TRANEXAMIC ACID IS EFFECTIVE IN DECREASING POSTOPERATIVE BLEEDING ANDTRANSFUSIONS IN PRIMARY CORONARY-ARTERY BYPASS OPERATIONS - A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED TRIAL

We evaluated the effects of tranexamic acid (TA) administered before a nd after cardiopulmonary bypass (CPB) in a prospective, randomized, pl acebo-controlled, double-blind study of adult patients undergoing prim ary coronary artery bypass grafting surgery. Patients received placebo (n = 30) or TA 15 mg/kg before CPB, followed by a TA infusion of 1 mg . kg(-1) . h(-1) for 5 h (n = 30) or TA 15 mg/kg after CPB, followed by a TA infusion of 1 mg . kg(-1) . h(-1) for 5 h (n = 30). Demographi c, medical, surgical, laboratory, mediastinal chest tube drainage (MCT D), hemoglobin loss, transfusion, and outcome data were collected. All ogenic blood product administration was tightly controlled. The demogr aphic, medical, and surgical characteristics were similar in all three groups. The median postoperative MCTD and hemoglobin loss in the pre- CPB TA group (710 mL, 8.6 g) was significantly less (P < 0.001) compar ed with the control (1202 mL, 44.2 g) and post-CPB TA groups (1020 mL, 23.4 g). The percentage of patients who received no allogenic blood p roducts was 27% for the pre-CPB TA group and 33% for the post-CPB TA g roup (not significant). These percentages were significantly lower tha n those in the placebo group (66%, P < 0.001). The median number of al logenic blood products administered to the pre-CPB TA group (0 units) was significantly less compared with the control group (4.5 units). Th e thromboelastogram and fibrinogen split product levels in the pre-CPB TA group indicated better platelet function and less activation of th e fibrinolytic system compared with the other two groups (P < 0.05). T here were no intergroup differences in reoperation, myocardial infarct ion, stroke, infections, or death. These data support the use of pre-C PB TA to decrease patient exposure to postcardiopulmonary bypass allog enic blood products. Implications: In this randomized, placebo-control led trial, we investigated the efficacy of tranexamic acid to decrease bleeding and blood transfusions after open-heart operations. Tranexam ic acid administered before and during the operation was effective in decreasing both bleeding and transfusions. When tranexamic acid was ad ministered immediately after the operation, it had a minor beneficial effect.