Topical use of tranexamic acid in coronary artery bypass operations: A double-blind, prospective, randomized, placebo-controlled study

Objectives: We sought to investigate the effect of topical application of t ranexamic acid into the pericardial cavity in reducing postoperative blood loss in coronary artery surgery. Methods: A prospective, randomized, double -blind investigation with parallel groups was performed. Forty consecutive patients undergoing primary coronary surgery were randomly assigned to grou p 1 (tranexamic acid group) or group 2 (placebo group). Tranexamic acid (1 g in 100 mt of saline solution) or placebo was poured into the pericardial cavity and over the mediastinal tissues before sternal closure. The drainag e of mediastinal blood was measured hourly. Results: Chest tube drainage in the first 24 hours was 485 +/- 166 mt in the tranexamic acid group and 641 +/- 184 mt in the placebo group (P =.01). Total postoperative blood loss w as 573 +/- 164 mt and 739 +/- 228 mt, respectively (P =.01), The use of ban ked donor blood products was not significantly different between the two gr oups. Tranexamic acid could not be detected in any of the blood samples bli ndly collected from 24 patients to verify whether any systemic absorption o f the drug occurred, There were no deaths in either group. None of the pati ents required reoperation for bleeding, Conclusions: Topical application of tranexamic acid into the pericardial cavity after cardiopulmonary bypass i n patients undergoing primary coronary bypass operations significantly redu ces postoperative bleeding. Further studies must be carried out to clarify whether a more pronounced effect on both bleeding and blood products requir ement might be seen in procedures with a higher risk of bleeding.