Tranexamic acid reduces postbypass blood use: A double-blinded, prospective, randomized study of 210 patients

Katsaros, Demetrios; Petricevic, M; Snow, Norman; Woodhall, Dennis D.; Bergen, Robert Van

doi:10.1016/0003-4975(96)00022-7

Cited by 101 publications

(35 citation statements)

References 22 publications

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“…The median amount of packed red cell transfusion in this study was slightly lower in the TA group, approximately 1.5 units, comparable to the median transfusion rate of 2 units reported by Hutton and colleagues; 19 however, there was no significant difference between groups, probably due to the hemostatic effect of intravenous TA administration in all patients. 16,17 There was no mortality, serious morbidity, or complications related to TA in this study, although one patient had transient acute kidney injury.…”

Section: Discussionmentioning

confidence: 93%

“…5,6 Many studies have shown that antifibrinolytic agents used in patients undergoing on-pump cardiac surgery had a significant effect in decreasing bleeding after surgery. 16,17 Khalil and colleagues 4 revealed that local fibrinolytic activity in the pericardium was higher than in blood because the pericardium releases a tissue plasminogen activator in large amounts, preventing blood clotting in the pericardium. A previous randomized study in CABG patients showed that local TA administration reduced postoperative blood loss by 25% (p ¼ 0.01).…”

Section: Discussionmentioning

confidence: 99%

“…17 This study was conducted to evaluate the efficacy of topical use of TA in addition to intravenous TA in reducing postoperative bleeding in elective on-pump open heart surgery.…”

Section: Discussionmentioning

confidence: 99%

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Additional effects of topical tranexamic acid in on-pump cardiac surgery

Taksaudom

Siwachat

Tantraworasin

2016

Asian Cardiovasc Thorac Ann

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Objective: Postoperative bleeding after cardiac surgery is commonly associated with hyperfibrinolysis. This study was designed to evaluate the efficacy of topical tranexamic acid in addition to intravenous tranexamic acid in reducing bleeding in cardiac surgery cases. Methods: From July 1, 2014 to September 30, 2015, 82 patients who underwent elective on-pump cardiac surgery were randomized into a tranexamic acid group and a placebo group. In the tranexamic acid group, 1 g of tranexamic acid dissolved in 100 mL of normal saline solution was poured into the pericardium during sternal closure; the placebo group had 100 mL of saline only. Two patients were excluded from the study due to obvious surgical bleeding. The primary endpoint was total blood loss 24 h after surgery. Repeated measures with mixed models was used to analyze bleeding over time.Results: There was no significant difference in demographic and intraoperative data except for a significantly lower platelet count preoperatively in the tranexamic acid group (p ¼ 0.030). There was no significant difference in postoperative drainage volumes at 8, 16, and 24 h, postoperative bleeding over time (coefficient ¼ 0.713, p ¼ 0.709), or blood product transfusion between the groups. There were no serious complications. Conclusions: Topical tranexamic acid is safe but it adds no additional efficacy to the intravenous application in reducing postoperative blood loss. Intravenous tranexamic acid administration alone is sufficient antifibrinolytic treatment to enhance the hemostatic effects during on-pump cardiac surgery.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Additional effects of topical tranexamic acid in on-pump cardiac surgery

Taksaudom

Siwachat

Tantraworasin

2016

Asian Cardiovasc Thorac Ann

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“…Aprotinin has been used in a considerable number of surgical procedures [8][9][10][11][12][13] since it was first utilized as an antifibrinolytic agent by Tice et al [10] in 1963. Its efficacy was observed in several studies and thus, it is routinely used in some centers, in particular in complex heart surgeries [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Several methods have been studied including normovolemic hemodilution, intraoperative autotransfusion with predonation of autologous blood and the use of pharmacological agents, including protamine [8,9].…”

Section: Introductionmentioning

confidence: 99%

<![CDATA[<B>Use of aprotinin in thoracic aortic operations associated with deep hypothermic circulatory arrest</B>: <B>a meta-analysis</B>]]>

Locali¹,

Buffolo²,

Palma³

2006

Braz. j. cardiovasc. surg.

