Reduction of blood loss and transfusion requirements after coronary arterybypass grafting: Similar efficacy of tranexamic acid and aprotinin in aspirin-treated patients

Background: In patients with coronary artery disease, continuation of aspir in may reduce the incidence of unstable angina and preoperative myocardial infarction before surgery, but the risk of perioperative bleeding may be in creased. Methods: The efficacy of aprotinin and tranexamic acid (TXA) was e xamined in a prospective, randomized, double-blind trial involving 56 patie nts scheduled for coronary artery bypass grafting and who received aspirin 100 mg/day until the day of the operation. Group I received high-dose aprot inin whereas group II received 10 g of tranexamic acid (TXA) over 20 minute s before sternotomy. Heparinization during cardiopulmonary bypass was contr olled with HDTT (high-dose thrombin time) to eliminate interference of apro tinin on ACT (celite activated clotting time). Postoperative blood loss and transfusion requirements were registered during the first 24 hours. Result s: The demographics, coagulation, and intraoperative parameters were simila r in both groups. Postoperative blood loss (aprotinin 840 mb /24 hours, TXA 880 mL/24 hours, p = 0.481). and transfusion requirements (2.18 units/pati ent in the aprotinin group, 2.11 units/patient in the TXA group) were not r emarkably different between the two regimen protocols. No perioperative myo cardial infarction, pulmonary embolism, cerebrovascular event, or other thr ombotic events were observed. Conclusions: In this trial, we were not able to demonstrate any difference in postoperative bleeding in patients pretrea ted with aspirin after high-dose aprotinin or TXA. From a practical point o f view, TXA is safe, less expensive than aprotinin, and easy to handle, and can be recommended in patients pretreated with aspirin to improve postoper ative hemostasis.