Effectiveness of Tranexamic Acid in Reducing Postoperative Blood Loss in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Khadanga, Prashant; Kanchi, Muralidhar; Gaur, Pallavi

doi:10.7759/cureus.11924

Cited by 2 publications

(5 citation statements)

References 16 publications

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“…Clinical studies on the application of TXA during OPCAB obtained good blood management results (10,11), and less bleeding and fewer blood transfusions were observed after TXA administration during OPCAB (10)(11)(12). However, the study evidence lacked robustness because of the small patient population.…”

Section: Introductionmentioning

confidence: 99%

Tranexamic Acid Administered During Off-Pump Coronary Artery Bypass Graft Surgeries Achieves Good Safety Effects and Hemostasis

Wang

Yuan

Wang³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundTranexamic acid (TXA) administered during off-pump coronary artery bypass (OPCAB) surgeries has achieved good blood control in small cohorts. We aimed to investigate the safety issues and hemostasis associated with TXA administration during OPCAB in a large retrospective cohort study.MethodsThis study included 19,687 patients with OPCAB from 2009 to 2019. A total of 1,307 patients were excluded because they were younger than 18 years or certain values were missing. Among the remaining 18,380 patients, 10,969 were in the TXA group and 7,411 patients were in the no-TXA group. There were 4,889 patients whose TXA dose was ≥50 mg/kg, and the remaining 6,080 patients had a TXA dose of <50 mg/kg. Propensity score matching (PSM) was performed between the TXA and no-TXA groups and between the high-dose and low-dose groups, and statistical analysis was performed.ResultsTranexamic acid administration did not increase the risk of hospital death or thromboembolic events. Patients who administered TXA had less blood loss at 24 h (478.32 ± 276.41 vs. 641.28 ± 295.09, p < 0.001) and 48 h (730.59 ± 358.55 vs. 915.24 ± 390.13, p < 0.001) and total blood loss (989.00 ± 680.43 vs. 1,220.01 ± 720.68, p < 0.001) after OPCAB than the patients with non-TXA. Therefore, the risk of total blood exposure [odds ratio (OR) = 0.50, 95% CI 0.47–0.54, p < 0.001] or blood component exposure (p < 0.001) was decreased significantly in the patients who administered TXA. The TXA dosage did not impact the patient survival, thromboembolic events, or blood management.ConclusionsThe application of TXA was safe and provided blood control in patients with OPCAB, and the dosage did not affect these parameters.

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Section: Introductionmentioning

confidence: 99%

Tranexamic Acid Administered During Off-Pump Coronary Artery Bypass Graft Surgeries Achieves Good Safety Effects and Hemostasis

Wang

Yuan

Wang³

et al. 2022

Front. Cardiovasc. Med.

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“…A total of 392 trials were excluded due to duplication and review of titles and abstracts. Finally, 12 (Pleym et al 2003 ; Ahn et al 2012 ; Shi et al 2013a , 2013b , 2013c ; Altun et al 2017 ; Banihashem et al 2019 ; Khadanga et al 2020 ; Landymore et al 1997 ; Guo et al 2007 ; Aelbrouck et al 2016 ; Myles et al 2017 ) eligible trials that satisfied the inclusion criteria were included in this meta-analysis. Descriptive analyses of these articles were presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Descriptive analyses of these articles were presented in Table 1 . Of the 12 eligible trials, 2 (Shi et al 2013b ; Guo et al 2007 ) were written in Chinese, the other 10 (Pleym et al 2003 ; Ahn et al 2012 ; Shi et al 2013a , 2013c ; Altun et al 2017 ; Banihashem et al 2019 ; Khadanga et al 2020 ; Landymore et al 1997 ; Aelbrouck et al 2016 ; Myles et al 2017 ) were in English (1 (Ahn et al 2012 ) from Korea, 2 (Shi et al 2013a , 2013c ) from China, 1 (Altun et al 2017 ) from Turkey, 1 (Banihashem et al 2019 ) from Iran, 1 (Khadanga et al 2020 ) from India, 1 (Landymore et al 1997 ) from Canada, 1 (Pleym et al 2003 ) from Norway, 1 (Aelbrouck et al 2016 ) performed in Belgium and USA, 1 (Myles et al 2017 ) performed in Australia, Canada, Italy, the Netherlands, New Zealand, China (Hong Kong), and UK). Seven trials (Pleym et al 2003 ; Shi et al 2013a , 2013b , 2013c ; Altun et al 2017 ; Banihashem et al 2019 ; Landymore et al 1997 ) included participants undergoing on-pump CABG, three trials (Ahn et al 2012 ; Khadanga et al 2020 ; Guo et al 2007 ) included off-pump CABG patients, and two trials (Aelbrouck et al 2016 ; Myles et al 2017 ) included mixed cardiac surgical patients.…”

