Effects of tranexamic acid on short‐term and long‐term outcomes of on‐pump coronary artery bypass grafting: Randomized trial and 7‐year follow‐up

Abstract

Summary Aims Safety evaluations of tranexamic acid (TXA) remain sparse, especially with respect to its impact on long‐term outcomes in patients undergoing on‐pump coronary artery bypass grafting (CABG). We hypothesized that the effects of TXA on perioperative bleeding and allogeneic transfusion and its impact on long‐term clinical outcomes of patients receiving on‐pump CABG are superior to those in the control group. Methods In this prospective, randomized, placebo‐controlled trial, 210 patients undergoing primary and isolated on‐pump CABG were randomly assigned to receive TXA or a corresponding volume of saline solution. Randomly assigned patients were followed up at 1, 3, 5, and 7 years after hospital discharge. Finally, 163 patients fulfilled the 7‐year follow‐up. The primary outcome was allogeneic red blood cell (RBC) transfusion. Long‐term mortality and morbidity were also evaluated. Results Compared with placebo, TXA reduced the allogeneic RBC requirement in terms of the volume transfused (4.20 ± 4.06 vs 6.25 ± 4.86 units; P < 0.01), ratio exposed (52.0% vs 71.6%; P < 0.01), and blood loss volume (879.0 ± 392.5 vs 1154.0 ± 582.8 mL; P < 0.01). Except for myocardial infarction, there were no significant differences in mortality or morbidity between the two groups during the 7‐year follow‐up. The TXA group had a lower rate of myocardial infarction than did the placebo group (0.0% vs 4.9% at 84 months; P = 0.03). Conclusions Tranexamic acid significantly decreased postoperative bleeding and allogeneic transfusion in patients undergoing on‐pump CABG. The 7‐year follow‐up suggested that the use of TXA was safe and might play a potential role in the prevention of long‐term myocardial infarction.

Effects of Tranexamic Acid in Reducing Blood Loss in Patients Undergoing Coronary Artery Bypass Surgery: A Systematic Review

“…One study, Zhang et al, found that the patients who received tranexamic acid required significantly less allogeneic RBC transfusions compared to the placebo group following on-pump CABG. [10] However, all other studies of on-pump CABG in this review indicate that there is no significant difference between the placebo and treatment groups when evaluating transfusion requirements postoperatively.…”

“…In the postoperative period, tranexamic acid administration significantly reduced blood loss, measured via chest tube drainage. [10] The 7-year follow-up found no significant difference between the placebo and tranexamic acid group in terms of morbidity and mortality, suggesting that postoperative tranexamic acid administration also carries low risk in the long term.…”

“…[10] Similarly, Fawzy et al found that tranexamic acid administration resulted in a statistically significant decrease in chest tube drainage in the first 24 hours after on-pump CABG, representing a 37% decrease in blood loss. [11] There was a 32% reduction in total blood loss in the postoperative period.…”

The efficacy and safety of intravenous administration of tranexamic acid in patients undergoing cardiac surgery: Evidence from a single cardiovascular center

“…Eighteen studies were randomized controlled trials (RCTs), and 5 were observational studies. Among the 23 studies, 10 included only adult patients undergoing coronary artery bypass graft (CABG) (6 on-pump, [21,[23][24][25][26][27] 3 off-pump [29][30][31] and 1 mixed on-pump and off-pump [33] ), 7 [16][17][18][19][20]22,28] included adult patients undergoing valve surgery with or without CABG, 2 [15,17] included adult patients undergoing mixed types of cardiac surgeries, 4 [32,[35][36][37] included only pediatric patients undergoing correction for congenital heart diseases (2 non-cyanotic, [32,37] 1 cyanotic [36] and 1 mixed cyanotic and non-cyanotic [35] ).…”

Patient Blood Management: Single Center Evidence and Practice at Fuwai Hospital

“…Currently, TXA is the most widely used antifibrinolytic agent, and the mainstay hemostatic agent at Fuwai Hospital. 50,[68][69][70][71][72][73] At present, the optimal doses of TXA for different cardiovascular surgical procedures and different risk groups of patients remains unknown.…”