THE EFFECTIVENESS OF LOW-DOSE TRANEXAMIC ACID IN PRIMARY CARDIAC-SURGERY

Purpose: This randomized controlled clinical trial compared three dose s of tranexamic acid (TA) in primary cardiac surgery in terms of blood loss and transfusion requirements. Methods: Patients presenting for p rimary coronary artery bypass grafting (CABG) and/or valve replacement were randomly assigned to one of three TA regimens : 20 mg.kg(-1) (LD ), 50 mg.kg(-1) (MD), and 100 mg.kg(-1) (HD), All participants and sta ff were blinded to the allocation, Haemoglobin (Hgb), haematocrit and platelet count were determined preoperatively, after bypass, at CCA ar rival, and 12 and 24 hr after surgery, Coagulation para meters were me asured before and after surgery, Blood loss was measured intraoperativ ely and for 24 hr post operatively following a standardized protocol. Blood products were administered in a standardized fashion. Results: T wo hundred twenty patients completed the trial over 10 months: 74 in L D, 75 in MD and 72 in HD dose groups. All patient groups were comparab le; similar procedures were performed in each group. No differences we re identified for blood loss intra-operatively (490 +/- 232 ml, 523 +/ - 413 ml, 488 +/- 357 ml, respectively), 24 hr post-operatively (543 /- 223 ml, 544 +/- 231, 458 +/- 210 ml, respectively), and overall (10 32 +/- 358 ml, 1067 +/- 502 ml, 946 +/- 459 ml, respectively). Blood p roduct administration was similar in the three groups, No differences in postoperative complications were found, Conclusions: This study dem onstrates the equivalency of the three doses of TA in primary cardiac surgical procedures. The use of low dose (20 mg.kg(-1)) TA results in comparable outcomes, without additional complications.