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Prophylactic tranexamic acid use in non‐cardiac surgeries at high risk for transfusion
Author(s) -
Houston Brett L.,
Fergusson Dean A.,
Falk Jamie,
Krupka Emily,
Perelman Iris,
Breau Rodney H.,
McIsaac Daniel I.,
Rimmer Emily,
Houston Donald S.,
Garland Allan,
Ariano Robert E.,
Tinmouth Alan,
Balshaw Robert,
Turgeon Alexis F.,
Jacobsohn Eric,
Zarychanski Ryan
Publication year - 2021
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/tme.12780
Subject(s) - tranexamic acid , medicine , perioperative , dosing , blood transfusion , cardiac surgery , blood management , anesthesia , surgery , blood loss
Background Tranexamic acid (TXA) reduces transfusion in a wide range of surgical populations, although its real‐world use in non‐cardiac surgeries has not been well described. The objective of this study was to describe prophylactic TXA use in non‐cardiac surgeries at high risk for transfusion. Methods This is a retrospective cohort study of all adult patients undergoing major non‐cardiac surgery at ≥5% risk of perioperative transfusion at five Canadian hospitals between January 2014 and December 2016. Canadian Classification of Health Interventions procedure codes within the Discharge Abstract Database were linked to transfusion and laboratory databases. TXA use was ascertained electronically from The Ottawa Hospital Data Warehouse and via manual chart review for Winnipeg hospitals. For each surgery, we evaluated the percentage of patients who received TXA as well as the specifics of TXA dosing and administration. Results TXA use was evaluable in 14 300 patients. Overall, 17% of surgeries received TXA, ranging from 0% to 68% among individual surgeries. TXA use was more common in orthopaedic ( n = 2043/4942; 41%) and spine surgeries (n = 239/1322; 18%) compared to other surgical domains (n = 109/8036; 1%). TXA was commonly administered as a bolus (n = 2097/2391; 88%). The median TXA dose was 1000 mg (IQR 1000–1000 mg). Conclusion TXA is predominantly used in orthopaedic and spine surgeries, with little uptake in other non‐cardiac surgeries at high risk for red blood cell transfusion. Further studies are needed to evaluate the effectiveness and safety of TXA and to understand the barriers to TXA administration in a broad range of non‐cardiac surgeries.