Safety and efficacy of tranexamic acid in spinal canal tumors: a retrospective cohort study

Zhang, Heng Zhu; Dong, Lun; Wang, Huan Ming; Hu, Fei; Shao, Qiang; Chen, Xu; Chen, Lang

doi:10.1080/02688697.2020.1717442

Cited by 5 publications

(11 citation statements)

References 11 publications

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“…However, they demonstrated that blood transfusions are statistically less frequent in the group that received TXA. More recently, in a retrospective analysis, Zhang et al 46 proved that, about surgery for spinal tumors, TXA can significantly reduce ( p <0.05) the amount of intraoperative blood loss and postoperative drainage without increasing the risk of DVT. The duration of the surgical intervention was not significantly reduced by the administration of the TXA 41 , 42 ( Table 3 ).…”

Section: Clinical Usage and Efficacy Of Tranexamic Acid In Oncologic ...mentioning

confidence: 99%

“… TXA 830 PLACEBO 1124 TXA NA PLACEBO NA TXA 13 (43.3%) PLACEBO 17 (56.7%) TXA N/E PLACEBO N/E S for blood loss but not for blood transfusion Damade C (2019) 45 France Spinal tumor 83 (36/47) 15 mg/kg at the time of induction then the same dose continously over 8h. TXA 444 ± 356 PLAECBO 370 ± 419 TXA 568 ± 250 but not specified the moment PLACEBO 631 ± 299 but the time is not specified TXA Rate N/E 348 mL (1.2 ± 1.4 units) PLAECBO Rate N/E 528 mL (1.8 ± 2.3) TXA N/E PLACEBO N/E NS for blood loss but S for blood transfusion Zhang HZ (2020) 46 China Spinal canal tumors 60 (30/30) 10 mg/kg 30 min before the operation, followed by a maintenance dose of 1 mg/kg per h. TXA 253.32 ± 54.04 PLACEBO 362.57 ± 62.31 TXA 84.34 ± 30.74 PLACEBO 140.65 ± 34.35 TXA N/E PLACEBO N/E TXA N/E PLACEBO N/E S for blood loss Bednar DA (2006) 44 Metastatic tumors of the Spine 28 (14/14) Loading dose of 1000 mg and maintained with infusion of 1 mg/kg/hour during their operations. TXA 1385 (trace to 4000) PLACEBO 1815 (400–5000) …”

Section: Clinical Usage and Efficacy Of Tranexamic Acid In Oncologic ...mentioning

confidence: 99%

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Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Zec¹,

Napoli²,

Fiévez³

et al. 2022

JMDH

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In cancer patients undergoing surgery, tumor biology and anticancer treatments can increase the risk of perioperative bleeding and blood transfusions. Notably, blood transfusions can be potentially associated with an increased risk of life-threatening immune responses, acute lung injury, postoperative infections, and thromboembolism. Moreover, the link between perioperative transfusion and increased risk of cancer recurrence cannot be excluded. On the other hand, cancer patients have an increased risk of thromboembolism due to cancer itself and antineoplastic systemic treatments including chemotherapy and anti-angiogenic drugs. In this complex scenario, effective and safe strategies aimed at the prevention of blood transfusions are warranted. This narrative review addresses the efficacy, and the safety of the synthetic antifibrinolytic agent tranexamic acid (TXA) when used perioperatively in cancer surgery. Although in not oncologic surgery the use of TXA has been extensively studied, in the setting of cancer patients requiring surgery, the evidence is scarce. An overview of the ongoing clinical research is also provided.

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Section: Clinical Usage and Efficacy Of Tranexamic Acid In Oncologic ...mentioning

confidence: 99%

Section: Clinical Usage and Efficacy Of Tranexamic Acid In Oncologic ...mentioning

confidence: 99%

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Zec¹,

Napoli²,

Fiévez³

et al. 2022

JMDH

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“…Several of the included studies reported 0% incidence of DVT/PE. [2,4,5,30] e study with the higher incidence was by Pennington et al [19] with an incidence of 14.3% of PE. Interestingly, in a subgroup analysis they found that patients receiving a higher dose of TXA (>20 mg/kg) were at even higher risk that those receiving less than that.…”

