Thursday, December 15, 2016

You Must Know This Before Your Next Operation

A new study out Baylor College of Medicine in Houston shows that use of effective anti-bleeding drugs during surgery is up, but not up enough. Dr. Henry Huang says,

 “There is a growing body of literature to support the use of antifibrinolytics to decrease perioperative blood loss, so the hope was that utilization rate would come up, and it did so in our study. But nearly 30% of centers have still decided not to use antifibrinolytics despite the increasing evidence.
Antifibrinolytics are drugs, such as TXA (tranexamic acid) that promote clotting.

As Dr. Huang reported at the 2016 World Congress of Anaesthesiologists, significant blood loss remains a perioperative concern for patients undergoing many types of surgery. So an important question before the Group was utilization rates of antifibrinolytics.

“Because there are a limited number of [a particular type of facial surgery] cases per year for each institute, it’s hard to use just one center’s data to study the surgical complications or anesthetic management outcomes,” Dr. Huang explained, “and one of the bigger fears of the procedure is bleeding.”

A broad study of TXA in 2012 called CRASH-2 looked at 20,000 patients (half given TXA, half a placebo). It proved beyond all doubt that doctors most common fears about TXA - that it would cause patients to "throw" a clot that would harm them - were absolutely groundless.

Hence, the 30% of operating teams that are not using TXA or something similar is a concern. What has prevented the adoption of what is essentially a miracle drug?

Of the centers that did not use antifibrinolytics, two factors were predominantly cited: surgeon preference and concerns about side effects.

Since CRASH-2 proved that the side effects were minimal, what's the remaining hold up? "Surgeon preference."


Take a card, write "TXA" on it in large letters, and keep it in your wallet. If you need surgery, pull it out. If your surgeon has a "preference" for blood transfusion instead of preventing blood loss, perhaps you should "prefer" another surgeon.

Please feel free to leave a comment. I've written quite a bit about blood medicine. To link to my other columns on this subject, click here.

Bill K. Underwood is the author of several novels and one non-fiction self-help book, all available at

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