TRANEXAMIC ACID REDUCES POSTBYPASS BLOOD USE - A DOUBLE-BLINDED, PROSPECTIVE, RANDOMIZED STUDY OF 210 PATIENTS

Background. Pharmacologic intervention to minimize postbypass bleeding and blood product transfusions has received increasing attention for both medical and economic reasons. Methods. Two hundred ten patients w ere entered into a double-blinded, prospective, randomized study to re ceive either 10 g of the fibrinolytic inhibitor tranexamic acid before incision (n = 104) or 250 mL of placebo saline solution (n = 106). Al l subjects requiring cardiopulmonary bypass were deemed suitable, incl uding those having first-time coronary bypass grafting, valve replacem ent, and reoperation. Results. There were no statistically significant differences between the groups with respect to demographic or operati ve characteristics. The tranexamic acid group had a 48% reduction in 2 4-hour blood drainage (p < 0.001) and received 69% fewer total units o f packed red blood cells, 83% fewer total units of plasma, and 75% few er platelet transfusion units than controls. Only 13 of 104 tranexamic acid patients received blood products versus 33 of 106 controls (p < 0.001). The incidences of thrombotic complications, perioperative myoc ardial infarction, renal failure, and neurologic complications were no t significantly different between the two groups. The tranexamic acid group had 0% mortality versus 1.9% for controls (not significant). Con clusions. Tranexamic acid is safe and effective in reducing blood loss and blood use in a wide variety of cardiac surgical patients.