The Effectiveness and Safety of Tranexamic Acid in Orthotopic Liver Transplantation Clinical Practice: A Propensity Score Matched Cohort Study.

Background: 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 re-appraisal of its effectiveness and safety. Methods: Following ethics approval, data was collected from 1,799 consecutive liver transplant recipients between January 1st 2002 and December 31st 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>10mg/kg for 50% of the operative duration. Results: Following 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 (RBC) [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 [4 (1.1%) vs 3(0.8%) p=0.71]. Conclusion: Tranexamic Acid appears effective in reducing RBC 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. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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