Tranexamic Acid in On-Pump Coronary Artery Bypass Grafting Without Clopidogrel and Aspirin Cessation: Randomized Trial and 1-Year Follow-Up

Shi, Jia; Wang, Guyan; Lv, Hong; Su, Yuan; Wang, Yanhong; Ji, Hongwen; Li, Lihuan

doi:10.1016/j.athoracsur.2012.07.015

Cited by 35 publications

(40 citation statements)

References 17 publications

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“…Shi et al compared the effect of TnX-A and a placebo in patients using DAPT and receiving the final dose within 7 days before surgery. They reported that TnX-A significantly reduced blood loss, rate of reoperation, and amounts of transfusion (16). We observed that bleeding beginning with skin incision in the form of diffuse tissue leakage delayed graft preparation and sternal closure in patients undergoing CABG while receiving DAPT in our clinic.…”

Section: Discussionmentioning

confidence: 72%

Emergency coronary bypass surgery in patients under the influence of dualantiplatelet therapy: effects of tranexamic acid and desmopressin acetate

Altun¹,

Hemsinli²,

Pulathan³

et al. 2017

Turk J Med Sci

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Background/aim: Bleeding in patients undergoing coronary artery bypass grafting (CABG) while using dual antiplatelet therapy (DAPT) is a cause of significant morbidity and mortality. The aim of this study is to examine the perioperative hemostatic effects of tranexamic acid (TnX-A) and desmopressin acetate (Des) in these patients. Materials and methods:This clinical study was planned in a prospective and randomized manner. Fifty-four patients were enrolled and classified into 4 different groups. They were compared in terms of various bleeding and transfusion parameters.Results: No significant differences were observed between the groups in pre/intraoperative data apart from closure times. Plasmin/α-2 antiplasmin complex values in the TnX-A and control groups were significantly higher than those in the Des and TnX-A+Des groups at the end of postoperative drug infusion. Mean duration of closure times, first 3-h and total postoperative amounts of drainage, administered volumes of erythrocyte suspension/fresh frozen plasma, cost of blood products, length of intubation, length of stay in the intensive care unit, and time to discharge were also significantly higher in the Des and control groups. Conclusion:Des had no significant effect on bleeding control and even delayed the hemostatic efficacy of TnX-A. Use of TnX-A infusion alone in these patient groups had a positive effect on hemostasis-related data.

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Section: Discussionmentioning

confidence: 72%

Emergency coronary bypass surgery in patients under the influence of dualantiplatelet therapy: effects of tranexamic acid and desmopressin acetate

Altun¹,

Hemsinli²,

Pulathan³

et al. 2017

Turk J Med Sci

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“…In contrast, TXA has been used in three RCTs in patients taking clopidogrel (with or without aspirin) before coronary artery bypass grafting (total 766 patients) and significantly reduced blood transfusion requirements (Ahn et al , ; Shi et al , ,b). No differences in adverse events were reported between the groups; however, the authors advised caution regarding the small numbers and limited follow‐up (in the two largest studies follow‐up was for 1 year).…”

Section: Platelet Function Disorders (Acquired)mentioning

confidence: 99%

Guidelines for the use of platelet transfusions

et al. 2016

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“…The efficacy of tranexamic acid to reduce bleeding and transfusion rates was also demonstrated during off-pump coronary surgery (Wang et al, 2012), on-pump surgery while on dual antiplatelet therapy (Shi et al, 2013) and emergency surgery for type A acute aortic dissection (Ahn et al, 2015).…”

Section: Intra-operative Managementmentioning

confidence: 98%

Blood conservation in cardiac surgery

Blaudszun

Butchart

Klein

2017

Transfusion Medicine

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This article aims at reviewing the currently available evidence about blood conservation strategies in cardiac surgery. Pre-operative anaemia and perioperative allogeneic blood transfusions are associated with worse outcomes after surgery. In addition, transfusions are a scarce and costly resource. As cardiac surgery accounts for a significant proportion of all blood products transfused, efforts should be made to decrease the risk of perioperative transfusion. Pre-operative strategies focus on the detection and treatment of anaemia. The management of haematological abnormalities, most frequently functional iron deficiency, is a matter for debate. However, iron supplementation therapy is increasingly commonly administered. Intra-operatively, antifibrinolytics should be routinely used, whereas the cardiopulmonary bypass strategy should be adapted to minimise haemodilution secondary to circuit priming. There is less evidence to recommend minimally invasive surgery. Cell salvage and point-of-care tests should also be a part of the routine care. Post-operatively, any unnecessary iatrogenic blood loss should be avoided.

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Tranexamic Acid in On-Pump Coronary Artery Bypass Grafting Without Clopidogrel and Aspirin Cessation: Randomized Trial and 1-Year Follow-Up

Cited by 35 publications

References 17 publications

Emergency coronary bypass surgery in patients under the influence of dualantiplatelet therapy: effects of tranexamic acid and desmopressin acetate

Emergency coronary bypass surgery in patients under the influence of dualantiplatelet therapy: effects of tranexamic acid and desmopressin acetate

Guidelines for the use of platelet transfusions

Blood conservation in cardiac surgery

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