Effect of tranexamic acid on postoperative bleeding and allogeneic transfusion in on-pump cardiac surgery (original) (raw)
Related papers
Anesthesiology, 2014
Background: The optimal dose of tranexamic acid (TA) is still an issue. The authors compared two doses of TA during cardiac surgery in a multicenter, double-blinded, randomized study. Methods: Patients were stratified according to transfusion risk, then randomized to two TA doses: 10 mg/kg bolus followed by 1 mg·kg−1·h−1 infusion (low dose) until the end of surgery or 30 mg/kg bolus followed by 16 mg·kg−1·h−1 infusion (high dose). The primary endpoint was the incidence of blood product transfusion up to day 7. Secondary ones were incidences of transfusion for each type of blood product and amounts transfused, blood loss, repeat surgery, TA-related adverse events, and mortality. Results: The low-dose group comprised 284 patients and the high-dose one 285. The primary endpoint was not significantly different between TA doses (63% for low dose vs. 60% for high dose; P = 0.3). With the high dose, a lower incidence of frozen plasma (18 vs. 26%; P = 0.03) and platelet concentrate (15 vs. ...
A Randomized Comparison of Two Doses of Tranexamic Acid in High-Risk Open-Heart Surgery
Nepalese Heart Journal
Background and aims: Tranexamic acid is commonly used in cardiac surgery to minimize perioperative bleeding. There are wide variations in dose of this drug. This study aims to find out the minimal effective dose of tranexamic acid. Methods: Patients were randomized into low dose group receiving 10 mg/kg and high dose group receiving 30 mg/kg bolus of tranexamic acid each followed by an infusion of 1mg/kg/hr until the end of surgery. Primary objective was to compare blood loss during the first postoperative day. Secondary objectives were to compare total blood products transfused during 24 hours post-operative period, to compare the incidence of re-explorations and to compare the adverse drug reactions between the groups. Results: There were sixty patients in each group. There was a signifcant difference in blood loss (435.17± 299.91 ml vs 528.64 ±254.04 ml) between the low dose group and dose group (p=0.010). Transfusion of packed red blood cell, re-exploration and adverse drug reac...
Asian Journal of Medical Sciences, 2020
Tranexamic acid is widely used as an antifibrinolytic drug to reduce blood loss intraoperative and postoperative time periods as well as to reduce transfusion of allogeneic blood. After releasing in the market, multidisciplinary surgeries have wide use of tranexamic acid due to its antifibrinolytic effect to reduce bleeding and transfusion of blood. In literature, there were mentioned a few adverse effects like thromboembolism, seizure, anaphylactic reaction, etc which are still unsolved questions to date. The aim of this review to minimize the blood loss from acute bleeding in different situations by updating the doses used in a different clinical scenario,since the release of tranexamic acid. It also gives an idea about appropriate doses to reduce blood loss, need for blood transfusion, minimize adverse effects and to understand the wide scope of application of TXA to date.
Caspian Journal of Internal Medicine, 2019
Background: Clopidogrel in combination with aspirin increases bleeding, allogeneic red cell transfusion and reoperation rates after CABG. Tranexamic acid, an antifibrinolytic agent, has been approved for use in cardiac surgery to reduce bleeding. In the present study, we evaluated the impact of tranexamic acid on the transfusion and post-operative blood loss after CABG in patients treated with clopidogrel less than 5 days before surgery. Methods: This study was a prospective, randomized, double-blinded clinical trial. Patients undergoing on-pump CABG with their last dose of clopidogrel and aspirin less than 5 days preoperatively were randomly assigned to receive tranexamic acid (10 mg/kg before surgical incision and 10 mg/kg after protamine neutralization) or a corresponding volume of saline solution. The incidence of allogeneic red cell transfusion and 48h postoperative blood loss were recorded. Results: The average volume of blood loss was 776.92±459.81mL for the TXA group and 1075.00±670.91mL for the control group (P=0.03) in the patients with clopidogrel exposure within 48 h before surgery. The average volume of blood loss was not different between two groups in the patients with clopidogrel exposure within 5 days before surgery and also transfusion rate. Conclusion: The result of this study shows that tranexamic acid reduced blood loss in the patients with clopidogrel exposure within 48 h before surgery. So, it is better that we use tranexamic acid before surgery in all patients.
Interactive cardiovascular and thoracic surgery, 2004
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether prophylactic tranexamic acid can safely reduce bleeding without increasing thrombotic complications in patients undergoing cardiac surgery. Altogether 334 papers were found using the reported search, of which 12 represented the best evidence on this topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We conclude that tranexamic acid clearly reduces blood loss, requirement for blood transfusion, and the risk of reoperation for bleeding, and although no study has yet looked directly at vein graft patency with tranexamic acid, no randomized studies have raised concerns over its safety.
Does tranexamic acid decrease bleeding in patients undergoing cardiopulmonary bypass?
PubMed, 1994
We reviewed the records of 66 patients who underwent cardiopulmonary bypass; half of these patients received the plasmin inhibitor, tranexamic acid. The demographics were not different between the group who received tranexamic acid and the group who did not (control group). There was no difference in the heparin or protamine requirements between the two groups. There was a significantly greater amount of 12-hr chest tube bleeding in the control group (495 +/- 484 vs. 863 +/- 655 in the control and tranexamic acid groups, respectively; p < .02). There was no difference between the groups in either the post-operative hematocrit, platelet count or the number of patients requiring transfusion. Although tranexamic acid decreased the amount of chest tube output, there was no demonstrable patient benefit derived from its use.
Journal of Cardiothoracic Surgery, 2009
Background Diffuse microvascular bleeding remains a common problem after cardiac procedures. Systemic use of antifibrinolytic reduces the postoperative blood loss. The purpose of this study was to examine the effectiveness of local application of tranexamic acid to reduce blood loss after coronary artery bypass grafting (CABG). Methods Thirty eight patients scheduled for primary isolated coronary artery bypass grafting were included in this double blind, prospective, randomized, placebo controlled study. Tranexamic acid (TA) group (19 patients) received 1 gram of TA diluted in 100 ml normal saline. Placebo group (19 patients) received 100 ml of normal saline only. The solution was purred in the pericardial and mediastinal cavities. Results Both groups were comparable in their baseline demographic and surgical characteristics. During the first 24 hours post-operatively, cumulative blood loss was significantly less in TA group (median of 626 ml) compared to Placebo group (median of 1040 ml) (P = 0.04). There was no significant difference in the post-op Packed RBCs transfusion between both groups (median of one unit in each) (P = 0.82). Significant less platelets transfusion required in TA group (median zero unit) than in placebo group (median 2 units) (P = 0.03). Apart from re-exploration for excessive surgical bleeding in one patient in TA group, no difference was found in morbidity or mortality between both groups. Conclusion Topical application of tranexamic acid in patients undergoing primary coronary artery bypass grafting led to a significant reduction in postoperative blood loss without adding extra risk to the patient.