Liver resections, while crucial for treating hepatic malignancies and other liver diseases, are frequently complicated by substantial blood loss. The HeLiX (Hepatic Resection and Lysis Inhibition with Tranexamic Acid) randomized clinical trial is currently evaluating the efficacy of tranexamic acid in mitigating this risk. Paul J. Karanicolas, MD, PhD, FRCSC, Sherif and Mary-Lou Hanna Chair, Surgical Oncology Research at the Edmond Odette Cancer Centre, Sunnybrook Health Sciences Centre, and Professor of Surgery at the University of Toronto, presented the trial's design and objectives.
The HeLiX trial is designed to assess whether the administration of tranexamic acid can reduce the need for blood transfusions in patients undergoing liver resection. Tranexamic acid, an antifibrinolytic agent, works by inhibiting the breakdown of blood clots, thereby reducing bleeding. The study is a randomized, double-blind, placebo-controlled trial, the gold standard for evaluating medical interventions. Patients undergoing elective liver resection are randomized to receive either tranexamic acid or a placebo. The primary outcome of the trial is the proportion of patients requiring a blood transfusion during or after surgery. Secondary outcomes include the total volume of blood transfused, the length of hospital stay, and the incidence of complications such as thromboembolic events.
Dr. Karanicolas highlighted the importance of minimizing blood transfusions in surgical patients, as transfusions are associated with increased morbidity, longer hospital stays, and higher healthcare costs. The current standard of care for managing blood loss during liver resection includes meticulous surgical technique, the use of cell salvage techniques, and, when necessary, blood transfusions. However, these strategies are not always sufficient to prevent significant blood loss and its associated complications. The HeLiX trial seeks to provide evidence-based guidance on the use of tranexamic acid as an adjunct to these standard measures.
The results of the HeLiX trial are anticipated to have a significant impact on clinical practice. If tranexamic acid is shown to be effective in reducing blood transfusions, it could become a routine part of the perioperative management of patients undergoing liver resection. This would not only improve patient outcomes but also reduce the burden on blood banks and lower healthcare costs. The trial's findings will be closely scrutinized by surgeons, anesthesiologists, and other healthcare professionals involved in the care of patients undergoing liver surgery.
