Tranexamic acid leads to paradoxical coagulation changes during cardiac surgery: a pilot rotational...

Area of Science:

• Anesthesiology
• Cardiovascular Surgery
• Hematology

Background:

• Tranexamic acid (TXA) is widely used in major surgery to minimize bleeding and transfusion needs.
• Its impact on coagulation dynamics during cardiac surgery requires further investigation.

Purpose of the Study:

• To evaluate the effects of TXA on coagulation parameters at various stages of cardiac surgery.
• To assess TXA's influence on clot formation, strength, and lysis using rotational thromboelastometry.

Main Methods:

• A nonrandomized observational study involving 19 adult males undergoing first-time cardiopulmonary bypass (CPB) surgery.
• Rotational thromboelastometry analysis was performed at baseline, after sternotomy, after CPB, and after protamine administration.

Main Results:

• TXA administration led to prolonged clotting times and reduced clot fibrinogen (FIBTEM) after sternotomy.
• Following CPB and surgery, TXA patients exhibited decreased clot strength (EXTEM) and persistent reductions in clot fibrinogen.
• TXA was associated with acute thrombocytopenia post-protamine administration, with platelet counts remaining low for two days.

Conclusions:

• TXA administration in medium-risk cardiac surgery patients resulted in prolonged clotting and reduced clot strength without significantly decreasing clot lysis.
• The findings question the routine necessity of TXA in this patient cohort, particularly concerning its impact on coagulation.
• Further research is warranted to clarify the precise role and optimal use of TXA in cardiac surgery.