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Single-dose tranexamic acid reduces postoperative bleeding after coronary surgery in patients treated with aspirin
Hilde Pleym1, Roar Stenseth, Alexander Wahba
1Departments of *Anesthesiology and †Cardiothoracic Surgery, St. Olav University Hospital, Trondheim, Norway; and ‡Department of Anaesthesia and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Insights
Tranexamic acid significantly reduced postoperative bleeding in patients undergoing coronary artery bypass grafting. This antifibrinolytic agent is effective even when patients continue aspirin medication before surgery.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Continuation of aspirin therapy until coronary artery bypass grafting (CABG) may increase postoperative bleeding.
- Tranexamic acid is an antifibrinolytic agent used to reduce bleeding.
Purpose of the Study:
- To evaluate the efficacy of a single dose of tranexamic acid in reducing postoperative bleeding after CABG in patients taking aspirin.
- To assess the impact of tranexamic acid on fibrinolysis in this patient population.
Main Methods:
- Prospective, randomized, double-blind, placebo-controlled, parallel-group trial.
- Eighty patients undergoing CABG were randomized to receive either tranexamic acid (30 mg/kg) or placebo before cardiopulmonary bypass (CPB).
- Postoperative blood loss and transfusion requirements were recorded.
Main Results:
- Patients receiving tranexamic acid experienced significantly less postoperative bleeding (475 mL) compared to the placebo group (713 mL) (P < 0.001).
- Tranexamic acid effectively inhibited fibrinolysis.
- No significant differences in transfusion rates were detailed, but bleeding was reduced.
Conclusions:
- A single dose of tranexamic acid administered before CPB effectively reduces postoperative bleeding in CABG patients on aspirin.
- Tranexamic acid is a safe and effective option for managing bleeding in this surgical context.
Unlabelled:
Tranexamic acid reduces postoperative bleeding after coronary artery bypass grafting. We evaluated the effects of a single dose of tranexamic acid given immediately before cardiopulmonary bypass (CPB) in patients treated with aspirin until the day before surgery. The study was a prospective, randomized, double-blinded, placebo-controlled, parallel-group trial. Eighty patients were included and divided into two groups: one group received tranexamic acid 30 mg/kg, and one group received placebo (0.9% NaCl) as a bolus injection before CPB. Postoperative blood loss was recorded for 16 h. Transfusions of blood products were recorded for the whole hospital stay. Transfusions of packed red cells were given when the hematocrit value was less than 20% during CPB and less than 25% after surgery. The patients in the tranexamic acid group had significantly less postoperative bleeding compared with the patients in the placebo group (mean [SD]) (475 [274] mL versus 713 [243] mL; P < 0.001). An effective inhibition of fibrinolysis was found in patients receiving tranexamic acid. Tranexamic acid reduces postoperative bleeding in coronary artery bypass grafting patients treated with aspirin until the day before surgery.
Implications:
Continuation of aspirin medication until the day before coronary artery bypass grafting may increase postoperative bleeding. The administration of a single dose of tranexamic acid (30 mg/kg) immediately before cardiopulmonary bypass significantly reduced postoperative bleeding and inhibited fibrinolysis in these patients.