Effect of tranexamic acid on intraoperative blood loss in patients undergoing debridement for necrotizing soft tissue infections: A randomized controlled trial.

New strategies focused on reducing blood loss are emerging and encouraging. Of these, bipolar diathermy, harmonic scalpel, local vasoconstrictors, induced hypotension, tourniquet application, and antifibrinolytic agents are the most widely used techniques. Tranexamic acid is a synthetic antifibrinolytic agent 7 -10 times more potent than Epsilon-aminocaproic acid. It competitively blocks the lysine-binding site of plasminogen, plasmin, and tissue plasminogen activator, preventing their association with fibrin. Plasminogen conversion to plasmin is thus retarded, and the proteolytic action of plasmin on fibrin monomers and fibrinogen is debarred

We expect tranexamic acid to reduce intraoperative blood loss, the requirement for blood transfusion, and the hospital stay in patients undergoing debridement for necrotizing soft tissue infections.

After registering the trial in CTRI, patients satisfying the inclusion and exclusion criteria will be recruited into the trial. In the intervention group, patients with necrotizing soft tissue infection will receive 1 g of tranexamic acid and patients in the control group will receive 10 ml of normal saline intravenously over 20 mins before beginning the surgery. Debridement will be performed as per the standard of care and intraoperative parameters like blood loss, requirement of blood transfusions, intravenous fluids will be compared between the two groups. Postoperative care will be the same for both the groups and complications like Deep vein thrombosis, Myocardial infarction, Transient ischemic attack. Pulmonary thromboembolism will be compared.