Efficacy of Tranexamic Acid in Reducing Perioperative Blood Loss and Blood Transfusion in Primary Malignant Musculoskeletal Tumor Surgery
Nuttara Wiboonthanasarn MD1, Sutipat Parojboriboon MD1, Puwadol Veeraphun MD1, Thipachart Punyaratabandhu MD1, Thawee Songpatanasilp MD, PhD1, Phutsapong Srisawat MD, MSc1
Affiliation : 1 Musculoskeletal Oncology Unit, Department of Orthopedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Background : Major operations on soft tissue and bone sarcomas are associated with significant blood loss and the requirement
for transfusions. There is a sharp increase in mortality rate in patients who receive allogenic blood transfusions and
subsequently acquire transfusion-acquired infections. Reducing blood loss and the need for transfusions could potentially
reduce that mortality rate. Low doses of tranexamic acid [TXA] may be able to reduce blood loss and transfusion requirements
during these operations.
Objective : To study the effect of TXA on perioperative blood loss and blood transfusion requirements in patients undergoing
extremity primary bone tumor surgery.
Materials and Methods : Twenty-two extremity primary bone tumor surgery patients were randomized into two groups.
The control group received a placebo, and the study group received 2 grams of TXA intravenously followed by intravenous
infusion of 1 gram in a drip every 8 hours postoperatively. The volume of intraoperative blood loss, amount of blood
transfused, volume of drained blood, hemoglobin levels, and any thromboembolic complications were recorded and assessed.
Results : The mean intraoperative blood loss in the TXA group and the control group were 300 ml and 600 ml, respectively
(p = 0.356). Volume of drained blood was not reduced in the TXA group compared with control group, but the difference was
not statistically significant: 180 mL (0 to 580) vs. 100 mL (0 to 580), respectively. The amount of blood transfused was lower
in patients receiving TXA than in the control group: 1 unit (0 to 15) unit vs. 0 units (0 to 5), respectively, but the different
was not significant (p = 0.699). Decrease of hemoglobin levels was non-significantly lower in TXA group than in the control
group: 1.79 g/dL (SD +1.39) vs. 2.51 g/dL (SD +1.36) (p = 0.235). No thromboembolic complications were detected in either
group.
Conclusion : Tranexamic acid has the clinical effect of decreasing blood loss and transfusion requirements in patients
undergoing extremity primary malignant musculoskeletal tumor surgery, but the reduction is not statistically significant.
Keywords : Tranexamic acid, Perioperative blood loss, Primary malignant musculoskeletal tumor
