Dr Tim Wang1, Dr Bish Soliman, Dr Shane O’Neill, Dr Jeon Cha
1Royal North Shore Hospital Sydney – Severe Burns Unit, Sydney, Australia
Background: Tranexamic acid significantly reduces blood loss and postoperative blood transfusion within the trauma literature. A Cochrane meta-analysis in trauma demonstrated reduced blood loss by 29% and need for transfusion by 45%.1 2 Therapeutic effect lasts up to 17 hours without hypertensive side-effects and rebound bleeding seen with adrenaline use. Additionally, TXA is proposed to reduce inflammation, oedema and recently, forms a novel treatment for post-inflammatory hyperpigmentation.3 Despite its potential, the evidence of TXA in burns surgery remains limited.
This review aims to clarify the indications, benefits, side-effects, dosages and technical consideration for the use of TXA in burns surgery.
Methods: A systematic review was performed in Medline, EMBASE, Google Scholar of all articles pertaining to TXA use in burns surgery.
Results: Six studies examined the use of tranexamic acid within burns surgery.4-9 All studies involved acute burn injuries with the majority of studies conducted in burns >20% TBSA. Dosages used, route of administration and administration protocol varied widely. All studies demonstrate reduced blood loss up to 46% (p<0.05). Two studies demonstrated reduced need for blood transfusion within the placebo compared to the TXA group (<0.05).5 8 Topical application of TXA was effective and superior to topical adrenaline.4 Importantly, nose of these studies reported increased rates of venous thromboembolism.
Conclusion: Perioperative use of TXA reduces blood loss and transfusion requirements in burns surgery without increased rates of thromboembolic events. More studies are required to evaluate the optimal dose, route and protocol of administration.
Dr Tim Wang is a post-fellowship senior registrar in Plastic Surgery at Royal North Shore Hospital with an interest in microsurgery, hand surgery and burns.
Raised in Scandinavia, Tim obtained his medical degree from Imperial College London, preceptorship in plastic surgery at Harvard University Beth Israel Deaconess Medical Centre and a Masters in plastic surgery from the University of Sydney. Outside of work he enjoys wrestling two young children, swimming, travel and photography.
Tim’s main aim is to use research as a means to optimise current clinical practice and improve patient care.