Tranexamic acid and primary coronary artery bypass surgery: a prospective study

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Hematology

Background:

• Coronary artery bypass grafting (CABG) often involves significant blood loss and requires allogeneic blood transfusions.
• Managing perioperative bleeding and optimizing hemostasis are critical challenges in cardiac surgery.

Purpose of the Study:

• To evaluate the efficacy of tranexamic acid in reducing postoperative drainage and blood transfusion requirements in patients undergoing on-pump primary CABG.
• To assess the safety and impact of tranexamic acid on graft patency, hemostasis, and other clinical outcomes.

Main Methods:

• A prospective, randomized, placebo-controlled, double-blind study involving 222 patients undergoing on-pump primary CABG.
• Patients received either tranexamic acid (bolus and infusion) or a saline placebo.
• Measurements included postoperative drainage, transfusion needs, graft patency, hemostasis markers, and safety parameters.

Main Results:

• Tranexamic acid significantly reduced postoperative drainage and improved blood conservation.
• Faster achievement of post-bypass hemostasis and reduced fibrinolysis were observed in the tranexamic acid group.
• No increased incidence of graft occlusion, stroke, or other adverse events was noted.

Conclusions:

• Tranexamic acid is effective in reducing blood loss and transfusion requirements during on-pump primary CABG.
• It improves hemostasis and fibrinolytic profiles without compromising graft patency or increasing safety risks.
• This antifibrinolytic agent offers a valuable option for blood management in cardiac surgery.