A comparative study to evaluate the effect of two different doses of tranexamic acid in reducing intraoperative blood loss during pancreaticobiliary surgeries

Background: Studies comparing the effect of different doses of tranexamic acid (TXA) in pancreaticobiliary surgeries are lacking. We conducted this randomized controlled trial to compare the effect of two different doses of TXA on intraoperative blood loss during pancreaticobiliary surgeries. Methods: 62 adult patients undergoing pancreaticobiliary surgeries were randomized to receive either 15mg/kg bolus of TXA before incision (group A) or 15 mg/kg TXA bolus before incision followed by 1/mg/kg/hr TXA infusion for the length of surgery (group B). The primary objective was to compare intraoperative blood loss between the two groups. Secondary objectives were to compare intraoperative blood transfusion, change in hematocrit, length of hospital stay (LOS), incidence of deep vein thrombosis (DVT) and 28-day mortality. Results: There was no significant difference in blood loss between the two groups {553.0 ml (257.5-728.0) in group A and 423.0 ml (313.5-499.0) in group B, p=0.17}. The change in hematocrit (2.2% and 0.4% in groups A and B respectively, p=0.35) and LOS (25 ± 8 days in group A vs. 20 ± 6 days in group B, p =0.80) were comparable between the groups. Both groups had a 0% 28-day mortality and no DVT was observed in any patient. Conclusion: We found that there was no difference in intraoperative blood loss in pancreaticobiliary surgeries when a bolus only or a bolus plus infusion regimen of TXA was used. No patient in either group had thrombotic complications.