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

Lin, Pei-Shuang; Yao, Yun-Tai; Tian, Lijuan; Jiang, Jihai; Zhang, Yang; He, Li-Xian; Yu, Yiping; Ma, Jun

doi:10.1097/md.0000000000033819

Cited by 3 publications

(2 citation statements)

References 68 publications

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“…Patient blood management (PBM) flowcharts individualized to a cardiac surgery center need to include a specific TXA dose. In one study of 27,729 patients, only medium or high dose TXA resulted in less patients exposed to platelet transfusion, although not lower average units per patient [16]. A meta-analysis showed a bolus technique is equally effective in reducing the average transfused red cells by one unit as is a bolus followed by a continuous infusion [17].…”

Section: Discussionmentioning

confidence: 99%

The Significant Role of Point-Of Care Coagulation Studies: Shorter Cardiac Surgery, Better Renal Function and Tranexamic Acid Can Not Alone Reduce Early Platelet Transfusions

Skidmore,

Borne,

Kallurkar

et al. 2023

Preprint

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Introduction: In recent years, platelets have been in short supply and high demand. Approximately one in five cardiac surgery patients require platelets. In our safety-net hospital, however, the incidence is over 40%. Renal dysfunction, long cardiopulmonary bypass (CPB) times, and absence of tranexamic acid (TXA) are common risk factors for requiring platelet transfusions. Methods: Our hypothesis was fewer platelets would be transfused within two hours after bypass under these three conditions: creatinine is low, predicted surgery duration is short, and TXA is uniformly administered. Our anesthesia department designed this retrospective before-and-after observational study when the surgery department decided to narrow preoperative criteria respective to these three elements. The Institutional Review Board of Louisiana State University Health Sciences Center Shreveport approved of the protocol and waived individual informed consent. We compared timing of platelet transfusions (within 7 days) in consecutive patients who had CPB during the first ninety days of 2022 to those in 2023 using t-tests in SAS 9.3. Confounders included age, weight, anticoagulants, gender, and the platelet counts and hemoglobin immediately prior to platelet transfusion. Secondary outcomes were postoperative day two creatinine and other components transfused. Results: Preoperatively creatinine tended to be higher in 2022 at 1.5 vs 1.1, reaching significance postoperatively at 1.9 vs 1.1 (p=0.02). Bypass times decreased from 174 to 124 minutes (p=0.06). TXA use increased from 18 of 28 to 26 of 29 patients. Platelet counts increased on bypass from 142 to 173 (p=0.06). Platelet and hemoglobin nadirs were higher (day 3: 8g/dL vs 8.8, p=0.04; 98 vs 138, p=0.005). Platelet units transfused per patient tended to increase (0.75+/-1 vs 0.93+/-1.5); if exposed, patients tended to receive more units (2.1+/-1.3 vs 2.5+/-1.4) sooner. Changes in transfusions for red cells were nonsignificant at 1.97 per patient to 1.21, cryoprecipitate 0.36 to 0.69, and FFP 0.93 to 0.83. Conclusions: This is the first study examining timing of platelet transfusions after bypass. In the present investigation, we measured platelet count during bypass and prothrombin hours after arrival in the intensive care. Platelets were often administered in sets of two because of scarce immediate supply, partly from lack of an agitator table. More importantly, these data support a need for point-of-care thromboelastograms intraoperatively, but the cost has been prohibitive. Some centers’ algorithms list triggers for transfusion by fibrinogen and prothrombin times, available immediately after separation from bypass.

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Section: Discussionmentioning

confidence: 99%

The Significant Role of Point-Of Care Coagulation Studies: Shorter Cardiac Surgery, Better Renal Function and Tranexamic Acid Can Not Alone Reduce Early Platelet Transfusions

Skidmore,

Borne,

Kallurkar

et al. 2023

Preprint

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“…Tranexamic acid (TXA) is a well-established antifibrinolytic agent that has been shown to reduce blood loss during joint replacement, cardiac surgery, and spine surgery (1)(2)(3). In spine surgery, perioperative bleeding can have serious consequences, including spinal cord injury and compression of the esophagus and trachea by hematoma (4).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of tranexamic acid in cervical spine surgery: a systematic review and meta-analysis

Luo,

Yang,

Wang

et al. 2024

Front. Neurol.

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BackgroundTranexamic acid (TXA) is an antifibrinolytic drug associated with reduced blood loss in a range of surgical specialties. This meta-analysis aimed to compare the efficacy and safety of TXA in cervical surgery, focusing on its effects on intraoperative blood loss and related outcomes.MethodsWe searched the PubMed, EMBASE, Medline, and Cochrane Library databases to identify all literature related to TXA used in cervical spinal surgery. Intraoperative blood loss, postoperative drainage volume, total blood loss, postoperative hematological variables, and complications were analyzed.ResultsEight trials met the inclusion criteria. The pooled results showed that intraoperative blood loss, total blood loss, and postoperative drainage volume were significantly lower in the TXA group than in the control group. The hemoglobin and hematocrit on postoperative day 1 was significantly higher in the TXA group than in the control group. There was no significant difference in complications between the two groups.ConclusionThe available evidence indicates that TXA effectively reduces blood loss in cervical spinal surgery while maintaining a favorable safety profile, without increasing associated risks.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023459652.

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The significant role of point-of-care coagulation studies: shorter cardiac surgery, better renal function and tranexamic acid cannot alone reduce early platelet transfusions

Skidmore,

Borne,

Kallurkar

et al. 2024

Adv Health Res

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After cardiopulmonary bypass (CPB) approximately 20% of patients require platelets. In our safety-net hospital, the incidence of platelet transfusion is over 40%, perhaps attributable to our prevalent risk factors of renal dysfunction, CPB duration, and absence of tranexamic acid (TXA). We designed this retrospective observational study after surgeons decided against offering CPB in the presence of these risk factors. The Institutional Review Board (IRB) approved the protocol and waived informed consent. Our hypothesis was the number of platelet transfusions in the consecutive patients during the first ninety days of 2022 would be higher than those in 2023. Confounders included platelet counts and hemoglobin immediately before platelet transfusion. Secondary outcomes were postoperative day two creatinine and other components transfused. Preoperatively creatinine trended higher in 2022 at 1.5 vs 1.1, reaching significance postoperatively at 1.9 vs 1.1 (p=0.02). CPB decreased from 174 to 124 min (p=0.06). TXA use increased from 18 of 28 to 26 of 29 patients. Platelets during CPB increased (142 to 173, p=0.06). Hemoglobin nadirs rose (8 g/dL to 8.8, p=0.04). Platelet units transfused per patient tended to rise (0.7±1 vs 0.93±1.5); if exposed, patients tended to receive more units (2.1±1.3 vs 2.5±1.4) sooner. These data support a need for thromboelastograms with platelet mapping immediately post-CPB.

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

Cited by 3 publications

References 68 publications

The Significant Role of Point-Of Care Coagulation Studies: Shorter Cardiac Surgery, Better Renal Function and Tranexamic Acid Can Not Alone Reduce Early Platelet Transfusions

The Significant Role of Point-Of Care Coagulation Studies: Shorter Cardiac Surgery, Better Renal Function and Tranexamic Acid Can Not Alone Reduce Early Platelet Transfusions

Efficacy and safety of tranexamic acid in cervical spine surgery: a systematic review and meta-analysis

The significant role of point-of-care coagulation studies: shorter cardiac surgery, better renal function and tranexamic acid cannot alone reduce early platelet transfusions

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