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The dose-response relationship of tranexamic acid
J C Horrow1, D F Van Riper, M D Strong
1Department of Anesthesiology, Medical College of Pennsylvania, Philadelphia.
Anesthesiology
|February 1, 1995
Summary
Prophylactic tranexamic acid at 10 mg/kg followed by 1 mg/kg/h effectively reduces bleeding after cardiac surgery. Higher doses of tranexamic acid (TXA) do not offer additional hemostatic benefits in these patients.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Anesthesiology
Background:
- Tranexamic acid (TXA) is an antifibrinolytic used to reduce bleeding after cardiac operations.
- Optimal dosing for TXA's prophylactic use in cardiac surgery remains undetermined.
- This study aimed to establish the dose-response relationship of TXA for hemostatic efficacy.
Purpose of the Study:
- To determine the optimal prophylactic dose of tranexamic acid for reducing blood loss after cardiac operations.
- To investigate the dose-response relationship between tranexamic acid administration and hemostatic efficacy.
- To evaluate the impact of different tranexamic acid doses on postoperative bleeding and transfusion requirements.
Main Methods:
- A prospective, randomized, double-blind study involved 148 patients undergoing cardiac surgery with extracorporeal circulation.
- Patients were assigned to a placebo group or one of five tranexamic acid groups with varying loading doses (2.5-40 mg/kg) and maintenance doses (1 mg/kg/h for 12 hours).
- Blood loss was measured via chest tube drainage over 12 hours, and allogeneic transfusions were recorded within 12 hours and 5 days.
Main Results:
- Patients receiving at least 10 mg/kg tranexamic acid followed by 1 mg/kg/h showed significantly less blood loss (365-369 g/12h) compared to placebo (552 g/12h).
- Postoperative D-dimer levels were lower in patients receiving tranexamic acid compared to placebo.
- Tranexamic acid dosage did not influence transfusion rates; initial hematocrit was the primary factor for transfusion within 5 days.
Conclusions:
- A prophylactic regimen of 10 mg/kg tranexamic acid followed by 1 mg/kg/h is effective in decreasing bleeding after cardiac surgery with extracorporeal circulation.
- Higher doses of tranexamic acid beyond this regimen do not confer additional hemostatic advantages.
- The findings support a specific dosing strategy for tranexamic acid to optimize hemostasis in cardiac surgical patients.