Key result
Intraoperative IV tranexamic acid during sarcoma resection is linked to ~10-fold higher postoperative PE risk.
Why the study?
Although tranexamic acid reduces blood loss in orthopedic procedures, it is unknown whether intraoperative use increases postoperative thrombotic complications following sarcoma resection.
Does intraoperative intravenous tranexamic acid increase the risk of postoperative thrombotic complications in patients undergoing sarcoma resection?
Cohort (n=1,099)
No
Does intraoperative intravenous tranexamic acid increase the risk of postoperative thrombotic complications in patients undergoing sarcoma resection?
Intraoperative use of intravenous tranexamic acid during sarcoma resection is associated with a significantly increased risk of postoperative pulmonary embolism, warranting caution in this patient population.
Caution advised with intraoperative TXA in sarcoma resection; hypothesis-generating and requires prospective validation before practice change.
Introduction Tranexamic acid (TXA) is an antifibrinolytic drug that has been shown to reduce blood loss following surgery. The use of TXA during orthopedic procedures has gained widespread acceptance, with multiple clinical studies demonstrating no increase in thrombotic complications. While TXA has been shown to be safe and effective for several orthopedic procedures, its use in orthopedic sarcoma surgery is not well established. Cancer‐associated thrombosis remains a significant cause of morbidity and mortality in patients with sarcoma. It is unknown if intraoperative TXA use will increase the risk of developing a postoperative thrombotic complication in this population. This study aimed to compare the risk of postoperative thrombotic complications in patients who received TXA during sarcoma resection to patients who did not receive TXA. Methods A retrospective review was performed of 1099 patients who underwent resection of a soft tissue or bone sarcoma at our institution between 2010 and 2021. Baseline demographics and postoperative outcomes were compared between patients who did and did not receive intraoperative TXA. We evaluated 90‐day complication rates, including: deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), cerebrovascular accident (CVA), and mortality. Results TXA was used more commonly for bone tumors ( p < 0.001), tumors located in the pelvis ( p = 0.004), and larger tumors ( p < 0.001). Patients who received intraoperative TXA were associated with a significant increase in developing a postoperative DVT (odds ratio [OR]: 2.22, p = 0.036) and PE (OR: 4.62, p < 0.001), but had no increase in CVA, MI, or mortality (all p > 0.05) within 90 days of surgery, following univariate analysis. Multivariable analysis confirmed that TXA was independently associated with developing a postoperative PE (OR: 10.64, 95% confidence interval: 2.23–50.86, p = 0.003). We found no association with DVT, MI, CVA, or mortality within 90 days postoperatively, following intraoperative TXA use. Conclusion Our results demonstrate a higher associated risk of PE following TXA use in sarcoma surgery and caution is warranted with TXA use in this patient population.
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Foster et al. (2023) conducted a cohort in Soft tissue or bone sarcoma (n=1,099). Intravenous tranexamic acid (TXA) vs. No intraoperative TXA was evaluated on Postoperative pulmonary embolism (PE) within 90 days (OR 10.64, 95% CI 2.23-50.86, p=0.003). Intraoperative intravenous tranexamic acid use during sarcoma resection was independently associated with an increased risk of postoperative pulmonary embolism (OR 10.64; 95% CI 2.23-50.86; p=0.003).
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