Title : Multi-route applications of tranexamic acid to reduce blood loss in elective surgery – risks and benefits
Blood loss control with tranexamic acid (TXA) may be a preferable alternative in elective surgery. Many randomized controlled trials and meta-analysis have been identified the efficacy of TXA. There is still no uniform standard for the best method of administration and dose of TXA. When compare IV administration of TXA with topical there is no significant difference in overall or for orthopaedic procedures. However, to reduce the potential risk of thromboembolic complications and extended the effect of TXA postoperatively, the topical administration of TXA can be considered. It may give notable clinical relevant effect for those where wound is accessible and for high thrombotic risk patients. Moreover, intrapericardial use of TXA in patients undergoing cardiac surgery can decrease postoperative bleeding without increasing the risk of postoperative seizures. In addition, topical TXA could reduce the postoperative swelling and thus the pain which caused by swelling can be reduced. In conclusion, there are no major differences between topical and intravenous tranexamic acid with respect to safety and efficacy, and both are superior to placebo with regards to blood loss and transfusion requirements. The effect does not appear to be dose-dependent in topical administration. There exist a lack of a relationship between topical TXA administration and an increased risk of adverse events including thromboembolism. Outside of orthopaedic surgery, the comparison of topically administered tranexamic acid to intravenously administered tranexamic acid warrants further exploration.