• Br J Surg · Jan 2023

    Randomized Controlled Trial Multicenter Study

    Tranexamic acid and blood loss in pancreaticoduodenectomy: TAC-PD randomized clinical trial.

    • Kenta Ishii, Yukihiro Yokoyama, Yoshihiko Yonekawa, Daisuke Hayashi, Fumie Kinoshita, Yachiyo Kuwatsuka, Masataka Okuno, Seiji Natsume, Takayuki Minami, Gen Sugawara, Kazuaki Seita, Fumiya Sato, Taro Aoba, Yasuhiro Shimizu, Yasuhiro Kurumiya, Atsuyuki Maeda, Ryuzo Yamaguchi, Kazuhiro Hiramatsu, and Tomoki Ebata.
    • Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
    • Br J Surg. 2023 Jan 10; 110 (2): 159165159-165.

    BackgroundTranexamic acid (TXA) may reduce intraoperative blood loss, but it has not been investigated in pancreaticoduodenectomy (PD).MethodsA pragmatic, multicentre, randomized, blinded, placebo-controlled trial was conducted. Adult patients undergoing planned PD for biliary, duodenal, or pancreatic diseases were randomly assigned to TXA or placebo groups. Patients in the TXA group were administered 1 g TXA before incision, followed by a maintenance infusion of 125 mg/h TXA. Patients in the placebo group were administered the same volume of saline as those in the placebo group. The primary outcome was blood loss during PD. The secondary outcomes included perioperative blood transfusions, operating time, morbidity, and mortality.ResultsBetween September 2019 and May 2021, 218 patients were randomly assigned and underwent surgery (108 in the TXA group and 110 in the placebo group). Mean intraoperative blood loss was 659 ml in the TXA group and 701 ml in the placebo group (mean difference -42 ml, 95 per cent c.i. -191 to 106). Of the 218 patients, 202 received the intervention and underwent PD, and the mean blood loss during PD was 667 ml in the TXA group and 744 ml in the placebo group (mean difference -77 ml, 95 per cent c.i. -226 to 72). The secondary outcomes were comparable between the two groups.ConclusionPerioperative TXA use did not reduce blood loss during PD.Registration NumberjRCTs041190062 (https://jrct.niph.go.jp).© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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