Journal Club - POISE 3 in favour of Wider Use of Tranexamic Acid in Noncardiac Surgery
Written By : Dr. Nandita Mohan
Medically Reviewed By : Dr. Kamal Kant Kohli
Published On 2022-04-29 06:45 GMT | Update On 2022-04-29 09:14 GMT
Perioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding. Tranexamic acid is indicated for heavy menstrual bleeding and hemophilia and has been used in cardiac surgery, but it is increasingly being used in noncardiac surgeries. As previously reported, POISE showed that the β-blocker...
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Perioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding.
Tranexamic acid is indicated for heavy menstrual bleeding and hemophilia and has been used in cardiac surgery, but it is increasingly being used in noncardiac surgeries. As previously reported, POISE showed that the β-blocker metoprolol lowered the risk for myocardial infarction (MI) but increased the risk for severe stroke and overall death, whereas in POISE-2, perioperative low-dose aspirin lowered the risk for MI but was linked to more major bleeding.
But now, a single dose of tranexamic acid (TXA) at the beginning and end of surgery significantly reduced major bleeding in patients undergoing noncardiac surgery compared with placebo, based on findings from the POISE-3 trial presented at ACC.22 and simultaneously published in the New England Journal of Medicine.
The study randomized 9,535 patients undergoing noncardiac surgery at 114 centers in 22 countries to receive TXA (1-g intravenous bolus) or placebo at the start and end of surgery. The primary efficacy outcome was a composite of life-threatening bleeding, major bleeding, or bleeding into a critical organ at 30 days.
The primary safety outcome was a composite of myocardial injury after noncardiac surgery, non-hemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism at 30 days. Overall results showed a composite bleeding outcome event occurred in 9.1% of those patients in the TXA group compared with 11.7% of patients in the placebo.
Researchers noted the benefit of TXA treatment was consistent, regardless of the type of noncardiac surgery patients received and hemoglobin was normal or low before surgery.
The authors observed that there was an unequivocal benefit of treatment [with TXA] on preventing bleeding and blood transfusions, with no increased risk of complications.
Given the number of people worldwide who undergo noncardiac surgery every year and the frequency of postsurgical bleeding complications, this has the potential to help a lot of patients.
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