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[Comparative effect of tranexamic acid on the reduction of bleeding during and after cardiac surgery]
K Okuyama1, T Matsukawa, F Abe
1Department of Anesthesia, Yamanashi Prefectural Chuo Hospital, Kofu.
Insights
Tranexamic acid (TA) administration before cardiopulmonary bypass (CPB) significantly reduced bleeding in coronary artery bypass grafting (CABG) patients. While beneficial, TA did not significantly decrease blood loss in valve replacement surgery patients.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Bleeding is a significant complication in cardiac surgery.
- Antifibrinolytic agents like tranexamic acid (TA) are used to mitigate blood loss.
- The efficacy of TA before cardiopulmonary bypass (CPB) warrants further investigation.
Purpose of the Study:
- To evaluate the impact of prophylactic tranexamic acid (TA) administration on blood loss during and after cardiac surgery.
- To compare bleeding volumes in patients undergoing coronary artery bypass grafting (CABG) and valve replacement surgery with and without TA.
Main Methods:
- Retrospective clinical trial involving 99 adult patients undergoing open heart surgery.
- Patients received either tranexamic acid (TA) intravenously post-anesthesia induction or no TA.
- Blood loss was measured intraoperatively and at 6 and 24 hours post-operation.
Main Results:
- Patients undergoing CABG who received TA showed significantly less intraoperative and total blood loss compared to the control group.
- In valve replacement surgery, patients receiving TA had lower total blood loss, though the difference was not statistically significant.
- TA administration demonstrated a trend towards reduced bleeding in both surgical groups.
Conclusions:
- Prophylactic administration of tranexamic acid (TA) prior to cardiopulmonary bypass (CPB) may effectively reduce bleeding in patients undergoing coronary artery bypass grafting (CABG).
- Further research is needed to confirm the significant efficacy of TA in reducing blood loss for valve replacement surgeries.
Abstract:
The administration of tranexamic acid (TA), an antifibrinolytic agent, prior to cardiopulmonary bypass (CPB) has been reported to reduce bleeding after cardiac surgery. In a retrospective clinical trial, 99 adults patients undergoing open heart surgery received TA (CABG, TA (+): n = 20; Valve replacement, TA (+): n = 20) or did not receive TA (CABG, TA (-): n = 20: Valve replacement, TA (-): n = 19). In the TA group, just after induction of general anesthesia, a 160 mg.kg-1 dose of TA was administered intravenously. In each group, bleeding volumes during operation, and at 6 and 24 hours after operation, were compared. Patients of [CABG, TA (+)] group had significantly less intraoperative and total blood loss [total blood loss 608 g : 313 g, intraoperatively, 134 g at 6 hours, and 296 g at 24 hours] compared with [CABG, TA (-)] group (total blood loss 1043 g: 640 g, intraoperatively, 232 g at 6 hours, and 403 g at 24 hours). Additionally, in patients of Valve replacement, TA (+) group had less but not significant total blood loss (total blood loss 903 g: 523 g, intraoperatively, 173 g at 6 hours, and 380 g at 24 hours) compared with TA (-) group (total blood loss 1237 g: 863 g, intraoperatively, 214 g at 6 hours, and 374 g at 24 hours). TA administered prior to CPB may reduce the amount of bleeding during and after cardiac surgery.