Tranexamic Acid Did Not Reduce Bleeding Following Liver Cancer Surgery

Treatment with tranexamic acid (TXA) did not reduce the incidence of post-operative bleeding or risk of blood transfusion among patients undergoing liver resection for a cancer-related diagnosis, according to research published Monday in JAMA.

In the Hemorrhage During Liver Resection: Tranexamic Acid (HeLiX) trial, red blood cell transfusion within seven days of surgery occurred in 16.3% of participants receiving TXA and 14.5% receiving placebo. Levels of Intraoperative blood loss and estimated blood loss over seven days were similar between groups, but participants in the TXA group were more likely to have postoperative complications (43.8% versus 37.9%, respectively).

According to the authors, the results contrast with recent trials that examined TXA use in traumatic brain injury, cardiac surgery and a range of noncardiac surgeries, which found that TXA significantly reduced bleeding, blood transfusion or disability due to bleeding. However, the trial’s results align with studies where TXA was ineffective, such as in gastrointestinal bleeding and cesarean delivery.

“It is plausible that tranexamic acid is effective in areas of microvascular bleeding or general ooze but ineffective in areas in which bleeding occurs from major blood vessels,” the authors wrote.

Given the increase in perioperative complications associated with TXA in this trial, the authors recommended careful consideration before adopting its use in liver resections and similar surgeries where its benefits have not been conclusively proven.

They also emphasized the need for future research to explore the effects of TXA on bleeding and postoperative complications in patients undergoing other major cancer surgeries, such as gastrectomy, pancreatectomy, and sarcoma resection.