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Published on: November 24, 2014
Efficiency of preoperative tranexamic Acid in coronary bypass surgery: an analysis correlated with preoperative
Sahin Senay1, Fevzi Toraman, Hasan Karabulut
1Department of Cardiovascular Surgery, Acibadem University School of Medicine, Istanbul, Turkey. sahinsenay@gmail.com
Insights
Prophylactic tranexamic acid effectively reduces bleeding and transfusion needs in coronary bypass surgery patients. Its benefits are observed even in patients taking clopidogrel, suggesting its value in this population.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac surgical procedure.
- Perioperative bleeding remains a significant concern, increasing morbidity and mortality.
- The use of antiplatelet agents like clopidogrel can complicate hemostasis management.
Purpose of the Study:
- To evaluate the efficacy of prophylactic tranexamic acid in reducing blood loss and transfusion requirements during CABG.
- To assess whether the effectiveness of tranexamic acid is influenced by concurrent clopidogrel use.
Main Methods:
- A retrospective analysis of 3754 patients undergoing isolated CABG with cardiopulmonary bypass.
- Patients were categorized into four groups based on the perioperative administration of clopidogrel and tranexamic acid.
- Comparative analysis of postoperative drainage, fresh frozen plasma use, and blood transfusion rates across groups.
Main Results:
- Tranexamic acid significantly decreased postoperative drainage and fresh frozen plasma requirements, regardless of clopidogrel use.
- Significant reductions in blood transfusion rates and the percentage of patients transfused were observed with tranexamic acid, but primarily in patients not receiving clopidogrel.
- While tranexamic acid showed a trend towards benefit in clopidogrel users, this was less pronounced compared to non-users.
Conclusions:
- Prophylactic tranexamic acid is effective in mitigating bleeding and transfusion needs in CABG patients.
- The beneficial effects of tranexamic acid are present but less prominent in patients pretreated with clopidogrel.
- Preoperative administration of tranexamic acid may be advantageous for patients on clopidogrel, without necessitating surgical delays.
Objective:
This study evaluates the efficiency of prophylactic tranexamic acid in coronary bypass surgery with respect to preoperative clopidogrel use.
Methods:
We analyzed data for 3754 consecutive patients who underwent isolated coronary bypass surgery with cardiopulmonary bypass between January 1999 and August 2008. The patients were placed into 4 groups according to the perioperative use of clopidogrel and tranexamic acid. Group 1 included patients administered neither of these medications (n = 3160, 84.2%); group 2 included patients who received tranexamic acid only (n = 444, 11.8%); group 3 included patients who received clopidogrel only (n = 113, 3.0%); and group 4 included patients who received both medications (n = 37, 1.0%).
Results:
In patients who received tranexamic acid, we noted significant decreases in postoperative drainage (615 +/- 336 mL versus 458 +/- 289 mL, group 1 versus group 2 [P = .0001]; 740 +/- 399 mL versus 570 +/- 408 mL, group 3 versus group 4 [P = .03]) and the use of fresh frozen plasma (1.4 +/- 1.4 units/patient versus 0.2 +/- 0.7 units/patient, group 1 versus group 2 [P = .0001]; 2.2 +/- 1.7 units/patient versus 0.5 +/- 1.3 units/patient, group 3 versus group 4 [P = .0001]), irrespective of the use of clopidogrel. We found significant decreases in postoperative blood transfusion (0.59 +/- 1.1 units/patient versus 0.39 +/- 1.1 units/patient, group 1 versus group 2 [P = .0001]; 1.2 +/- 1.8 units/patient versus 0.7 +/- 1.1 units/patient, group 3 versus group 4 [P > .05]) and in the percentage of patients who received transfusions (31.3% versus 19.3%, group 1 versus group 2 [P = .0001]; 54.5% versus 37.8%, group 3 versus group 4 [P > .05]) only in the patients who did not receive clopidogrel.
Conclusion:
Prophylactic tranexamic acid reduces bleeding and the need for transfusion. This effect exists in patients using clopidogrel but is less prominent. Preoperative use may be beneficial in patients using clopidogrel without any need for delaying the surgical procedure.
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