Multicenter randomized trial of tranexamic acid in patients undergoing liver resection for a cancer-related indication

Tranexamic acid reduces bleeding and blood transfusion in many types of surgery, but its effect in patients undergoing liver resection for a cancer-related indication is unclear. The double-blind HeLiX trial, at ten centers in Canada and one center in the USA, randomized such patients 1:1 to tranexamic acid or placebo beginning at the induction of anesthesia. Perioperative characteristics were similar between groups. The primary outcome was receipt of red blood cell transfusion within 7 days of surgery. Red blood cell transfusion occurred in 16.3% of patients in the tranexamic acid group and 14.5% of patients in the placebo group (p=0.38). Intraoperative blood loss (tranexamic acid 817.3 mL, placebo 836.7 mL; p=0.75) and total blood loss over 7 days (1504.0 ml versus 1551.2 ml; p=0.38) were similar between groups. Participants receiving tranexamic acid experienced significantly more complications compared with placebo (OR 1.28; p=0.03) with no significant difference in venous thromboembolism (OR 1.68; p=0.08). The authors conclude that among patients undergoing liver resection for a cancer-related indication, tranexamic acid did not reduce bleeding or blood transfusion but increased perioperative complications (visual abstract).