Effect of Topical Tranexamic Acid on Postoperative Bleeding in Cardiac Surgery

Abstract

Background: One of the major cardiac surgery problems is post-operative bleeding which may lead to blood transfusion. Blood loss is due to many causes one of them is fibrinolysis. Many antifibrinolytic drugs have been used to decrease the post-operative bleeding for cardiac surgery including eaminocaproic acid, aprotinin and tranexamic acid. Tranexamic acids are synthetic derivatives of the amino acid lysine. It binds with the lysine on binding site of plasminogen and plasmin due to that the plasminogen dislodge from the surface of the fibrin so demoralizing the fibrinolysis process. Aim of Study:To study the effect of application of topical tranexamic acid in reducing the postoperative bleeding in patients undergoing cardiac surgery by median sternotomy. Patients and Methods: A Randomized Controlled ClinicalTrialwas carried out one 50 subjects was programmed for elective open cardiac surgery, enrolled by computer program and divided randomly in two group, group A (n=25) received TxA 2g in 100ml NSS in the pericardial cavity and mediastinum before the sternal closure While group B (n=25) 100ml of NSS alone. The drains will be monitored in the next 24 hours with calculation of blood loss. Blood products will be calculated when given for patient. Re exploration is done if there urgency. Results:The result of the study revealed statistically significant difference between TxA group and the placebo group regarding the postoperative blood loss and the need for packed RBC transfusion. This means the topical application of TxA decreasing the postoperative bleeding, blood transfusion and the need for reopration, but there was no statistically significant difference in plasma and platelet transfusions between the two groups. Conclusion:The use of topical TXA have a significant effect on the reduction of bleeding after Cardiac Surgery, also was able to decrease the blood transfusions. Moreover, show better results in reducing the return to the operating room due to bleeding.