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Journal Club - POISE 3 in favour of Wider Use of Tranexamic Acid in Noncardiac Surgery
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.
Dr. Nandita Mohan
BDS, MDS( Pedodontics and Preventive Dentistry)
Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at firstname.lastname@example.org. Contact no. 011-43720751