Tranexamic Acid in Patients Undergoing Liver Resection: The HeLiX Randomized Clinical Trial.

Karanicolas, Paul J.; Lin, Yulia; McCluskey, Stuart A.; Tarshis, Jordan; Thorpe, Kevin E.; Wei, Alice; Dixon, Elijah; Porter, Geoff; Chaudhury, Prosanto; Nanji, Sulaiman; Ruo, Leyo; Tsang, Melanie E.; Skaro, Anton; Eeson, Gareth; Cleary, Sean; Moulton, Carol-Anne; Ball, Chad G.; Hallet, Julie; Coburn, Natalie; Serrano, Pablo E.

Key Points: Question: Does tranexamic acid reduce red blood cell transfusion within 7 days of liver resection? Findings: In this randomized clinical trial, red blood cell transfusion within 7 days of surgery occurred in 16.3% of participants receiving tranexamic acid and 14.5% receiving placebo. Participants receiving tranexamic acid experienced significantly more complications perioperatively compared with placebo (odds ratio, 1.28; 95% CI, 1.02-1.60; P =.03). Meaning: Among patients undergoing liver resection for a cancer-related indication, tranexamic acid did not reduce bleeding or blood transfusion but increased perioperative complications. Importance: Tranexamic acid reduces bleeding and blood transfusion in many types of surgery, but its effect in patients undergoing liver resection for a cancer-related indication remains unclear. Objective: To determine whether tranexamic acid reduces red blood cell transfusion within 7 days of liver resection. Design, Setting, and Participants: Multicenter randomized clinical trial of tranexamic acid vs placebo conducted from December 1, 2014, to November 8, 2022, at 10 hepatopancreaticobiliary sites in Canada and 1 site in the United States, with 90-day follow-up. Participants, clinicians, and data collectors were blinded to allocation. A volunteer sample of 1384 patients undergoing liver resection for a cancer-related indication met eligibility criteria and consented to randomization. Interventions: Tranexamic acid (1-g bolus followed by 1-g infusion over 8 hours; n = 619) or matching placebo (n = 626) beginning at induction of anesthesia. Main Outcomes and Measures: The primary outcome was receipt of red blood cell transfusion within 7 days of surgery. Results: The primary analysis included 1245 participants (mean age, 63.2 years; 39.8% female; 56.1% with a diagnosis of colorectal liver metastases). Perioperative characteristics were similar between groups. Red blood cell transfusion occurred in 16.3% of participants (n = 101) in the tranexamic acid group and 14.5% (n = 91) in the placebo group (odds ratio, 1.15 [95% CI, 0.84-1.56]; P =.38; absolute difference, 2% [95% CI, −2% to 6%]). Measured intraoperative blood loss (tranexamic acid, 817.3 mL; placebo, 836.7 mL; P =.75) and total estimated blood loss over 7 days (tranexamic acid, 1504.0 mL; placebo, 1551.2 mL; P =.38) were similar between groups. Participants receiving tranexamic acid experienced significantly more complications compared with placebo (odds ratio, 1.28 [95% CI, 1.02-1.60]; P =.03), with no significant difference in venous thromboembolism (odds ratio, 1.68 [95% CI, 0.95-3.07]; P =.08). Conclusions and Relevance: Among patients undergoing liver resection for a cancer-related indication, tranexamic acid did not reduce bleeding or blood transfusion but increased perioperative complications. Trial Registration: ClinicalTrials.gov Identifier: NCT02261415 This randomized clinical trial assesses the effect of tranexamic acid vs placebo on the need for blood transfusion among patients undergoing cancer-related liver resection.

COLORECTAL liver metastasis; BLOOD loss estimation; TRANEXAMIC acid; SURGICAL blood loss; BLOOD transfusion; RED blood cell transfusion

JAMA: Journal of the American Medical Association, 2024, Vol 332, Issue 13, p1080

0098-7484

Academic Journal

10.1001/jama.2024.11783