Tranexamic Acid to Reduce Infection After Gastrointestinal Surgery

Study Aims: To conduct a large, multicentre clinical trial of tranexamic acid (TxA), an antifibrinolytic drug routinely used to reduce bleeding in cardiac and some orthopaedic surgery, in 3,300 patients undergoing major gastrointestinal (GI) surgery. Our specific aims are to investigate whether TxA:

Aim 1: Reduces surgical site infection ("wound infection"), and other healthcare-associated infections (pneumonia and sepsis).

Aim 2: Reduces red cell transfusion in GI surgery. Aim 3: Reduces a pooled composite of any serious postoperative complications, and so increases "days alive and at home up to 30 days after surgery" (DAH30).

Aim 4: To evaluate the temporal effect of TxA on perioperative immune and inflammatory responses.

Study Hypothesis Prophylactic TxA administration in patients undergoing major GI surgery reduces the incidence of surgical site infection (SSI) after surgery when compared with placebo.

Inclusion criteria

• Adult patients scheduled for elective or semi-elective (inpatient) open or lap-assisted GI surgery (oesophageal, gastric, hepatobiliary, colorectal) with one or more risk factors for complications:

• Age ≥70 years
• ASA physical status 3 or 4
• Known or suspected history of: heart failure, diabetes, peripheral vascular disease, or chronic respiratory disease
• Obesity (BMI ≥30 kg/m2)
• Anaemia (preoperative haemoglobin <130 g/l in males and <120 g/l in females)
• Renal impairment (se. creatinine ≥150mol/l)
• Low albumin (<30 g/L)

Exclusion criteria

• Poor spoken and or written language comprehension
• Laparoscopic cholecystectomy and other minor (eg. closure of stoma) surgery
• Pre-existing infection/sepsis
• Known history of: spontaneous pulmonary embolism, arterial thrombosis familial thrombophilia (e.g. Lupus anticoagulant, protein C deficiency, factor V Leiden)