TRANEXAMIC ACID REDUCES BLOOD-LOSS, TRANSFUSION REQUIREMENTS, AND COAGULATION-FACTOR USE IN PRIMARY ORTHOTOPIC LIVER-TRANSPLANTATION

Background: Patients with end-stage liver disease frequently incur lar ge-volume blood loss during liver transplantation associated with mech anical factors, preexisting coagulopathy, and intraoperative fibrinoly sis. Methods: Between April 1992 and May 1994, the authors of this dou ble-blind, randomized, placebo-controlled study examined the effect of high-dose tranexamic acid (maximum of 20 g) on blood loss and blood p roduct requirements in patients undergoing primary isolated orthotopic liver transplantation. Primary outcome measures were volume of blood loss (intraoperative blood loss and postoperative drainage) and erythr ocyte, plasma, platelet, and cryoprecipitate use during surgery and th e 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 p lacebo group (n = 20; median, 8 l; interquartile range, 5 to 15.8), an d reduced intraoperative plasma, platelet, and cryoprecipitate require ments. Median perioperative erythrocyte use was 9 units (interquantile range, 4 to 14 units) in patients receiving transexamic acid and 13 u nits (interquantile range, 7.5 to 31 units) in controls (P = 0.03). To tal 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). Resul ts for postoperative wound drainage were similar. Hospital stay and ne ed for retransplantation were comparable in both groups. No patient in either group showed clinical evidence of hepatic artery or portal ven ous thrombosis within 1 month of transplantation. Conclusions: High-do se tranexamic acid significantly reduces intraoperative blood loss and perioperative donor exposure in patients with end-stage parenchymal l iver disease who are undergoing orthotopic liver transplantation, with marked reductions in platelet and cryoprecipitate requirements.