Trial Information

Tranexamic Acid Versus Placebo to Reduce Perioperative Bleeding in Patients Undergoing Major Liver Resection: A Pilot, Randomized Controlled Trial

Liver resection remains the optimal treatment for patients with primary or metastatic liver
malignancies, benign liver tumors, and some biliary diseases. Despite improvements such as
advances in preoperative imaging and evaluation of liver functional reserve, extensive
intraoperative blood loss remains a major risk factor for postoperative morbidity and
mortality, as well as long-term survival after liver resection.

Several strategies to reduce blood loss during liver resection have been developed and
tested including operative and non-operative interventions. Operatively, surgeons may use
sophisticated methods of liver dissection and parenchymal transection including ultrasonic
dissectors, hydrodissectors, bipolar cautery, stapling devices, and more. Surgeons may also
selectively reduce the blood flow to the liver during liver resection by continuously or
intermittently clamping the portal vein and hepatic artery (the Pringle Maneuver). The
anaesthesiologist has a crucial role in reducing blood loss and transfusion requirements by
maintaining a low central venous pressure (CVP) during parenchymal transection. These
advances have resulted in substantially less blood loss during liver surgery compared with
prior decades, however bleeding remains a problem during major liver resection with up to
30-40% of patients in recent series receiving blood products.