Additional effects of topical tranexamic acid in on-pump cardiac surgery

Abstract

Objective: Postoperative bleeding after cardiac surgery is commonly associated with hyperfibrinolysis. This study was designed to evaluate the efficacy of topical tranexamic acid in addition to intravenous tranexamic acid in reducing bleeding in cardiac surgery cases. Methods: From July 1, 2014 to September 30, 2015, 82 patients who underwent elective on-pump cardiac surgery were randomized into a tranexamic acid group and a placebo group. In the tranexamic acid group, 1 g of tranexamic acid dissolved in 100 mL of normal saline solution was poured into the pericardium during sternal closure; the placebo group had 100 mL of saline only. Two patients were excluded from the study due to obvious surgical bleeding. The primary endpoint was total blood loss 24 h after surgery. Repeated measures with mixed models was used to analyze bleeding over time.Results: There was no significant difference in demographic and intraoperative data except for a significantly lower platelet count preoperatively in the tranexamic acid group (p ¼ 0.030). There was no significant difference in postoperative drainage volumes at 8, 16, and 24 h, postoperative bleeding over time (coefficient ¼ 0.713, p ¼ 0.709), or blood product transfusion between the groups. There were no serious complications. Conclusions: Topical tranexamic acid is safe but it adds no additional efficacy to the intravenous application in reducing postoperative blood loss. Intravenous tranexamic acid administration alone is sufficient antifibrinolytic treatment to enhance the hemostatic effects during on-pump cardiac surgery.

Different dose regimes and administration methods of tranexamic acid in cardiac surgery: a meta-analysis of randomized trials

“…This result can be further confirmed by several studies comparing intravenous plus topical use of TXA with intravenous application alone. In a RCT conducted by Taksaudom et al [62], 1 g of topical TXA was poured into the pericardial cavity in addition to 1 mg/kg/h of intravenous infusion in the experiment group, and only 1 mg/kg/h of intravenous infusion was applied in the control group. No significant reduction was seen in post-operative blood loss, and transfusion rate was even higher in the experiment group (75.6% vs 70.6%).…”

What Are the Optimal Dose of Administration and Time of Drainage for Topical Tranexamic Acid in Patients Undergoing Cardiac Surgery?

“…They reported that simultaneously using intravenous and topical TXA reduced blood loss and the frequency of transfusions [ 3 ]. Taksaudom et al [ 4 ] dissolved 1 g of TXA in 100 mL of normal saline and administered it intrapericardially during sternal closure in patients undergoing on-pump cardiac surgery. They reported no significant difference in postoperative bleeding or the frequency of blood transfusions between the patients who received TXA and those who did not [ 4 ].…”

“…Taksaudom et al [ 4 ] dissolved 1 g of TXA in 100 mL of normal saline and administered it intrapericardially during sternal closure in patients undergoing on-pump cardiac surgery. They reported no significant difference in postoperative bleeding or the frequency of blood transfusions between the patients who received TXA and those who did not [ 4 ]. Kimenai et al [ 5 ] administered 2 g of TXA intravenously before making the sternal incision and 2 g of TXA diluted in 200 mL of saline intrapericardially before sternal closure, as well as 2 g of TXA after surgery.…”