Prophylactic tranexamic acid in elective, primary coronary artery bypass surgery using cardiopulmonary bypass

Abstract

An antifibrinolytic effect following prophylactic use of TA in elective, primary CABG among patients with a low risk of postoperative bleeding, did not result in any significant decrease in postoperative bleeding compared to a placebo group.

Off-Pump Versus On-Pump Coronary Artery Surgery Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective, Randomized Study

“…Presently, we do not have enough data in available literature comparing roTEG signs of fibrinolysis with relevant plasma markers (fibrin degradation products, D-dimer) to determine which test is superior, but thromboelastography seems to be a fast and reliable method for the immediate evaluation of hyperfibrinolysis during cardiac surgery. 26) Although in many cardiac surgery centers pharmacological strategies based on fibrinolytic inhibitors are used on a routine basis, and their clinical effectiveness has been clearly validated, 27,28) we unexpectedly did not find evident and explicit roTEG signs of hyperfibrinolysis in the majority of patients investigated. Our preliminary roTEG results display a slightly greater activation of fibrinolysis in on-pump coronary surgery during the course of cardiopulmonary bypass, but the off-pump versus on-pump differences are fairly subtle and imply a need for subsequent randomized trials with considerably larger numbers of patients allowing to justify the results by power analysis.…”

Fibrinolytic inhibitors in off-pump coronary surgery: a prospective, randomized, double-blind TAP study (tranexamic acid, aprotinin, placebo)

“…The favourable effect of fibrinolytic inhibitors (aprotinin, tranexamic acid, aminocaproic acid) on the decrease in perioperative bleeding in on-pump coronary surgery has been confirmed in a large number of controlled trials [1][2][3][4]. In many centers these pharmacological strategies are used on a routine basis [5,6].…”

Valid Comparisons of Antifibrinolytic Agents Used in Cardiac Surgery

“…2 However, significant reductions in the number of patients transfused have been noted in patients who underwent various cardiac surgical procedures requiring cardiopulmonary bypass when lysine analogues were compared with placebo. [12][13][14][15][16][17] Reexploration for bleeding occurs in Ͻ5% of patients after cardiac surgery, but it usually is indicative of clinically significant surgical bleeding and is associated with an increase in operative mortality and morbidity. In 17 studies comparing high-dose aprotinin with control and 11 studies comparing TXA with control, aprotinin but not TXA was consistently associated with a significant reduction in the need for reexploration.…”