Surgical Bleeding

Every year, an estimated 230 million people undergo major surgical procedures worldwide.Bleeding is an important complication and many patients require a blood transfusion.

About one third of transfused blood in the UK is used for surgical patients who receive an average of two units. However, blood for transfusion is a scarce and costly resource and most people in the world do not have access to donor blood. Furthermore, blood transfusion is not without risk.

TXA has been used for many years in surgery and there is good evidence from randomised controlled trials that it reduces surgical bleeding. A systematic review identified 130 trials including 10,528 patients. The results showed that TXA reduces the probability of receiving a blood transfusion by 40% (RR=0.60, 95% CI 0.56 to 0.64; p<0.001). This effect was seen across different surgical procedures and remained large when the analysis was restricted to the 29 trials with good allocation concealment (RR=0.66, 95% CI 0.60 to 0.73; p<0.001).

A total dose of 1 g appears to be sufficient for most adult surgical patients. However, the effects of TXA on thromboembolic events and mortality in surgery are uncertain. Although there were fewer deaths and myocardial infarctions in the TXA group, the pooled estimates were imprecise, and because many trials did not report data for these outcomes, there is the potential for bias due to selective reporting. The uncertainty concerning the effect on thromboembolic events is an important factor limiting the uptake of TXA since an increase in thrombosis could outweigh the benefits of reduced blood use.

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traumatic intra-cranial bleeding trial
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