Tranexamic acid in cardiac surgery: Are low doses enough?

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Pharmacology

Background:

• Tranexamic acid is crucial for managing hyperfibrinolysis and reducing blood loss in cardiac surgery.
• Determining optimal dosing strategies is essential for patient safety and treatment efficacy.

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 tranexamic acid doses on blood product administration and adverse events.

Main Methods:

• A prospective cohort study involving 427 patients undergoing on-pump cardiac surgery.
• Patients received either low-dose (LD), intermediate-dose (ID), or high-dose (HD) tranexamic acid.
• Outcomes included hyperfibrinolysis, blood product use, chest tube output, and convulsions, analyzed using propensity score matching.

Main Results:

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

Conclusions:

• Low-dose tranexamic acid demonstrates comparable efficacy to higher doses in hyperfibrinolysis prophylaxis and preventing postoperative bleeding in cardiac surgery.
• These findings suggest that lower doses of tranexamic acid can be effectively utilized in cardiac surgical procedures.