Background: Major operations on soft tissue and bone sarcomas are associated with significant blood loss and the requirement for transfusions. There is a sharp increase in mortality rate in patients who receive allogenic blood transfusions and subsequently acquire transfusion-acquired infections. Reducing blood loss and the need for transfusions could potentially reduce that mortality rate. Low doses of tranexamic acid [TXA] may be able to reduce blood loss and transfusion requirements during these operations.

Objective: To study the effect of TXA on perioperative blood loss and blood transfusion requirements in patients undergoing extremity primary bone tumor surgery.

Materials and Methods: Twenty-two extremity primary bone tumor surgery patients were randomized into two groups. The control group received a placebo, and the study group received 2 grams of TXA intravenously followed by intravenous infusion of 1 gram in a drip every 8 hours postoperatively.
The volume of intraoperative blood loss, amount of blood transfused, volume of drained blood, hemoglobin levels, and any thromboembolic complications were recorded and assessed.

Results: The mean intraoperative blood loss in the TXA group and the control group were 300 ml and 600 ml, respectively (p = 0.356). Volume of drained blood was not reduced in the TXA group compared with control group, but the difference was not statistically significant: 180 mL (0 to 580) vs. 100 mL (0 to 580), respectively. The amount of blood transfused was lower in patients receiving TXA than in the control group: 1 unit (0 to 15) unit vs. 0 units (0 to 5), respectively, but the different was not significant (p = 0.699). Decrease of hemoglobin levels was non-significantly lower in TXA group than in the control group: 1.79 g/dL (SD +1.39) vs. 2.51 g/dL (SD +1.36) (p =
0.235). No thromboembolic complications were detected in either group.

Conclusion: Tranexamic acid has the clinical effect of decreasing blood loss and transfusion requirements in patients undergoing extremity primary malignant musculoskeletal tumor surgery, but the reduction is not statistically significant.

Keywords: Tranexamic acid, Perioperative blood loss, Primary malignant musculoskeletal tumor