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Tranexamic acid reduces blood transfusions in elderly patients undergoing combined aortic valve and coronary artery
Guri Greiff1, Roar Stenseth, Alexander Wahba
1Department of Cardiothoracic Anesthesia and Intensive Care, St Olav University Hospital, Trondheim, Norway. guri.greiff@gmail.com
Insights
Tranexamic acid significantly reduced red blood cell transfusions in elderly patients undergoing combined heart surgery. This antifibrinolytic agent is effective in managing blood loss during aortic valve replacement and coronary artery bypass graft procedures.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Elderly patients undergoing combined aortic valve replacement and coronary artery bypass graft (CABG) surgery are at high risk for significant postoperative blood loss and require substantial blood product transfusions.
- Managing perioperative bleeding is crucial in this patient population to minimize complications and improve outcomes.
Purpose of the Study:
- To evaluate the efficacy of tranexamic acid in reducing postoperative blood loss and transfusion requirements in elderly patients undergoing combined aortic valve replacement and CABG surgery.
Main Methods:
- A prospective, randomized, double-blinded, placebo-controlled trial was conducted at a single university hospital.
- Sixty-three patients aged 70 years or older undergoing combined aortic valve replacement and CABG were randomized to receive either tranexamic acid or a placebo.
- Tranexamic acid was administered as a pre-operative bolus followed by a continuous infusion during surgery.
Main Results:
- Patients receiving tranexamic acid required significantly fewer packed red blood cell (PRBC) transfusions compared to the placebo group (median 3.0 vs. 5.0 units, p=0.049).
- The study recorded postoperative blood loss for 16 hours and transfusion requirements throughout the hospital stay.
Conclusions:
- Tranexamic acid effectively reduces the number of packed red blood cell transfusions in elderly patients undergoing combined aortic valve replacement and CABG surgery.
- The findings support the use of tranexamic acid as an adjunct therapy to manage blood loss in this high-risk surgical population.
Objective:
To evaluate the effects of tranexamic acid on postoperative blood loss and transfusion requirements in elderly patients undergoing combined aortic valve replacement and coronary artery bypass graft surgery (CABG).
Design:
A prospective, randomized, double-blinded, placebo-controlled, parallel-group trial.
Setting:
A university hospital (single institution).
Participants:
Sixty-four patients 70 years or older undergoing combined aortic valve replacement and CABG surgery were included. One patient was withdrawn from the study after randomization by the attending surgeon because of a change in the surgical procedure. The remaining 63 patients were analyzed as intention to treat.
Interventions:
The included patients were randomized to treatment with either tranexamic acid, 10 mg/kg, as a bolus injection before surgery followed by 1 mg/kg/h as an infusion during surgery, or a corresponding volume of 0.9% sodium chloride.
Measurements And Main Results:
Postoperative blood loss was recorded for 16 hours. The transfusion of blood products was recorded during the entire hospital stay. The number of packed red cell transfusions given to the patients was significantly lower in the tranexamic acid group compared with the placebo group (median, 3.0 [interquartile range, 2-5] v 5.0 [3-7], p = 0.049).
Conclusion:
Tranexamic acid reduced the number of packed red cell transfusions given to patients 70 years or older undergoing combined aortic valve replacement and CABG surgery.
