Tranexamic acid reduces blood loss, transfusion requirements, and coagulation factor use in primary orthotopic liver transplantation

被引:149
作者
Boylan, JF
Klinck, JR
Sandler, AN
Arellano, R
Greig, PD
Nierenberg, H
Roger, SL
Glynn, MFX
机构
[1] UNIV TORONTO, TORONTO HOSP, DEPT ANAESTHESIA, TORONTO, ON M5G 2C4, CANADA
[2] UNIV TORONTO, TORONTO HOSP, DEPT SURG, TORONTO, ON M5G 2C4, CANADA
[3] UNIV TORONTO, TORONTO HOSP, DEPT HAEMATOL, TORONTO, ON M5G 2C4, CANADA
[4] UNIV TORONTO, TORONTO HOSP, MULTIORGAN TRANSPLANT PROGRAM, TORONTO, ON M5G 2C4, CANADA
关键词
liver; transplantation; blood; antifibrinolytics; tranexamic acid; hemorrhage;
D O I
10.1097/00000542-199611000-00012
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Patients with end-stage liver disease frequently incur large-volume blood loss during liver transplantation associated with mechanical factors, preexisting coagulopathy, and intraoperative fibrinolysis. Methods: Between April 1992 and May 1994, the authors of this double-blind, randomized, placebo-controlled study examined the effect of high-dose tranexamic acid (maximum of 20 g) on blood loss and blood product requirements in patients undergoing primary isolated orthotopic liver transplantation. Primary outcome measures were volume of blood loss (intraoperative blood loss and postoperative drainage) and erythrocyte, plasma, platelet, and cryoprecipitate use during surgery and the first 24 h of intensive care unit stay. Results: Patients receiving transexamic acid (n = 25) had less intraoperative blood loss (median, 4.3 l; interquartile range, 2.5 to 7.9; P = 0.006) compared with the placebo group (n = 20; median, 8 l; interquartile range, 5 to 15.8), and reduced intraoperative plasma, platelet, and cryoprecipitate requirements. Median perioperative erythrocyte use was 9 units (interquantile range, 4 to 14 units) in patients receiving transexamic acid and 13 units (interquantile range, 7.5 to 31 units) in controls (P = 0.03). Total perioperative donor exposure was 20.5 units (interquantile range, 16 to 41 units) in patients receiving transexamic acid and 43.5 units (interquantile range, 29.5 to 79 units) in controls (P = 0.003). Results for postoperative wound drainage were similar. Hospital stay and need for retransplantation were comparable in both groups. No patient in either group showed clinical evidence of hepatic artery or portal venous thrombosis within 1 month of transplantation. Conclusions: High-dose tranexamic acid significantly reduces intraoperative blood loss and perioperative donor exposure in patients with end-stage parenchymal liver disease who are undergoing orthotopic liver transplantation, with marked reductions in platelet and cryoprecipitate requirements.
引用
收藏
页码:1043 / 1048
页数:6
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