Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

Karanicolas, Paul J.; Lin, Yulia; Tarshis, Jordan; Law, Calvin H. L.; Coburn, Natalie G.; Hallet, Julie; Nascimento, Barto; Pawliszyn, Janusz; McCluskey, Stuart A.

Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

dc.contributor.author	Karanicolas, Paul J.
dc.contributor.author	Lin, Yulia
dc.contributor.author	Tarshis, Jordan
dc.contributor.author	Law, Calvin H. L.
dc.contributor.author	Coburn, Natalie G.
dc.contributor.author	Hallet, Julie
dc.contributor.author	Nascimento, Barto
dc.contributor.author	Pawliszyn, Janusz
dc.contributor.author	McCluskey, Stuart A.
dc.date.accessioned	2017-10-16T13:37:35Z
dc.date.available	2017-10-16T13:37:35Z
dc.date.issued	2016-12-01
dc.description	The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.hpb.2016.09.005 © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/	en
dc.description.abstract	Background: Hyperfibrinolysis may occur due to systemic inflammation or hepatic injury that occurs during liver resection. Tranexamic acid (TXA) is an antifibrinolytic agent that decreases bleeding in various settings, but has not been well studied in patients undergoing liver resection. Methods: In this prospective, phase II trial, 18 patients undergoing major liver resection were sequentially assigned to one of three cohorts: (i) Control (no TXA); (ii) TXA Dose I - 1 g bolus followed by 1 g infusion over 8 h; (iii) TXA Dose II - 1 g bolus followed by 10 mg/kg/hr until the end of surgery. Serial blood samples were collected for thromboelastography (TEG), coagulation components and TXA concentration. Results: No abnormalities in hemostatic function were identified on TEG. PAP complex levels increased to peak at 1106 mu g/L (normal 0-512 mu g/L) following parenchymal transection, then decreased to baseline by the morning following surgery. TXA reached stable, therapeutic concentrations early in both dosing regimens. There were no differences between patients based on TXA. Conclusions: There is no thromboelastographic evidence of hyperfibrinolysis in patients undergoing major liver resection. TXA does not influence the change in systemic fibrinolysis; it may reduce bleeding through a different mechanism of action.	en
dc.identifier.uri	http://dx.doi.org/10.1016/j.hpb.2016.09.005
dc.identifier.uri	http://hdl.handle.net/10012/12550
dc.language.iso	en	en
dc.publisher	Elsevier	en
dc.rights	Attribution-NonCommercial-NoDerivatives 4.0 International	*
dc.rights.uri	http://creativecommons.org/licenses/by-nc-nd/4.0/	*
dc.subject	Prospective Randomized-Trial	en
dc.subject	Colorectal-Cancer Surgery	en
dc.subject	Central Venous-Pressure	en
dc.subject	Blood-Transfusion	en
dc.subject	Hepatic Resection	en
dc.subject	Cardiac-Surgery	en
dc.subject	Trauma Patients	en
dc.subject	Cardiopulmonary Bypass	en
dc.subject	Hepatectomy	en
dc.subject	Transplantation	en
dc.title	Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid	en
dc.type	Article	en
dcterms.bibliographicCitation	Karanicolas, P. J., Lin, Y., Tarshis, J., Law, C. H. L., Coburn, N. G., Hallet, J., … McCluskey, S. A. (2016). Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid. HPB, 18(12), 991–999. https://doi.org/10.1016/j.hpb.2016.09.005	en
uws.contributor.affiliation1	Faculty of Science	en
uws.contributor.affiliation2	Chemistry	en
uws.peerReviewStatus	Reviewed	en
uws.scholarLevel	Faculty	en
uws.typeOfResource	Text	en