Evaluation of Tranexamic Acid for the Reduction of Blood Loss During Burn Surgery in Adults (Tranburn Study)

The objective of this study is the evaluation of the use of tranexamic acid (TXA) for the reduction of blood loss and the use of blood products. We conducted a prospective, multicenter, interventional, randomized, blinded study in 4 burn intensive care units. Patients over 18 years of age with at least 5% body surface area burns scheduled for surgery were included. The treated group received 1g TXA intravenously, then 1g TXA over 8h. The placebo group received saline. Blood loss was calculated using the Mercuriali formula. 121 patients were enrolled. The groups were similar in terms of sex, age, burn etiology, total burn surface area (TBSA), SAPS II and ASA scores, weight, height and estimated total blood volume. The median TBSA was 15% and the median graft size was 1499 cm². The graft was typically performed 13 days after injury. Median total blood loss was 0.7 mL/cm² of excised and grafted skin [0.5-1.1] in the TXA group compared to 0.7 mL/cm² [0.5-1.2] in the placebo group (p=0.361). The packed red blood cells (pRBC) volume was similar in the 2 groups (0 [0-550] vs 0 [0-569]; p=0.992). There was no difference between the two groups regarding death, myocardial infarction, stroke, venous thrombosis, graft failure, seizure or acute renal failure. TXA does not offer any additional benefits when used alongside topical epinephrine in limited burn graft surgery. Further studies may be of interest in order to determine the threshold beyond which the use of additional TXA would be useful.