Bleeding Reduction in Acute and Chronic Kidney Patients Having Surgery (BRACKETS) Pilot Trial

Prior treatment

• Women who are known to be pregnant, breastfeeding, or who meet both of the following criteria: i) are of childbearing potential and do not have a negative pregnancy test documented in the 7 days before surgery, AND ii) are not using effective contraception; or
• Previously enrolled in the BRACKETS-Pilot Trial.
  • Eligibility criteria specific to the desmopressin factorial component of trial

Other illness

• Undergoing cardiac surgery;
• Undergoing surgery for creation or revision of arteriovenous fistula or graft for dialysis access;
• Hypersensitivity or known allergy to TXA;
• History of seizure disorder;
• Recent (within 90 days) stroke, myocardial infarction, acute arterial thrombosis, deep venous thrombosis, pulmonary embolism, or thrombosis of an arteriovenous fistula or graft;
• History of thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome, or antiphospholipid antibody syndrome;
• Hypersensitivity or known allergy to desmopressin.

Lab values

• Most recent serum sodium concentration \< 130 mEq/L;
• Known or suspected von Willebrand disease (any kind), hemophilia, or platelet function disorder; or

Other

• Undergoing intracranial neurosurgery;
• Planned use of prophylactic systemic TXA or ϵ-aminocaproic acid;
• The hospital does not have access to desmopressin;
• Planned use of prophylactic desmopressin;

• 1\. Included in the TXA factorial.

Criteria the registry did not label

• Eligibility criteria specific to the tranexamic acid (TXA) factorial component of trial Inclusion Criteria:
• One of either:
  • 1.1. eGFR \<25 ml/min/1.73m2 estimated using the CKD-Epi 2009 or 2021creatinine-based equation from the most recent serum creatinine measurement done in the previous 6 months; or 1.2. Receipt of dialysis (including hemodialysis, peritoneal dialysis, hemofiltration, or hemodiafiltration) within the last 7 days;
• Planned noncardiac surgery (elective, urgent, or emergency surgery);
• Expected to require at least an overnight hospital admission after surgery;
• Age ≥18 years; and
• Informed consent is obtained to participate in the BRACKETS-Pilot Trial.