Thursday, December 15, 2016

You Must Know about TXA Before Your Next Operation

A new study out of Baylor College of Medicine in Houston shows that use of effective anti-bleeding drugs during surgery is up. That's good. But it is 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.

A huge 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 fear about TXA - that it would cause patients to throw a dangerous clot - were absolutely groundless. (Remember that term - CRASH-2. Ask your doctor if he is familiar with the CRASH-2 study.)

30% of surgical teams not using TXA, or something similar, is a concern. What has inhibited the adoption of what is essentially a miracle drug?

Of the centers that did not use antifibrinolytics, two factors were predominantly cited: 1., surgeon preference, and 2., concerns about side effects.

Since CRASH-2 proved beyond doubt 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 can help support this site by purchasing a book.

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