Abstract
Background and aimHead and neck cancer is frequent, and surgeries pose more significant morbidity and mortality due to multitudinal causes; heavy blood loss and transfusion are among them. Tranexamic acid (TXA) is known to stabilize the micro clots hence controlling excessive blood loss. The present study aimed to compare perioperative blood loss with two different doses of TXA and placebo to find the effectiveness and optimal dose.MethodsWith ethical approvals and informed consent, the present prospective, randomized, double-blind, controlled study was conducted in a teaching institute from May 31, 2018, to Dec 28, 2019. Patients undergoing elective head and neck cancer (HNC) surgeries were included. Preoperative Hb < 7 gm% or > 16 gm%, known coagulopathy, anticoagulant therapy, contraindications to TXA, intraoperative torrential or blood loss due to arterial injury were excluded. Group T-1 received TXA 10mg/kg, T-II received 15 mg/kg, while the control group (Gr-C) received equal volume normal saline. Data about demography, surgical time, intraoperative and postoperative blood loss, and transfusion were collected and compared. SPSS software was used for analysis; p-value <0.05 was considered significant.ResultsNinety patients were screened, 84 completed the study. All three groups were similar in demographics. The median blood loss with 25th -75th percentile in group C, T-I, and T-II groups were 762.5 (513.5-1193), 541.5 (296.5-787), and 536.0 (180.5 - 879) mL, respectively; p: 0.025. There was a significant difference between the control group and T-I (p-value: 0.0153), and control and T-II (p-value: 0.0248), but an insignificant difference between T-I and T-II (p-value: 0.706). 5 (17.85%) in each of T-I and T-II required transfusion, whereas 14 (50%) in the control group required it; p < 0.011). No major clinically significant related to study drugs were noted.ConclusionCompared to placebo (normal saline), preoperative administration of TXA in bolus significantly reduced perioperative blood losses and transfusion requirement in patients undergoing HNC surgery as estimated using the Hb-based method. A bolus dose of doses of 10mg/kg and 15 mg/kg is equally effective.
Highlights
Head and neck cancers (HNC) are the sixth most common cancer, while in the Indian subcontinent, the prevalence is higher [1,2]
The present study aimed to evaluate the efficacy of a single preoperative bolus dose of Tranexamic acid (TXA) on reduction in blood loss measured from fall in hemoglobin and red blood cell transfusion in patients undergoing head and neck cancers (HNC) surgery and its gross adverse effects any
Patients aged 18-65 of either male or female gender having a body mass index of 18.529.99 kg/m2 belonging to the American Society of Anesthesiologists physical class up to III undergoing elective Head and Neck Cancer surgeries were included
Summary
Head and neck cancers (HNC) are the sixth most common cancer, while in the Indian subcontinent, the prevalence is higher [1,2]. The etiology, clinical presentation, and patient characteristics make HNC in India unique [4]. Bleeding is a challenge for surgeons and anesthesiologists, and often blood and blood products transfusion is required. The administration of blood and blood products carries multiple risks and adverse effects [5]. Head and neck cancer is frequent, and surgeries pose more significant morbidity and mortality due to multitudinal causes; heavy blood loss and transfusion are among them. The present study aimed to compare perioperative blood loss with two different doses of TXA and placebo to find the effectiveness and optimal dose
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