Tranexamic acid in off-pump coronary surgery: A preliminary, randomized, double-blind, placebo-controlled study

Background. We evaluated the hemostatic effects of tranexamic acid, a synth etic antifibrinolytic drug, in patients undergoing beating-heart coronary s urgery. Methods. Forty consecutive patients were in a double-blind manner, prospect ively randomized into two groups: 20 patients received tranexamic acid (bol us of 1 g before skin incision, followed by continuous infusion of 400 mg/h r during surgery), and 20 patients received saline. As primary outcomes, bl eeding and allogeneic transfusions were considered. D-dimer and fibrinogen plasma levels were also evaluated to monitor the activation of fibrinolysis . Major postoperative thrombotic events, as a potential consequence of anti fibrinolytic treatment, were recorded. Results. The treatment group had sig nificantly lower postoperative bleeding (median [25th to 75th percentiles]: 400 mL [337 to 490 mL] vs 650 ml [550 to 862 mL], p < 0.0001), lower need for allogeneic blood products (1,200 vs 5,300 mL, p < 0.001), and lower pos toperative D-dimer plasma levels. No postoperative thrombotic complications were observed in either group. Conclusions. In this initial series of patients undergoing off-pump coronar y surgery, tranexamic acid appears to be effective in reducing postoperativ e bleeding and the need for allogeneic blood products. (C) 2001 by The Soci ety of Thoracic Surgeons.