Postoperative Outcomes Using Tranexamic acid

MedicalResearch.com Interview with Stavros G. Memtsoudis, MD, PhD, FCCP Clinical Professor of Anesthesiology and Public Health Weill Cornell Medical College Senior Scientist and Attending Anesthesiologist Hospital for Special SurgeryMedicalResearch.com Interview with
Stavros G. Memtsoudis, MD, PhD, FCCP
Clinical Professor of Anesthesiology and Public Health
Weill Cornell Medical College
Senior Scientist and Attending Anesthesiologist
Hospital for Special Surgery

Medical Research: What are the main findings of the study?

Dr. Memtsoudis: In this large population based study we found that perioperative tranexamic acid administration significantly reduced the need for blood transfusions in joint arthroplasty patients, while not increasing the risk of major complications, including thromboembolic, cardiac and renal events.

Medical Research: Were any of the findings unexpected?

Dr. Memtsoudis: Yes, a common reservation among practitioners who use tranexamic acid to decrease blood loss surrounding operative procedures such as joint replacements, do so with the caveat that this drug may increase clotting complications although supporting data were thus far missing. Interestingly, our results suggest that this may not be the case and that complications such myocardial infarctions may even be reduced in patients receiving the drug. This may theoretically be explained by the assumption that avoiding lower hemoglobin levels outweighs any potential prothrombotic risks.

Medical Research: What should clinicians and patients take away from your report?

Dr. Memtsoudis: This study evaluating the use of tranexamic acid use in real world practice suggests that it is not only effective in reducing blood transfusions but that the drug may not lead to increased risk of major periopertaive complications. While results are derived from real world experience without application of the stringent constraints of inclusion and exclusion criteria often found in randomized prospective trials, our findings will have to interpreted with some caution. In this context, some important, clinically relevant cofounders could not be accounted for, for example transfusion triggers.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Memtsoudis: Although performing prospective randomized clinical trials on this topic may be difficult to perform due to the large sample size needed and the relatively low incidence of outcomes of interest, multicenter approaches may be able to achieve this goal. As the use of tranexamic acid widens, new available data should be reexamined frequently to identify subgroups of patients whose outcomes potentialyl deviate from those of the whole cohort . Future research should focus on subgroup analyses to ensure that efficacy and safety apply to special populations, such as those with previous coronary artery stents. Therefore, although our results are encouraging, tranexamic acid should be used judiciously in patients either at risk for large blood loss and/or need for blood transfusions.

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