Prophylactic Intravenous Tranexamic Acid in Thoracic Surgery: A Matched-pair Analysis From the German Thoracic Registry.

Objectives: To evaluate the effect of prophylactic intravenous tranexamic acid (TXA) on bleeding complications, thromboembolic events, and hospital stay in patients undergoing thoracic surgery.

Design: Retrospective matched-pair analysis of registry data.

Setting: German Thorax Registry data from multiple thoracic surgery centers across Germany.

Participants: A total of 1,034 adult patients undergoing thoracic surgical procedures, matched 1:1 (517 received intravenous TXA, 517 did not).

Interventions: Administration of prophylactic intravenous TXA prior to thoracic surgery.

Measurements and main results: Postoperative bleeding complications, including reoperations for bleeding and transfusion requirements, did not differ significantly between groups. However, thromboembolic complications were significantly less frequent in the TXA group (1.0% v 5.1%). Cardiac complications were also less frequent in the TXA group. No significant differences were observed in overall complication rates or length of hospital stay.

Conclusions: Prophylactic intravenous TXA did not reduce bleeding complications in thoracic surgery but was associated with a lower incidence of thromboembolic and cardiac events. While no definitive conclusions can be made about the efficacy of TXA in reducing bleeding complications, the study offers insights into its potential role in reducing thromboembolic and cardiac complications. A well-powered, randomized controlled trial is needed to confirm these results.