Can delirium after major surgery be reduced by tranexamic acid?

ANZCA funded study will look at whether tranexamic acid can reduce confusion and delirium after major surgery.

Congratulations to Professor Paul Myles on his grant from the Australia and New Zealand College of Anaesthetists (ANZCA) of $120,000 over two years for the project "Tranexamic acid to reduce delirium after gastrointestinal surgery: the TRIGS-D trial".

Delirium is a devastating complication of medical and surgical care, associated with increased morbidity and mortality, dementia and impaired long-term cognition, and loss of independence.

Prof Myles said, "A readily available medication called tranexamic acid (TxA) can reduce bleeding complications after all types of surgery, but it may also have other benefits. Our proposed studies will be focusing on whether TxA can reduce the cognitive changes and confusion (delirium) seen in some people after major surgery."

Prof Myles is collaborating with Professor Rob Medcalf at the Australian Centre for Blood Diseases (ABCD) and collaborators Professor Rob Sanders at the University of Sydney and Associate Professor Lisbeth Evered at Cornell University in New York.

Prof Myles said, “We have recently shown that blood loss and inflammation are two key underlying mechanisms associated with confusion after surgery. This seems to be associated with a breakdown in the protective barrier within the brain that otherwise insulates it from the rest of the body. Animal studies have shown that TxA provides some protection of the brain’s protective barrier, so we want to investigate whether this occurs in people having surgery."

The team will study TxA administration compared to placebo in a study of 821 patients undergoing abdominal surgery. They will perform some baseline cognitive testing and follow these patients for 3 days postoperatively to monitor the onset and severity of confusion.

"We also want to study how TxA can reduce inflammation and enhance immune function after surgery. In a subset of these patients, we will obtain preoperative, postoperative day 1 and postoperative day 3 blood samples and test for levels of inflammation," said Prof Myles.

The trial will provide important information about the use of TxA to prevent postoperative delirium, as well as providing novel information about the mechanisms of postoperative delirium.