September FY24

[kristenhorsman]

This month's journal article is presented by Cathy Lawry. With the increased requests by surgeon for TXA, this article is a great review. 

Please reference the article attached to the email and answer the following two questions:

1. Name 3 absolute contraindications and 3 relative contraindications for TXA use.

2. What surgical procedures have you administered TXA during? Did you use a low dose or a high dose regimen?

[Sarah Jazzar]

1) - Absolute contraindications for TXA: history of anaphylactic reaction, active coagulopathy, renal failure, acute subarachnoid hemorrhage, recent PE, DVT, or coronary stenting within six months
- Relative contraindications: renal dysfunction, preexisting coagulopathy or anticoagulation treatment, uncontrolled seizure disorder, and patients with increased risk of venous thromboembolism

2) I have used both high and low dose TXA for the following procedures: cardiothoracic, orthopedic, OB, and neurosurgery.

[sjsimmons]

1. The absolute contraindications for TXA include history of anaphylactic reaction, active coagulopathy, renal failure, acute subarachnoid hemorrhage,
and recent pulmonary embolism, deep vein thrombosis (DVT), or coronary stenting within six months. Relative contraindications include renal dysfunction, preexisting coagulopathy or anticoagulation treatment, uncontrolled seizure disorder, and patients with increased risk of venous thromboembolism. While these are valid concerns, the overwhelming and consistent evidence provided by multiple systematic reviews and meta-analyses demonstrates that the risk of thromboembolism in patients who receive TXA is not significantly different than untreated control groups. TXA administration has an extraordinary safety profile, even with high dosing regimens.

2. Personally, I have used TXA in cardiac surgery, open GYN surgery, and orthopedic surgery (joint replacement & spine).

[Soo-Ok Kim]

1. Name 3 absolute contraindications and 3 relative contraindications for TXA use.
Absolute contraindication: h/o anaphylactic reaction to TXA, active coagulopathy, renal failure, acute SAH, recent PE, DVT, or coronary stenting within 6months
Relative contraindication: renal dysfunction, preexisting coagulopathy or anticoagulation treatment, uncontrolled seizer disorder, and pts with increased risk of venous thromboembolism.

2. What surgical procedures have you administered TXA during? Did you use a low dose or a high dose regimen?
PSF, craniofacial surgery, knee and hip surgery, C/S
I used both low dose and high dose. For knee/hip/ and C/S, either 1g or 2g TXA which may me 1-2mg/kg/dose, for PSF, used either 10-30mg/kg bolus then 5-10mg/kg/hr gtt.

[kel]

3 absolute contraindications: anaphylaxis to TXA/active coagulation problems/renal failure

3 relative contraindications for TXA use: renal dysfunction/ uncontrolled seizures/ pts with increased risk of venous thromboembolism.


2. What surgical procedures have you administered TXA during? Once I gave a one time 1000 bolus of TXA for a fibroid surgery

[Amy Swank]

The journal article states there is consensus regarding the absolute contraindications for TXA to include: h/o anaphylactic reaction, active coagulopathy, renal failure, acute subarachnoid hemorrhage, and recent PE, DVT, or coronary stenting within 6 mos.
Relative contraindications include renal dysfunction, preexisting coagulopathy or anticoagulation, treatment, uncontrolled seizure d/o, and patients with increased risk of venous thromboembolism.

I learned that Topical TXA should be considered for patients with possible contraindications for IV TXA and that topical TXA has similar hemostatic efficacy as IV TXA with a higher safety profile. Great to know that!

I have recently used TXA for a complex breast reconstruction case (was not mentioned in the article). Have also used with Ortho cases and high blood loss general and Gyne cases.
Thanks for the article Cathy!

[Wai-Ling Lo]

1. Name 3 absolute contraindications and 3 relative contraindications for TXA use.
According to the article: absolute contraindications for TXA include history of anaphylactic reaction, active coagulopathy, renal failure, acute subarachnoid hemorrhage, recent pulmonary embolism, deep vein thrombosis (DVT), and coronary stenting within six months.
Relative contraindications include renal dysfunction, preexisting coagulopathy or anticoagulation treatment, uncontrolled seizure disorder, and patients with increased risk of venous thromboembolism.



2. What surgical procedures have you administered TXA during? Did you use a low dose or a high dose regimen?
I have used it mainly for spine and orthopedic surgeries at both low or high dose regimen.

[Jennifer Hannon]

1)Absolute contraindications for TX are a history of anaphylactic reaction, active coagulopathy, renal failure, acute subarachnoid hemorrhage, recent PE, DVT.
- Relative contraindications: renal dysfunction, preexisting coagulopathy or anticoagulation treatment, uncontrolled seizure disorder, and patients with increased risk of venous thromboembolism

2)I usually have used the loading and then maintenance infusion in Ortho and in TG cases.

[Tracey Trainum]

1. Absolute contraindications: hx of anaphylaxis, active coagulopathy, renal failure, subarachnoid hemorrhage, recent DVT/PE, or coronary stent within 6 months.
Relative contraindications: renal dysfunction, hx of coagulopathy or anticoagulation treatment, uncontrolled seizure disorder, patients with risk factors for DVT

2. I have given TXA for joint replacement surgeries (hip, knee, shoulder) and well as breast mastectomies. Typically, I have given 1 gram IV prior to the start of the case. Per the article, a low dose bolus dose is 5-10 mg/kg and a high dose bolus dose is >10 mg/kg. Considering a standard 70 kg patient, 1 gram(1000 mg) would fall in the >10 mg/kg range = high dose loading dose

On a side note, I have recently learned that TXA is making its way into skin care products topically. It's becoming the new "it" ingredient in skin care products.