Tranexamic Acid for Bleeding Management in Adult Patients on Extracorporeal Membrane Oxygenation

Abstract

This study described the outcomes of patients receiving topical, nebulized, endobronchial, or systemic tranexamic acid (TXA) for bleeding events while on extracorporeal membrane oxygenation (ECMO). We performed a single-center case series including adult patients >18 years old supported on either venovenous (VV) or venoarterial (VA) ECMO from January 1, 2014, to April 21, 2021. The primary outcome was hemostatic control defined as a composite of initial cessation of therapeutic interventions to mitigate bleeding or resumption of anticoagulation if previously held. Secondary outcomes included changes in transfusion requirements and lysis at 30-minute (LY30) values, venous thromboembolism (VTE) events, and seizures. In total, 47 patients were included for full analysis. There were 19 patients with surgical bleeds, 18 patients with medical bleeds, and 10 patients with multiple bleeds. Overall, initial hemostatic control was achieved in 79%, 67%, and 90% of patients, respectively. Pre- and post-TXA transfusion requirements were not significantly different (p = 0.2), although the intraindividual change in median LY30 was −5.1% compared with baseline (95% confidence interval [CI], −12.4% to −1.5%, p = 0.005). The occurrence of VTE and seizures was relatively low and similar among patient bleeding groups. Tranexamic acid provided initial hemostatic control in roughly three quarters of patients with bleeding events on ECMO and side effects were infrequent.

Fibrinolysis as a Causative Mechanism for Bleeding Complications on Extracorporeal Membrane Oxygenation: A Pilot Observational Prospective Study

“…In a retrospective study including 7,910 children, 21% of patients received tranexamic acid-mostly on the first day of ECMO-and 7% received ε-aminocaproic acid, but the effectiveness and safety of this hemostatic strategy was not investigated. 41 On the other hand, Jakowenko et al 42 have described the outcomes of patients receiving topical, nebulized, endobronchial, or systemic tranexamic acid for bleeding events while on ECMO. In the 47 patients, tranexamic acid administration resulted in initial hemostatic control in three fourths of patients with bleeding events on ECMO, and side effects were rare.…”