Kulkarni, A.P., Chaukar, D.A., Patil, V.P., Metgudmath, R.B., Hawaldar, R.W., & Divatia, J.V. (2016). Does tranexamic acid reduce blood loss during head and neck cancer surgery? Indian Journal of Anaesthesia, 60, 19–24. 

To evaluate the effect of the administration of tranexamic acid (TA) upon blood loss and the need for transfusions in patients undergoing head and neck surgery

Patients undergoing supramajor head and neck surgeries were randomized to receive TA (10 mg/kg) or placebo (normal saline). The patients were stratified a priori based upon their anticipated surgical procedure. The attending anesthesiologist, blinded to the drug, administered 100 ml of solution of normal saline with or without TA (10 mg/kg) during 20 minutes postinduction of anesthesia, and, if the surgery was prolonged, every three hours during the surgery. Blood loss was measured during surgery and postoperatively for the first 24 hours. A transfusion trigger was established.

• N = 219   
• AGE = 51.9 years (TA) and 50.67 (placebo)
• MALES: 77%, FEMALES: 23%
• CURRENT TREATMENT:  Other
• KEY DISEASE CHARACTERISTICS: Resectable squamous cell carcinoma oral cavity
• OTHER KEY SAMPLE CHARACTERISTICS: Undergoing surgical resection and reconstructive procedures

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Tertiary referral cancer center in India

PHASE OF CARE: Active antitumor treatment

Randomized, placebo-controlled, double-blind, prospective study

Gravimetry, blood collection in suction bottles, and visual inspection were used to calculate intraoperative blood loss; postoperative blood loss was calculated with a measure of the blood collected in suction bottles during 24 hours.

Differences in intraoperative blood loss between the groups was not significant (p = 0.22); however, the placebo group demonstrated a significantly greater amount of blood loss postoperatively than the TA group (p = 0.009). This difference, however, did not translate to a significant difference between groups in the number of transfusions (p = 0.51).

The administration of TA in patients undergoing head and neck cancer surgery did not decrease intraoperative blood loss or overall blood loss; although it did reduce postoperative bleeding, this did not translate to a reduction in the number of transfusions.

Nurses must assess perioperative blood loss because it places patients at risk for serious complications. An ongoing need to evaluate measures exists to decrease this risk.