The Use of Tranexamic Acid in Gynecologic and Oncology Surgery

Abstract

Background: Gynecologic surgery encompasses many surgical approaches, some of which are associated with considerable perioperative blood loss, blood transfusion administration, and increased morbidity and mortality. Similarly, women undergoing surgery for gynecologic cancer need to have as many tumors removed as possible, which can become major abdominal surgery with massive blood loss and blood transfusions required. It is widely known perioperative blood transfusions are associated with increased adverse events, potentially causing life-threatening complications. The purpose of this Doctor of Nursing Practice scholarly project was to develop a clinical practice guideline governing the use of tranexamic acid in the gynecologic and oncology surgery population to decrease the amount of perioperative blood loss and incidence of blood transfusions, further decreasing morbidity and mortality. Local Problem: Leadership at the highest level of the institution requested that a tranexamic acid protocol be developed for several surgical populations where it could prove beneficial. There was a difference among providers on the correct dosing of tranexamic acid, when to administer the medication, and the precautions and contraindications concerning its use. Interventions: A literature review was performed including systematic reviews, randomized control trials, and existing clinical practice guidelines. This literature was summarized to develop the clinical practice guideline. Institutional stakeholders utilized the Appraisal of Guidelines for Research and Evaluation Tool to assess the rigor of the guideline and provided feedback on guideline development. The guideline was then presented to anesthesia department staff during a weekly meeting, after which staff completed the Provider Feedback Questionnaire to evaluate the potential use of the guideline at the institution. Results: Results from each tool were collected and descriptive statistics were calculated. The overall domain rating score based on Appraisal of Guidelines for Research and Evaluation Tool results was 79%, while both stakeholders approved the guideline with modifications. For the Provider Feedback Questionnaire, 95% of anesthesia department staff agreed they would both “apply the recommendations to my patients” as well as “use it in my own practice” if the guideline was approved. Conclusions: Tranexamic acid is a safe and effective drug for gynecologic and oncology surgery that can decrease the amount of perioperative blood loss and incidence of blood transfusions. The dosing, timing of administration, and contraindications can potentially be implemented at other institutions and for other surgical populations to provide safer care to patients.