Prevention of bleeding after cardiopulmonary bypass with high-dose tranexamic acid

Abstract

This prospective, double-blind, randomized trial assessed the effectiveness of high-dose tranexamic acid given in the preoperative period on blood loss in patients undergoing cardiopulmonary bypass. One hundred fifty patients scheduled to undergo cardiac operations with cardiopulmonary bypass were randomized into three groups of equal size. The first group received 10 gm of tranexamic acid intravenously over 20 minutes before sternotomy and a placebo infusion over 5 hours. The second group received 10 gm of tranexamic acid over 20 minutes and then another 10 gm infused intravenously over 5 hours. The control group received a placebo bolus and a placebo infusion over 5 hours (0.9% normal saline solution). The blood loss after the operation was measured at 6 hours and 24 hours. The homologous blood and blood products given during and up to 48 hours after operation were recorded. Eighteen percent of the control group patients shed more than 750 ml blood in 6 hours compared with only 2% in both tranexamic acid groups. Patients who shed more than 750 ml blood required 93% more red blood cell transfusions than patients without excessive bleeding. Tranexamic acid (10 gm) given intravenously in the period before cardiopulmonary bypass reduced blood loss over 6 hours by 50% and over 24 hours by 35%. Continued tranexamic acid infusion (10 gm over 5 hours) did not reduce bleeding further. There was no difference in the coagulation profile before operation between patients with and without excessive bleeding. However, coagulation tests done in the postoperative period indicated ongoing fibrinolysis and platelet dysfunction in patients with excessive bleeding.

Efficacy of Tranexamic Acid in Decreasing Blood Loss during and after Cesarean Section: A Randomized Case Controlled Prospective Study

“…[13] the study by Karski et al too, a high dose of infusion at the rate of 10 g intravenously over 5 h after a bolus of 10 g showed no additional benefit over placebo infusion. [12] There was no significant alteration in the vital signs of subjects following tranexamic acid administration. There were no abnormalities in hemoglobin, liver and renal function, and urine analysis.…”

“…[11]. A double-blind randomized clinical trial by Karski et al used TXA pre-operatively for prevention of bleeding after cardiopulmonary bypass in a very high dose of 10 g intravenously over 20 min before sternotomy followed by another 10 g infused intravenously over 5 h. [12]]. Horrow et al used prophylactic TXA in the dose range of 2.5-40 mg/kg in patients undergoing cardiac surgeries and concluded that the dose of 10 mg/kg followed by 1 mg/kg/h decreased bleeding after extracorporeal circulation.…”

Adjuncts for Tissue stasis

“…Some studies have found a significant reduction of transfusion rates for lysine analogues compared to a placebo 92 while other studies have found no difference. 88,93,94 Meta-analyses were performed from clinical data accrued during the 1990s to clarify the effects of EACA and TXA as they are used in cardiac surgery. The earliest of these studies evaluated the four lysine analogue studies and found a significant reduction in transfusion requirements and decreased blood loss.…”

Association between CK-MB Area Under the Curve and Tranexamic Acid Utilization in Patients Undergoing Coronary Artery Bypass Surgery

“…It is currently recommended by joint practice guidelines (level of evidence 1A) to reduce peri-operative blood loss and the number of blood transfusions in patients undergoing cardiac surgery [4]. Randomized trials and meta-analyses have reported that TA reduces blood loss, number of transfusions, reoperation, and length of stay [5][6][7][8][9][10][11][12].…”