. Conclusion:We conclude that administration of intravenous TXA reduces intraoperative and postoperative blood loss, transfusion rates, and hospital stay in resection and endoprosthetic reconstruction of the distal femoral osteosarcomas in children. Type of Study: This was a retrospective comparative study. Level of Evidence: Level III.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Tranexamic Acid in Resection and Endoprosthetic Reconstruction of Distal Femoral Osteosarcomas in Children: A Retrospective Cohort Study

Sofulu

Ozturk²,

Polat³

et al. 2021

Journal of Pediatric Orthopaedics

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“…However, emerging evidence suggests that the use of TA may be considered safe in cancer patients, contrary to previous beliefs (27).…”

Section: Discussionmentioning

confidence: 70%

Evaluating the Efficacy and Safety of a Single-Dose Tranexamic Acid in Reducing Blood Loss During Cytoreductive Surgery Followed by Hyperthermic Intraperitoneal Chemotherapy: A Randomized Comparative Pilot Study

Shaker,

Soliman,

Hussein

et al. 2023

Anesth Pain Med

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Background: Hyperthermic intraperitoneal chemotherapy (HIPEC), following cytoreductive surgery (CRS), is a lengthy procedure, usually associated with considerable bleeding due to the extensive nature of surgery. Various techniques have been used to decrease blood transfusion requirements. Objectives: This study aimed to evaluate the possible advantage of a single dose of tranexamic acid (TA) in such surgeries. Methods: In this randomized comparative pilot study, 60 patients scheduled to undergo CRS followed by HIPEC were randomly assigned to 2 equal groups: group 1 (TA group) that received 10 mg/kg of TA in 100 mL of 0.9% NaCl over 20 minutes after the induction of anesthesia and before surgical incision, and group 2 (control group) that received a placebo of 100 mL of 0.9% NaCl during the same time interval. The primary endpoint was the blood loss volume. The secondary endpoints were the number of patients requiring transfusion and the occurrence of any postoperative thrombotic events 30 days after surgery. Serum creatinine levels were measured before the operation and on postoperative days 1, 3, and 5. Intraoperative and first 24 hours urine outputs were also recorded. The levels of hemoglobin (Hb) were measured before the operation, immediately after the operation, and 5 days postoperatively. Results: Compared to the control group, the TA group exhibited lower intraoperative blood loss, as well as lower blood loss on postoperative day 1 and in total blood loss (P = 0.006, 0.035, and 0.001, respectively). However, the blood loss on the remaining postoperative days was comparable between both groups. Intraoperative blood transfusion requirements were lower in the TA group (P = 0.032) than in the control group. The total number of units of blood and plasma transfused was also lower in the TA group both intra and postoperatively (0.007, 0.40, and 0.032, 0.008, respectively) than in the control group. Hemoglobin levels, serum creatinine levels, and urine outputs during the first 24 hours postoperatively were comparable between the 2 groups. The thromboembolic events within 30 days were also comparable between the 2 groups. Conclusions: Administering a single dose of TA between the induction of anesthesia and the surgical incision may reduce blood loss and transfusion rates in CRS followed by HIPEC without causing significant adverse effects. It is a promising approach in surgeries where massive blood loss is expected shortly after anesthesia induction. This can minimize the drawbacks of repeated blood transfusions during and after the operation without causing significant adverse effects. Besides reducing the need for repeated blood transfusions, it would also reduce the costs of blood/blood products and the risks of transfusion.

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“…Focusing on orthopaedic and oncologic surgery, Ackerman et al [30] reported 104 oncological cases treated with perioperative intravenous injections of 15mg/kg of TXA during orthopaedic procedures. In their experience the incidence of major complications was relatively low (17%) and significant postoperative bleeding and hemodynamic instability were extremely uncommon (3%).…”

Section: Discussionmentioning

confidence: 99%

Use of Tranexamic Acid to Reduce PostOperative Bleeding in Orthopaedic Oncology

Andreani

Chiaro

Ipponi

et al. 2022

AML

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Background: Orthopaedic oncology often causes major blood losses that may put at risk patients’ hemodynamic balance and their overall clinical stability. To this date, transfusion therapy still represents the pivotal treatment to counterbalance the reduction in hemoglobin levels which occur after surgery. Although effective, transfusions are expensive and inevitably associated with a number of complications and therefore other solutions, such as procoagulative drugs, could play an important role to prevent massive blood losses.Material and methods: We reviewed the clinical intercourse of 37 patients who underwent major bone resection due to malignant tumors of the lower limb. Cases were divided in two different groups: group G1 consisting of 12 patients treated intraoperatively with tranexamic acid and group G2 which was made of 25 controls.Results: On average, patients treated with tranexamic acid (G1) required transfusion of 3.9 concentrated blood cells units during surgery and 0.9 units during the postoperative course. Other patients (G2), for their part, required on average 3.1 units intraoperatively and 2.1 units postoperatively. No significant difference was found in intraoperative transfusion rate (p=0.402). Instead, postoperative transfusions were significantly less frequent for patients treated with tranexamic acid (p=0.023). None of the 12 patients treated with tranexamic acid had evidence of Deep Vein Thrombosis.Conclusion: Our outcomes indicate that the use of TXA was effective in reducing blood losses also for major surgical interventions in orthopedic oncology.

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Incidence of Thromboembolic Events in Oncology Patients Receiving Intraoperative Tranexamic Acid During Orthopedic Surgery: A Retrospective Review at a Comprehensive Cancer Center

Cited by 6 publications

References 15 publications

Efficacy and Safety of Tranexamic Acid in Resection and Endoprosthetic Reconstruction of Distal Femoral Osteosarcomas in Children: A Retrospective Cohort Study

Efficacy and Safety of Tranexamic Acid in Resection and Endoprosthetic Reconstruction of Distal Femoral Osteosarcomas in Children: A Retrospective Cohort Study

Evaluating the Efficacy and Safety of a Single-Dose Tranexamic Acid in Reducing Blood Loss During Cytoreductive Surgery Followed by Hyperthermic Intraperitoneal Chemotherapy: A Randomized Comparative Pilot Study

Use of Tranexamic Acid to Reduce PostOperative Bleeding in Orthopaedic Oncology

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