Tranexamic acid administration after cardiac surgery: a prospective, randomized, double-blind, placebo-controlled...

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Tranexamic acid is an antifibrinolytic used in cardiac surgery.
• Optimal dosing and administration timing remain debated.
• This study compares intraoperative-only versus extended postoperative tranexamic acid use.

Purpose of the Study:

• To evaluate the efficacy of continuing tranexamic acid infusion into the postoperative period after cardiac surgery.
• To compare bleeding, transfusion requirements, and complications between intraoperative-only and extended tranexamic acid treatment regimens.

Main Methods:

• 510 patients undergoing elective cardiac surgery were randomized.
• Intraoperative tranexamic acid was administered to all patients.
• Postoperative groups received either saline, 1 mg/kg/h tranexamic acid, or 2 mg/kg/h tranexamic acid for 12 hours.

Main Results:

• No significant differences in postoperative bleeding or overall outcomes were observed between groups.
• The 1 mg/kg/h tranexamic acid group required more packed red blood cells due to lower baseline hematocrit.
• Multivariate analysis indicated no advantage of extended treatment on primary outcomes.

Conclusions:

• Extending tranexamic acid treatment into the postoperative period after cardiac surgery does not improve bleeding or transfusion rates compared to intraoperative administration alone.
• While postoperative complication rates were similar, extended antifibrinolytic therapy may carry an increased risk of procoagulant effects.
• Postoperative tranexamic acid should be reserved for cases of excessive bleeding due to primary fibrinolysis.