Does topical tranexamic acid reduce postcoronary artery bypass graft bleeding?

Area of Science:

• Cardiac Surgery
• Anesthesiology
• Pharmacology

Background:

• Postoperative bleeding is a significant complication following cardiac surgery.
• Coronary artery bypass graft (CABG) surgery, particularly on-pump procedures, carries a risk of excessive blood loss.
• Topical tranexamic acid (TA) is explored as a potential agent to mitigate bleeding.

Purpose of the Study:

• To evaluate the efficacy of topical tranexamic acid (TA) in reducing postoperative bleeding.
• To assess the impact of TA on chest tube drainage and transfusion requirements in CABG patients.

Main Methods:

• A randomized clinical trial involving 126 isolated primary CABG patients.
• Patients were divided into two groups: one receiving topical TA (1g in 100ml saline) and a control group receiving saline.
• Chest tube drainage, hemoglobin levels, and packed red blood cell (RBC) transfusion needs were compared between groups.

Main Results:

• No statistically significant difference in mean chest tube drainage within the first 24 hours or overall between the TA and control groups.
• No significant differences observed in mean hemoglobin decrease or the need for packed RBC transfusions.
• Topical application of 1g TA did not demonstrate a reduction in postoperative bleeding in on-pump CABG surgery.

Conclusions:

• Topical administration of 1g tranexamic acid in 100ml normal saline is not recommended for reducing blood loss in on-pump CABG patients.
• Further research may be needed to explore alternative dosages or administration methods of TA in cardiac surgery.