Is tranexamic acid safe in patients undergoing coronary endarterectomy?

Background. Patients undergoing coronary endarterectomy during coronary art ery bypass grafting (CABG) are at increased risk of perioperative myocardia l infarction due to coronary intimal disruption. Data assessing the safety of the antifibrinolytic drug tranexamic acid (TA) in patients undergoing th is procedure are lacking. Methods. From September 1997 to December 1999, 221 patients underwent nonem ergency primary CABG with endarterectomy of the right coronary artery alone in 149, the left anterior descending in 35, or both right and left anterio r descending in 27. TA was administered intraoperatively to 87 patients (TA group: average total dose 62 +/- 4.4 mg/kg; range 20 to 109 mg/kg), and wa s not administered to 134 patients (No TA group). Results. The patient characteristics of the 2 groups were similar. In-hospi tal mortality consisted of 2 patients in the TA group and 4 patients in the No TA group. Perioperative myocardial infarction rates were 2% and 5% in t he TA and No TA groups, respectively (p = 0.49). The relative risk for any type of perioperative cardiac ischemic event in the TA group versus the No TA group was 0.77 (95% CI; 0.4, 1.2). Patients in the TA group had a signif icant reduction in postoperative chest tube drainage (685 versus 894 mt in the TA versus No TA groups, respectively) and in the use of fresh-frozen pl asma (p 0.03). Conclusions. These results suggest that the clinical effectiveness of trane xamic acid in reducing, postoperative blood loss in patients undergoing cor onary endarterectomy is not associated with a higher incidence of myocardia l ischemia-related complications. (Ann Thorac Surg 2001;71:1508-11) (C) 200 1 by The Society of Thoracic Surgeons.