Prospective clinical trial on dosage optimizing of tranexamic acid in non-emergency cardiac surgery procedures

Waldow, Thomas; Szłapka, Michał; Haferkorn, M; Burger, Laura L.; Plötze, Katrin; Matschke, Klaus

doi:10.3233/ch-131782

Cited by 21 publications

(17 citation statements)

References 21 publications

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“…Waldow et al [3] conducted a larger study (n = 1182) in on-pump cardiac surgery patients and detected no statistically significant differences in blood loss, 30-day mortality, myocardial infarction or stroke between patients receiving low (1 g priming dose), moderate (5 g priming dose) or high-dose TA (3 g priming dose plus weight-adjusted infusion).…”

Section: Resultsmentioning

confidence: 99%

What dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery?: Table 1:

Hodgson

Larvin

Dearman

2015

Interact CardioVasc Thorac Surg

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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: what dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery? Altogether 586 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Current evidence shows clinical benefit of using high-dose tranexamic acid (>80 mg/kg total dose) as opposed to low-dose tranexamic acid (<50 mg/kg total dose) in cardiac surgery with cardiopulmonary bypass. Evidence from a large randomized controlled trial shows that patients receiving high-dose tranexamic acid lose less blood postoperatively than patients receiving low-dose tranexamic acid (590 vs 820 ml, P = 0.01). Patients receiving high-dose tranexamic acid also require fewer units of blood product transfusion (2.5 units vs 4.1 units; P = 0.02) and are less likely to undergo repeat surgery to achieve haemostasis. This effect is larger in those who are at high risk of bleeding. Several prospective studies comparing doses found no difference in clinical outcomes between high- and low-dose regimens, but excluded patients at high risk of bleeding. However, data from numerous observational studies demonstrate that tranexamic acid use is associated with an increased risk of postoperative seizure; one analysis showed tranexamic acid use to be a very strong independent predictor (odds ratio = 14.3, P < 0.001). There is also evidence that this risk of seizure is dose-dependent, with the greatest risk at higher doses of tranexamic acid. We conclude that, in general, patients with a high risk of bleeding should receive high-dose tranexamic acid, while those at low risk of bleeding should receive low-dose tranexamic acid with consideration given to potential dose-related seizure risk. We recommend the regimens of high-dose (30 mg kg(-1) bolus + 16 mg kg(-1) h(-1) + 2 mg kg(-1) priming) and low-dose (10 mg kg(-1) bolus + 1 mg kg(-1) h(-1) + 1 mg kg(-1) priming) tranexamic acid, as these are well established in terms of safety profile and have the strongest evidence for efficacy.

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Section: Resultsmentioning

confidence: 99%

What dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery?: Table 1:

Hodgson

Larvin

Dearman

2015

Interact CardioVasc Thorac Surg

View full text Add to dashboard Cite

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“…A prospective clinical trial (n ¼ 1182) investigated the efficacy of giving small and medium 'single shots' of tranexamic acid in CPB priming volume (1 g and 5 g, respectively), and a medium dose (3 g)plus 15 mg kg À1 h À1 ) infusion in elective cardiac surgical patients. 209 The trial found no significant differences between the groups in postoperative blood loss, and the authors concluded that the higher doses were no more effective than the single low dose of tranexamic acid.…”

Section: Antifibrinolytic Therapy (Tranexamic Acid and Eaminocaproic mentioning

confidence: 96%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

676

316

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: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.

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“…Intravenous TXA use is increasing in cardiothoracic surgery after the withdrawal of aprotinin. In orthopaedic surgery, several studies have shown benefit from peri‐operative IV TXA in arthroplasties.…”

Section: Discussionmentioning

confidence: 99%

“…The Cochrane reviews on topical and IV TXA found that the reporting of safety outcomes was too inconsistent to allow conclusions to be drawn. A trial in cardiac surgery involving patients with previous thrombotic events showed no increase in adverse events with high‐dose TXA. The large ( n = 872,416) review of IV TXA in orthopaedic surgery found no increase in thromboembolic events following IV TXA.…”

Section: Discussionmentioning

confidence: 99%