Topical Versus Intravenous Tranexamic Acid in Patients Undergoing Cardiac Surgery: The DEPOSITION Randomized...

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Intravenous tranexamic acid is standard for reducing bleeding in cardiac surgery.
• Topical tranexamic acid may offer a safer alternative by lowering plasma concentrations and potentially reducing seizure risk.

Purpose of the Study:

• To evaluate if topical tranexamic acid reduces in-hospital seizures in cardiac surgery patients.
• To determine if topical tranexamic acid increases the need for blood transfusions compared to intravenous administration.

Main Methods:

• A multicenter, double-blind, randomized controlled trial involving 3242 cardiac surgery patients.
• Patients received either intravenous or topical tranexamic acid.
• The trial was terminated early due to safety concerns identified by the data and safety monitoring board.

Main Results:

• In-hospital seizures occurred in 0.2% of the topical group versus 0.7% in the intravenous group (P=0.07).
• Red blood cell transfusion increased by 8.3% in the topical group compared to the intravenous group (P=0.007).
• A higher proportion of patients in the topical group received ≥4 units of red blood cells.

Conclusions:

• Topical tranexamic acid did not significantly reduce seizure incidence in cardiac surgery patients.
• Topical tranexamic acid was associated with a significant increase in red blood cell transfusion requirements.