Intrapleural instillation of Tranexamic acid for the control of postoperative bleeding following thoracic surgical procedures for chronic inflammatory pleural/pulmonary diseases - A Randomised prospective clinical study
Journal Title: Stanley Medical Journal - Year 2017, Vol 4, Issue 2
Abstract
Context Postoperative bleeding following open thoracic surgical procedures for chronic inflammatory pleural/pulmonary diseases (CIPPD) is adding considerable morbidity and mortality by increasing the need for more blood transfusion and its related complications. Aim We aim to study the effectiveness of intra-pleural instillation of Tranexamic acid (TA) to control postoperative bleeding in patients undergoing various open thoracic surgical procedures for CIPPD. Settings and Design: 5 years and 6 months from October 2011 to March 2017 at a single surgical unit in the Department of Cardiovascular & Thoracic Surgery, Rajiv Gandhi Government General Hospital & Madras Medical College, Chennai. Study design Randomized prospective double-blind controlled study. Methods and Material: 240 consecutive adult patients with CIPPD scheduled for various types of open thoracic surgical procedures ranging from Decortication to pneumonectomy were assigned randomly to receive either intrapleural instillation of TA (1gm in 100 ml normal saline) [Group 1] or 100 ml of normal saline alone [Group 2] on closure of thoracotomy wound after adequate haemostasis and aerostasis through intercostal drainage (ICD) tube. A minimum contact time of 1 hour was kept to allow for local effect and systemic absorption of drug. All patients were maintained in lateral decubitus position postoperatively with wound site facing upwards during this contact period of one hour before allowing for tube drainage. In patients with air leak, a second ICD tube was kept open for air drainage while the other ICD tube in dependent position was temporarily blocked for one hour to allow for contact time. Complete blood counts, bleeding and clotting times were done pre and postoperatively. Postoperative blood loss and blood products requirements were noted. The results were compared and analysed between the two groups. Statistical analysis used To find the significant difference between the bivariate samples in Independent groups the Unpaired sample t-test was used. To find the significance in categorical data Chi-Square test and Fisher's exact test were used. In all the above statistical tools the probability value of 0.05 is considered as significant level. Results Significant postoperative bleeding was noted in group 2 compared with group 1. The mean total blood loss was 211 ± 147 ml in group 1 and 460 ± 235 ml in group 2. Blood transfusion requirements were lower in group 1 (22.14%) when compared to group 2 (54.28%). No thrombotic or transfusion related complications were noted in both the groups. Conclusions Our prospective observational study results showed Intra-pleural instillation of TA was beneficial and effective in reducing the postoperative bleeding and blood products requirements in patients undergoing open thoracic surgical procedures for CIPPD. Moreover the use of TA didn’t increase thrombotic complications. Key-words Chronic inflammatory pleural/pulmonary disease (CIPPD)– Post operative bleeding – Intrapleural Tranexamic acid (TA)
Authors and Affiliations
Amaravathi Sivaraman, Arasu Abinayavallaban, Srinivasan Thiruneelakandan
Keywords
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