Tranexamic acid in cardiac surgery: Are low doses enough?

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Pharmacology

Background:

• Tranexamic acid (TXA) is a key antifibrinolytic agent used to manage bleeding in on-pump cardiac surgery.
• Optimizing TXA dosage is crucial for balancing efficacy and potential side effects.

Purpose of the Study:

• To compare the efficacy of low-dose (LD) versus high-dose (HD) tranexamic acid in preventing hyperfibrinolysis and postoperative bleeding.
• To evaluate the impact of different TXA doses on blood product administration and patient outcomes.

Main Methods:

• A prospective cohort study involving 427 patients undergoing on-pump cardiac surgery.
• Patients were assigned to LD, intermediate dose (ID), or HD TXA groups across two hospitals.
• Outcomes assessed included hyperfibrinolysis, blood product use, chest tube output, and convulsions, with propensity score matching for analysis.

Main Results:

• No statistically significant differences were observed in hyperfibrinolysis, blood product administration, chest tube output, or convulsion incidence between LD and HD/ID TXA groups.
• The LD group received less fibrinogen but more fresh frozen plasma compared to the HD and ID groups, respectively.

Conclusions:

• Low-dose tranexamic acid demonstrates comparable efficacy to higher doses in preventing hyperfibrinolysis and reducing postoperative bleeding in cardiac surgery.
• These findings support the use of lower TXA doses, potentially optimizing treatment while maintaining effectiveness.