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dc.contributor.authorBadenoch Aen_US
dc.contributor.authorSharma Aen_US
dc.contributor.authorGower Sen_US
dc.contributor.authorSelzner Men_US
dc.contributor.authorSrinivas Cen_US
dc.contributor.authorWąsowicz Men_US
dc.contributor.authorMcCluskey SAen_US
dc.description.abstractBackground. Randomized trials have demonstrated the efficacy of tranexamic acid (TXA) in reducing blood loss and transfusion requirements during liver transplantation. However, clinical utilization is limited due to a perceived lack of generalizable effectiveness and concerns regarding its thromboembolic risks. The aim of this study was to describe the clinical use of TXA and to provide a pragmatic reappraisal of its effectiveness and safety. Methods. After ethics approval, data were collected from 1799 consecutive liver transplant recipients between January 1, 2002, and December 31, 2015, using retrospectively collected electronic databases. Propensity matching was used to account for confounders of transfusion and thrombotic risk. Exposure was defined as a total TXA dose greater than 10 mg/kg for 50% of the operative duration. Results. After propensity matching, 367 unique pairs were well balanced in terms of all measured covariates. In the matched pairs, patients exposed to TXA received less red blood cell (3 [0, 6] vs 4 [1, 7] P = 0.003) and frozen plasma (6 [2, 10] vs 6 [2, 12], P = 0.032) transfusions. There were no differences in thromboembolic events between the groups (22 [6.0%] vs 36 [9.8%]). Conclusions. TXA appears effective in reducing red blood cell transfusion requirements without increasing the risk of thromboembolic events across a wide variety of liver transplant recipients, including those at low risk of bleeding or high risk of thromboembolic complications. We did not detect evidence of an increased risk of thrombotic complications with TXA exposure.en_US
dc.subjectAntifibrinolytic Agents/adverse effectsen_US
dc.subjectAntifibrinolytic Agents/therapeutic use*en_US
dc.subjectBlood Loss, Surgical/prevention & control*en_US
dc.subjectDatabases, Factualen_US
dc.subjectErythrocyte Transfusionen_US
dc.subjectLiver Transplantation*/adverse effectsen_US
dc.subjectLogistic Modelsen_US
dc.subjectPostoperative Hemorrhage/etiologyen_US
dc.subjectPostoperative Hemorrhage/prevention & control*en_US
dc.subjectPropensity Scoreen_US
dc.subjectRetrospective Studiesen_US
dc.subjectRisk Assessmenten_US
dc.subjectRisk Factorsen_US
dc.subjectThromboembolism/chemically induceden_US
dc.subjectTime Factorsen_US
dc.subjectTranexamic Acid/adverse effectsen_US
dc.subjectTranexamic Acid/therapeutic use*en_US
dc.subjectTreatment Outcomeen_US
dc.titleThe Effectiveness and Safety of Tranexamic Acid in Orthotopic Liver Transplantation Clinical Practice: A Propensity Score Matched Cohort Studyen_US
dc.typeJournal Articleen_US
dc.description.affiliatesToronto General Hospital, University Health Network, University of Toronto, Ontario, Canadaen_US
dc.description.affiliatesAustralian and New Zealand College of Anaesthetistsen_US
dc.type.studyortrialCohort Studyen_US
item.openairetypeJournal Article-
item.fulltextWith Fulltext-
Appears in Collections:Scholarly and Clinical
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TXA 2017.pdf
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Main Article320.47 kBAdobe PDFView/Open    Request a copy
TXA 2017 Supplemental digital content.pdf
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Supplementary Digital Content (Appendix)235.68 kBAdobe PDFView/Open    Request a copy
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