Effects of intravenous tranexamic acid on bleeding during burn surgery: A double-blinded randomized clinical trial

Blood loss during burn surgery significantly contributes to morbidity and mortality. Tranexamic acid (TXA), an antifibrinolytic agent, is hypothesized to reduce intraoperative bleeding. This double-blinded, randomized clinical trial aimed to assess the efficacy of systemic TXA in severe burn patients (total body surface area [TBSA] > 20 %) undergoing surgery. The study evaluated the impact of TXA on surgical bleeding, operating room (OR) time, intravenous (IV) fluid requirements, length of hospital stay (LOS), and overall patient outcomes. A total of 94 patients, with equal distribution in age, sex, and TBSA, were randomly assigned into two groups (47 each). We administered TXA as a 10 mg/kg loading dose followed by a 1 mg/kg/h infusion during surgery. Results demonstrated significant reductions in blood loss (P = 0.043), total IV fluid volume (P = 0.021), OR time (P = 0.002), LOS (P = 0.0001), and transfusions (P = 0.024) in the TXA group. Notably, women and patients without inhalation injuries exhibited better responses to TXA treatment, and graft survival was lower in the TXA group. The study concludes that IV TXA administration during burn surgery can reduce bleeding, minimize IV fluid and blood transfusion needs, and shorten surgery duration, enhancing overall surgical outcomes.