Tranexamic Acid in Patients Undergoing Liver Resection

作者：Paul J. Karanicolas, Yulia Lin, Stuart A. McCluskey, Jordan Tarshis, Kevin E. Thorpe, Alice C. Wei, Elijah Dixon, Geoff Porter, Prosanto Chaudhury, Sulaiman Nanji, Leyo Ruo, Melanie E. Tsang, Anton Skaro, Gareth Eeson, Sean P. Cleary, Carol-Anne Moulton, Chad G. Ball, Julie Hallet, Natalie Coburn, Pablo E. Serrano, Shiva Jayaraman, Calvin Law, Ved Tandan, Gonzalo Sapisochín, David Nagorney, Douglas Quan, Rory L. Smoot, Steven Gallinger, Peter Metrakos, Trevor Reichman, Diederick Jalink, Sean Bennett, Francis Sutherland, Edward Solano, Michele Molinari, Ephraim Tang, Susanne G. Warner, Oliver F. Bathe, Jeffrey Barkun, Michael L. Kendrick, Mark J. Truty, Rachel Roke, Grace Xu, Myriam Lafrenière‐Roula, Gordon Guyatt, HPB CONCEPT Team · 发表于：JAMA · 年份：2024 · DOI：10.1001/jama.2024.11783 · 被引用次数：35 · 研究领域：Blood transfusion and management、Cancer, Hypoxia, and Metabolism、Inflammatory Biomarkers in Disease Prognosis

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% C...