Sargant, N., Roy, A., Simpson, S., Chandrakumaran, K., Alves, S., Coakes, J., . . . Moran, B. (2016). A protocol for management of blood loss in surgical treatment of peritoneal malignancy by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Transfusion Medicine, 26, 118–122.
To determine if tranexamic acid and cryoprecipitate led to a reduction in blood loss and red cell transfusions in patients with peritoneal malignancies having surgery, and to see if the effect of the change in practice would lead to change in coagulation parameters or incidences of thrombosis
For the group in 2011, the standard protocol for cytoreductive surgery with hyperthermic intraperitoneal peroperative chemotherapy included using fresh frozen plasma (FFP) pre-emptively two hours into surgery, as well as for significant blood loss guided by laboratory values. Red blood cells, platelets, and cryoprecipitate were also transfused per laboratory values, per protocol. Following the CRASH-2 study, in 2013, a new protocol was devised to administer tranexamic acid at the beginning of surgery, with a repeated dose four hours into the procedure. If hemorrhage starts before 2 L of blood loss, cryoprecipitate is given with pre- and post-coagulation laboratory values. Laboratory tests were conducted throughout the surgery with intervention as appropriate.
PHASE OF CARE: Active antitumor treatment
Prospective trial with a matched historical comparison group
The new protocol, using tranexamic acid, led to maintained average fibrinogen levels, a statistically significant increase in hemoglobin levels during and just following surgery, and a statistically significant reduction in blood loss. No significant reduction in FFP was observed and no difference in deep vein thrombosis existed in the two groups.
The patients given tranexamic acid and cryoprecipitate during cytoreductive surgery had higher fibrinogen levels and a decrease in blood loss—higher hemoglobin levels and fewer red cell transfusions. No higher arterial or venous thrombosis were observed in this group compared to the prior group.
Nurses caring for patients with peritoneal cancer undergoing cytoreductive surgery and hyperthermic intraperitoneal peroperative chemotherapy should be aware of tranexamic acid and cryoprecipitate use to reduce blood loss.