Section: Discussionmentioning

confidence: 95%

“…e second study with the highest EBL was the one by Bednar et al [2] with a reported mean blood loss of 1385 mL. Zhang et al [30] compared two groups of patients with spine tumors one receiving TXA and the other did not: the group receiving TXA the mean blood loss was 253.3 mL compared to 362.6 mL for those who did not receive TXA. Damade et al [4] also compared TXA versus no TXA and found that the TXA group their EBL was 444 mL on average compared to 370 mL (P = 0.85).…”

Section: Intraoperative Blood Lossmentioning

confidence: 99%

Antifibrinolytics use during surgery for oncological spine diseases: A systematic review

Ávila

Orenday-Barraza

Cavagnaro

et al. 2022

Surgical Neurology International

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Background: Data exist of the benefits of antifibrinolytics such as tranexamic acid (TXA) in general spine surgery. However, there are limited data of its use in oncological spine patients. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane, OVID, and Embase databases were searched. Search terms: “tranexamic acid”, “aprotinin,” “aminocaproic acid,” “spine surgery,” “spine tumors,” and “spine oncology.” Included studies were full text publications written in English with patients treated with either agent or who had surgery for oncological spine disease (OSD). Results: Seven hundred results were reviewed form the different databases, seven were selected. A total of 408 patients underwent spine surgery for OSD and received antifibrinolytics. There was a male predominance (55.2%) and mean age ranged from 43 to 62 years. The most common tumor operated was metastatic renal cancer, followed by breast and lung. Most studies administered TXA as a bolus followed by an infusion during surgery. Median blood loss was of 667 mL (253.3–1480 mL). Patients with TXA required 1–2 units less of transfusion and had 56–63 mL less of postoperative drainage versus no TXA. The median incidence of deep venous thrombosis (DVT) was 2.95% (0–7.9%) and for pulmonary embolism (PE) was 4.25% (0–14.3%). The use of TXA reduced intraoperative blood loss, transfusions and reduced postoperative surgical drainage output compared to no TXA use in patients with OSD. Conclusion: In this review, we found that TXA may diminish intraoperative blood loss, the need for transfusion and postoperative drainage from surgical drains when used in OSD without major increase in rates of DVT or PE.

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“…A number of small RCTs and retrospective cohort studies were performed to assess the effect of perioperative antifibrinolytics on bleeding during and after cancer surgery, in a variety of solid malignancies. The studies including patients with liver, prostate and gynecological cancer found a reduction in blood transfusion requirements during and after surgery in the TXA arms [36][37][38][39][40][41]. In contrast, antifibrinolytics did not influence bleeding outcomes in major orthopedic cancer surgery or in oncologic spinal canal, head and neck and neurosurgeries [42][43][44][45].…”

Section: Solid Tumorsmentioning

confidence: 99%

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Leader

Hofstetter

Spectre

2021

JCM

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Cancer patients have varying incidence, depth and duration of thrombocytopenia. The mainstay of managing severe chemotherapy-induced thrombocytopenia (CIT) in cancer is the use of platelet transfusions. While prophylactic platelet transfusions reduce the bleeding rate, multiple unmet needs remain, such as high residual rates of bleeding, and anticancer treatment dose reductions/delays. Accordingly, the following promising results in other settings, antifibrinolytic drugs have been evaluated for prevention and treatment of bleeding in patients with hematological malignancies and solid tumors. In addition, Thrombopoeitin receptor agonists have been studied for two major implications in cancer: treatment of severe thrombocytopenia associated with myelodysplastic syndrome and acute myeloid leukemia; primary and secondary prevention of CIT in solid tumors in order to maintain dose density and intensity of anti-cancer treatment. Furthermore, thrombocytopenic cancer patients are often prescribed antithrombotic medication for indications arising prior or post cancer diagnosis. Balancing the bleeding and thrombotic risks in such patients represents a unique clinical challenge. This review focuses upon non-transfusion-based approaches to managing thrombocytopenia and the associated bleeding risk in cancer, and also addresses the management of antithrombotic therapy in thrombocytopenic cancer patients.

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Safety and efficacy of tranexamic acid in spinal canal tumors: a retrospective cohort study

Cited by 5 publications

References 11 publications

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Antifibrinolytics use during surgery for oncological spine diseases: A systematic review

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

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