Section: Resultsmentioning

confidence: 99%

“…The screening included 3018 patients undergoing cardiac surgery, and 1510 were assigned to TXA group and 1508 to Control group. Eleven trials compared TXA with saline (Pleym et al 2003 ; Ahn et al 2012 ; Shi et al 2013a , 2013b , 2013c ; Altun et al 2017 ; Banihashem et al 2019 ; Khadanga et al 2020 ; Guo et al 2007 ; Aelbrouck et al 2016 ; Myles et al 2017 ), and 1 trial compared TXA with blank (Landymore et al 1997 ). Six trials (511 patients), 5 trials (2379 patients), and 1 trial (128 patients) described patients who underwent DAPT, aspirin, or clopidogrel therapy, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Three trials failed to report information on random sequence generation and were rated to have unclear risk of bias for this item (Altun et al 2017 ; Landymore et al 1997 ; Guo et al 2007 ). Two trials were classified high risk of blinding assessments or participants and personnel (Altun et al 2017 ; Khadanga et al 2020 ), one trial was classified high risk of random sequence generation (Banihashem et al 2019 ), and the other RCTs were assessed as low bias risk, indicating that they were of good quality (Supplemental Fig. 1 and Fig.…”

Section: Resultsmentioning

confidence: 99%

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Hemostatic effects of tranexamic acid in cardiac surgical patients with antiplatelet therapy: a systematic review and meta-analysis

Tian,

Li,

et al. 2024

Perioper Med

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Background The purpose of the current study was to assess the efficacy of tranexamic acid (TXA) on reducing bleeding in cardiac surgical patients with preoperative antiplatelet therapy (APT). Methods Five electronic databases were searched systematically for randomized-controlled trials (RCTs) assessing the impact of intravenous TXA on post-operative bleeding on cardiac surgical patients with preoperative APT until May 2024. Primary outcome of interest was post-operative blood loss. Secondary outcomes of interest included the incidence of reoperation due to post-operative bleeding, post-operative transfusion requirements of red blood cells (RBC), fresh-frozen plasma (FFP), and platelet concentrates. Mean difference (MD) with 95% confidence interval (CI) or odds ratios (OR) with 95% CI was employed to analyze the data. Subgroup and meta-regression analyses were performed to assess the possible influence of TXA administration on reducing bleeding and transfusion requirements. Results A total of 12 RCTs with 3018 adult cardiac surgical patients (TXA group, 1510 patients; Control group, 1508 patients) were included. The current study demonstrated that TXA significantly reduced post-operative blood loss (MD = − 0.38 L, 95% CI: − 0.73 to − 0.03, P = 0.03; MD = − 0.26 L, 95% CI: − 0.28 to − 0.24, P < 0.00001; MD = − 0.37 L, 95% CI: − 0.63 to − 0.10, P = 0.007) in patients receiving dual antiplatelet therapy (DAPT), aspirin, or clopidogrel, respectively. Patients in TXA group had significantly lower incidence of reoperation for bleeding as compared to those in Control group. The post-operative transfusion of RBC and FFP requirements was significantly lower in TXA group than Control group. Subgroup analyses showed that studies with DAPT discontinued on the day of surgery significantly increased the risk of post-operative blood loss [(MD: − 1.23 L; 95% CI: − 1.42 to − 1.04) vs. (MD: − 0.16 L; 95% CI: − 0.27 to − 0.05); P < 0.00001 for subgroup difference] and RBC transfusion [(MD: − 3.90 units; 95% CI: − 4.75 to − 3.05) vs. (MD: − 1.03 units; 95% CI: − 1.96 to − 0.10); P < 0.00001 for subgroup difference] than those with DAPT discontinued less than 5–7 days preoperatively. Conclusions This meta-analysis demonstrated that TXA significantly reduced post-operative blood loss and transfusion requirements for cardiac surgical patients with preoperative APT. These potential clinical benefits may be greater in patients with aspirin and clopidogrel continued closer to the day of surgery. Trial registration number CRD42022309427.

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Effectiveness of Tranexamic Acid in Reducing Postoperative Blood Loss in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Cited by 2 publications

References 16 publications

Tranexamic Acid Administered During Off-Pump Coronary Artery Bypass Graft Surgeries Achieves Good Safety Effects and Hemostasis

Tranexamic Acid Administered During Off-Pump Coronary Artery Bypass Graft Surgeries Achieves Good Safety Effects and Hemostasis

Hemostatic effects of tranexamic acid in cardiac surgical patients with antiplatelet therapy: a systematic review and meta-analysis

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