{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T20:00:20Z","timestamp":1793736020526,"version":"4.6.1"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"Importance<\/jats:title>Tranexamic acid reduces bleeding and blood transfusion in many types of surgery, but its effect in patients undergoing liver resection for a cancer-related indication remains unclear.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine whether tranexamic acid reduces red blood cell transfusion within 7 days of liver resection.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Multicenter randomized clinical trial of tranexamic acid vs placebo conducted from December 1, 2014, to November 8, 2022, at 10 hepatopancreaticobiliary sites in Canada and 1 site in the United States, with 90-day follow-up. Participants, clinicians, and data collectors were blinded to allocation. A volunteer sample of 1384 patients undergoing liver resection for a cancer-related indication met eligibility criteria and consented to randomization.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Tranexamic acid (1-g bolus followed by 1-g infusion over 8 hours; n\u2009=\u2009619) or matching placebo (n\u2009=\u2009626) beginning at induction of anesthesia.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was receipt of red blood cell transfusion within 7 days of surgery.<\/jats:p><\/jats:sec>Results<\/jats:title>The primary analysis included 1245 participants (mean age, 63.2 years; 39.8% female; 56.1% with a diagnosis of colorectal liver metastases). Perioperative characteristics were similar between groups. Red blood cell transfusion occurred in 16.3% of participants (n\u2009=\u2009101) in the tranexamic acid group and 14.5% (n\u2009=\u200991) in the placebo group (odds ratio, 1.15 [95% CI, 0.84-1.56]; P<\/jats:italic>\u2009=\u2009.38; absolute difference, 2% [95% CI, \u22122% to 6%]). Measured intraoperative blood loss (tranexamic acid, 817.3 mL; placebo, 836.7 mL; P<\/jats:italic>\u2009=\u2009.75) and total estimated blood loss over 7 days (tranexamic acid, 1504.0 mL; placebo, 1551.2 mL; P<\/jats:italic>\u2009=\u2009.38) were similar between groups. Participants receiving tranexamic acid experienced significantly more complications compared with placebo (odds ratio, 1.28 [95% CI, 1.02-1.60]; P<\/jats:italic>\u2009=\u2009.03), with no significant difference in venous thromboembolism (odds ratio, 1.68 [95% CI, 0.95-3.07]; P<\/jats:italic>\u2009=\u2009.08).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Among patients undergoing liver resection for a cancer-related indication, tranexamic acid did not reduce bleeding or blood transfusion but increased perioperative complications.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT02261415<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2024.11783","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T15:00:59Z","timestamp":1724079659000},"page":"1080","source":"Crossref","is-referenced-by-count":46,"title":["Tranexamic Acid in Patients Undergoing Liver 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