Das, A., Chattopadhyay, S., Mandal, D., Chhaule, S., Mitra, T., Mukherjee, A., . . . & Chattopadhyay, S. (2015). Does the preoperative administration of tranexamic acid reduce perioperative blood loss and transfusion requirements after head neck cancer surgery? A randomized, controlled trial. Anesthesia, Essays and Researches, 9, 384–390. 

To determine the effectiveness of a preoperative bolus dose of tranexamic acid on the amount of blood loss and transfusions required during surgery for patients with head and neck cancer

The study participants were randomly selected into two groups. One group received 25 ml of normal saline only (control group) over five minutes through the IV route. The second group received 20 mg/kg dose of tranexamic acid diluted in 25 ml of normal saline over five minutes through the IV route. Both groups received the intervention 15 minutes prior to the initiation of anesthesia prior to surgery. Labs were done preoperatively, and in the first 6 and 24 hours postoperatively.

• N = 80
• AGE = 35–55 years
• CURRENT TREATMENT: Surgery
• KEY DISEASE CHARACTERISTICS: Patients with head and neck cancer having surgery
• OTHER KEY SAMPLE CHARACTERISTICS: No significant results

• SITE: Single site
• SETTING TYPE: Tertiary care hospital
• LOCATION: India

• PHASE OF CARE: Active antitumor treatment

• Double-blind randomized, controlled trial (RCT)

• Student’s t test
• Chi-squared test

Total blood loss was significantly higher in the control group when compared to the treatment group (p = 0.0001), requiring more blood transfusions both during the operation and at 24 hours post-procedure points. Even after transfusions, the control group’s hemoglobin remained significantly lower at 6 and 24 hours post-procedure (p < 0.05).

The use of tranexamic acid infusion prior to surgery for patients with head and neck cancer has shown significant reduction in blood loss during and following the procedure. With no reported adverse side effects with the use of this medication, the benefits outweigh any potential risks. The intervention will need to be studied in other disease state procedures to recommend use prior to all cancer surgeries.

• Small sample (less than 100)
• Optimal dose of tranexamic acid would need to be tested with a larger study.
• Study done in developing country limited the types of biochemical parameters of bleeding episodes measured.

Nurses practicing in the surgical oncology field will be interested in these findings, as they can help them improve patients' quality of life during and after surgery for head and neck cancer. By reducing the amount of allogeneic red blood cell transfusions patients receive, The use of tranexamic acid prior to surgery is improving lives by reducing the amount of allogeneic red blood cell transfusions patients need.