ROCHESTER, Minn. — A multi-center study, co-led by researchers at Mayo Clinic and Michigan State University, found that patients who received tranexamic acid during liver surgery were three times less likely to develop post-hepatectomy liver failure than patients who received a placebo. The findings were published in Blood .
Post-hepatectomy liver failure is one of the most serious complications following liver surgery and remains a leading cause of death after liver resection. Currently, there are no approved medications specifically designed to prevent this complication.
The findings provide both mechanistic and clinical evidence that targeting the body's fibrinolytic system — which helps break down blood clots — may support liver regeneration and reduce the risk of liver failure after surgery. Tranexamic acid is a medication that prevents the breakdown of blood clots. It is widely used to manage or prevent excessive bleeding in trauma, heavy menstrual periods, childbirth, and dental or surgical procedures.
"The possibility that a widely available, low-cost medication could substantially reduce this risk is exciting because it has the potential to improve outcomes for patients undergoing surgery for liver cancer and other serious liver diseases," says Patrick Starlinger, M.D., Ph.D. , a hepatobiliary and pancreas surgeon at Mayo Clinic in Rochester and co-senior author of the study.
When part of the liver is removed to treat cancer or other conditions, the remaining tissue must regenerate to restore normal organ function. In some patients, that regeneration does not happen after surgery, leading to liver failure.
Researchers first found in pre-clinical models that temporarily reducing plasminogen, a protein involved in the fibrinolytic system, enhanced liver regeneration after resection. They then analyzed data from the HeLiX trial, a large international clinical study in which patients undergoing liver resection received either tranexamic acid or a placebo. The protective effect of tranexamic acid was strongest among patients with impaired liver function before surgery, a group at particularly high risk for post-hepatectomy liver failure.
The findings also challenge a longstanding assumption about liver regeneration.
"For decades, the field believed plasminogen was necessary for liver regeneration based on pre-clinical models," says Dr. Starlinger. "By using a more precise and reversible approach, we found the opposite effect. Our findings open a new avenue for understanding how the body's clotting and fibrinolytic systems influence liver recovery after surgery."
Researchers say the findings support further studies to determine whether tranexamic acid could become part of a strategy to prevent post-hepatectomy liver failure in patients at highest risk.
"While these findings need to be confirmed in a dedicated clinical trial, they provide a strong rationale for evaluating whether tranexamic acid can help protect patients from one of the most feared complications in liver surgery," says Dr. Starlinger.
For a complete list of authors, disclosures and funding, review the study .
