Tranexamic Acid (TXA) is an antifibrinolytic agent that is administered to prevent blood loss, and it works by slowing the breakdown of blood clotting. TXA can help reduce the need or degree of blood transfusion, but it does not always eliminate transfusion requirements. The use of TXA should not necessarily be viewed as an alternative to autotransfusion (ATS); in fact, the use of TXA and autotransfusion together can increase survival rates, accelerate recovery, and improve outcomes.
How Is TXA Used?
Although the only FDA-approved uses of TXA are for hemophilia, research has shown it to be safe and effective for patients with blood-loss trauma, hemorrhage, or perioperative bleeding. According to StatPearls, TXA has proven effective in the following circumstances, even though these uses are technically “off-label”:
- Elective C-sections
- Total knee arthroplasty
- Orthognathic surgery
- Cardiac surgery
- Spinal surgery
- Transurethral retrograde prostatectomy
- Non-traumatic subarachnoid hemorrhage
- Postpartum hemorrhage
- Gastrointestinal bleeding
- Post-procedural after cervical conization
- Hereditary angioedema (HAE)
- Transurethral retrograde prostatectomy (TURP)
- Tooth extractions in patients on oral anticoagulants
- Total unilateral hip replacement surgery
- Traumatic hyphema
- Nosebleed
- Hemoptysis
In most cases where transfusions would normally be indicated, TXA helped reduce the transfusion requirement. For this reason, TXA is also effective in treating blood-loss trauma in any case where the patient is requiring a massive transfusion protocol or is at risk of hemorrhage.
TXA and Autotransfusion Work Effectively Together
It’s very positive news that TXA has an effective history of being able to decrease blood loss and thereby reduce the need for blood transfusion. Allogeneic blood transfusion can be costly and increase the risk of infection or complications for patients, which can increase hospital stays and slow recovery times.
However, autotransfusion holds far less risk for patients because they’re receiving their own blood back, which means no heightened immune response or compatibility concerns. Autotransfusion also allows patients to maintain hemoglobin and hematocrit levels that commonly drop during surgery. It’s a fast way to provide patients with fresh red blood cells; in just three to five minutes, a patient will receive his or her own blood back after it is cleansed in the ATS machine.
In trauma or hemorrhage situations, when blood is precious, TXA and autotransfusion offer two high-impact ways of salvaging the patient’s blood, improving survival rates and allowing for more efficient recovery times. Autotransfusion can’t replace the use of TXA — or vice versa — but they perform well together in their respective functions.
This is why they can be an ideal pair in surgical cases. In fact, a study in The International Journal of Clinical and Experimental Medicine on the use of TXA and autotransfusion during total knee arthroplasty operations found that although autotransfusion didn’t reduce the rate of blood loss like the use of TXA, it decreased the rate of complications and promoted functional recovery. For this reason, the study concluded that the use of autotransfusion and TXA together resulted in improved outcomes.
Get Autotransfusion Support
If you’re interested in what the use of TXA and autotransfusion can do for your patients, get in touch with us today! We can provide trained autotransfusion specialists to your hospital to support your OR and help improve outcomes. At SpecialtyCare, it’s our mission to make surgery safer, and our teams are integrated with 1,200 hospitals and health systems nationwide, supporting 13,500 physicians during 500,000+ procedures annually. Contact us today to learn more about how we can help you!
