36. Does tranexamic acid increase the risk of thromboembolism?

Depth of Anesthesia

Dr. Zach Cost and Dr. Tem Bendapudi join the show to discuss the literature pertaining to tranexamic acid and thromboembolic risk.

Dr. Zach Cost is an anesthesia resident at the Massachusetts General Hospital. Dr. Pavan (“Tem”) Bendapudi holds a joint faculty appointment in the Division of Hematology and Blood Transfusion Service and is assistant professor of medicine at Harvard Medical School.

This podcast was recorded as part of the Depth of Anesthesia podcast elective.

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Music by Stephen Campbell, MD.

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References

CRASH-2 trial collaborators; Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010 Jul 3;376(9734):23-32. doi: 10.1016/S0140-6736(10)60835-5. Epub 2010 Jun 14. PMID: 20554319.

Henry DA, Carless PA, Moxey AJ, et al. Anti‐fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews. 2011;(1). doi:10.1002/14651858.CD001886.pub3

Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054. doi:10.1136/bmj.e3054

Myles PS, Smith JA, Forbes A, et al. Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. New England Journal of Medicine. 2017;376(2):136-148. doi:10.1056/NEJMoa1606424

Devereaux PJ, Marcucci M, Painter TW, et al. Tranexamic Acid in Patients Undergoing Noncardiac Surgery. New England Journal of Medicine. 2022;386(21):1986-1997. doi:10.1056/NEJMoa2201171 POISE 3 PeriOperative ISchemic Evaluation-3 (POISE-3) study

Shakur H, Roberts I, Fawole B, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum hemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial. The Lancet. 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4

Roberts I, Shakur-Still H, Afolabi A, et al. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. The Lancet. 2020;395(10241):1927-1936. doi:10.1016/S0140-6736(20)30848-5

Taeuber I, Weibel S, Herrmann E, et al. Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Surgery. 2021;156(6):e210884. doi:10.1001/jamasurg.2021.0884