Safety and Efficacy of Tranexamic Acid in General Surgery.

Summary

In 3,260 general surgery patients within POISE-3, prophylactic TXA reduced the composite bleeding outcome (HR 0.74; 95% CI, 0.59-0.93; P=0.01) without increasing the composite cardiovascular safety outcome (HR 0.95; 95% CI, 0.78-1.16). Benefits were consistent across general surgery subtypes, including hepatopancreaticobiliary and colorectal procedures.

Key Findings

• TXA reduced life-threatening/major/critical organ bleeding composite vs placebo (HR 0.74; 95% CI 0.59-0.93).
• No increase in cardiovascular safety composite (myocardial injury after noncardiac surgery, nonhemorrhagic stroke, arterial thrombosis, symptomatic proximal VTE) with TXA (HR 0.95; 95% CI 0.78-1.16).
• Benefit observed across general surgery subtypes, notably hepatopancreaticobiliary (HR 0.55; 95% CI 0.34-0.91) and colorectal (HR 0.67; 95% CI 0.45-0.98) surgery.

Clinical Implications

Anesthesiologists can consider routine prophylactic TXA in eligible general surgery patients to reduce major bleeding without increasing vascular events, with particular benefit in hepatopancreaticobiliary and colorectal procedures.

Limitations

• Subgroup analysis inherits limitations of secondary analyses and may be underpowered for rare harms
• Applicability limited to patients similar to POISE-3 eligibility (≥45 years, elevated cardiovascular risk)

Future Directions

Implementation studies to optimize TXA dosing/timing in specific general surgery pathways and evaluate real-world effectiveness and rare adverse events.