Impact of single dose intravenous tranexamic acid on peri-operative blood transfusion requirements in burn patients: A prospective, randomized trial

Abstract

Objective: Debridement of burn wounds and skin graft harvesting is associated with increased peri-operative bleeding. In this study we evaluated the effectiveness of tranexamic acid in reducing blood transfusion requirements during burn wound debridement/eschar removal and skin graft harvesting in adults with major burn injuries, with the primary outcome being the total amount of intraoperative blood loss. Methods: Fifty adult patients having >20% total body surface area of burn wounds, scheduled for wound debridement/eschar removal ± skin grafting after 10 days of burn injury under general anaesthesia were included. Patients were randomly allocated to receive either injection tranexamic acid 15 mg/kg diluted to 25 ml with isotonic saline over 10 min or an equal volume of only isotonic saline before induction of general anaesthesia. Venous blood gas analysis was done in the beginning and end of surgery, and then at 24 postoperative hours to assess hemoglobin levels of the patients. Blood transfusion was given when hemoglobin levels fell down to or below 7 gm/dl. Intraoperative blood loss was calculated using the Gross formula. Results: Intraoperative blood loss was found to be significantly higher in placebo group compared to tranexamic group, 990 ± 358.9 ml vs 581 ± 333.2 ml (p < 0.00), with more blood and colloid solutions being used to replace the blood loss in placebo group (p < 0.05). Conclusions: Preoperative administration of a single dose of tranexamic acid significantly reduces blood loss during debridement of burn wounds and skin graft harvesting surgeries without increasing the risk of untoward side-effects or complications.

Keywords

• Tranexamic acid
• Burn debridement
• Blood loss
• Blood transfusion