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RBCCV 44205-845Uso da aprotinina na operação da aorta torácica associada à hipotermia profunda e parada circulatória: metanálise Use of aprotinin in thoracic aortic operations associated with deep hypothermic circulatory arrest: a meta-analysis Abstract Objective: To evaluate complications involved in the use of aprotinin in patients after thoracic aortic aneurysm or dissection surgeries associated with deep hypothermic circulatory arrest.Methods: A systematic review of literature was carried out, with a search strategy of low specificity, in the Medline ® and LILACS ® databases. Two independent researchers carried out article selection following the criteria adopted for inclusion of studies, grouping them into two groups, one where low doses of aprotinin were employed and the other with high doses. The results are presented as relative risk for the dichotomy variable, and as weighted mean differences for continuous variables, both with 95% confidence intervals.Results: Seven articles were included in the systematic review selected from 2044 revised studies. Meta-analysis of the only randomized controlled trial did not demonstrate risks with the use of aprotinin, and presented a significant reduction in bleeding and blood transfusion requirements. Meta-analysis of the studies that used low doses of aprotinin was similar. On the other hand, meta-analysis of the studies that adopted high doses of aprotinin did not present statistical significance in any of the studied variables.Conclusion: Despite of the results not showing any effective risks with the use of aprotinin, the statistical power of the meta-analysis is low. Therefore, new randomized controlled trials are required, in order to detect possible complications in the use of aprotinin in this type of operation.Descriptors: Aprotinin. Aorta thoracic. Hypothermia induced. Meta-analysis. 378LOCALI, RF ET AL -Use of aprotinin in thoracic aortic operations associated with deep hypothermic circulatory arrest: a meta-analysis Braz J Cardiovasc Surg 2006; 21(4): 377-385 INTRODUCTIONThe conventional surgical treatment of aneurysms or dissections of the ascending or transverse aorta is indispensable to guarantee a satisfactory prognosis of the patient. It is well known that this procedure is associated with high morbimortality rates. Thus, in order to reduce the intra-operative risks, it is necessary to establish cardiopulmonary bypasses (CPB) and deep hypothermia with circulatory arrest (DHCA) [1,2]. However, it is also well known that the combination of CPB with DHCA may contribute to a greater risk of complications of the surgical procedure by triggering hemostatic dysfunction and coagulopathies [2,3].Coagulopathies triggered by CPB have a multifactorial origin although its primary cause is exposure of the blood to the materials of the heart-lung machine [4]. Additionally, the administration of heparin and protamine cause alterations to the hemostatic balance by activation of the platelets, neutrophils and of the fibrinolytic system as well as consuming coagul...

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Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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IMPORTANCE Tranexamic acid (TXA) is an efficient antifibrinolytic agent; however, concerns remain about the potential adverse effects, particularly vascular occlusive events, that may be associated with its use.OBJECTIVE To examine the association between intravenous TXA and total thromboembolic events (TEs) and mortality in patients of all ages and of any medical disciplines.DATA SOURCE Cochrane Central Register of Controlled Trials and MEDLINE were searched for eligible studies investigating intravenous TXA and postinterventional outcome published between 1976 and 2020.STUDY SELECTION Randomized clinical trials comparing intravenous TXA with placebo/no treatment. The electronic database search yielded a total of 782 studies, and 381 were considered for full-text review. Included studies were published in English, German, French, and Spanish. Studies with only oral or topical tranexamic administration were excluded.DATA EXTRACTION AND SYNTHESIS Meta-analysis, subgroup and sensitivity analysis, and meta-regression were performed. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Vascular occlusive events and mortality.RESULTS A total of 216 eligible trials including 125 550 patients were analyzed. Total TEs were found in 1020 (2.1%) in the group receiving TXA and 900 (2.0%) in the control group. This study found no association between TXA and risk for total TEs (risk difference = 0.001; 95% CI, −0.001 to 0.002; P = .49) for venous thrombosis, pulmonary embolism, venous TEs, myocardial infarction or ischemia, and cerebral infarction or ischemia. Sensitivity analysis using the risk ratio as an effect measure with (risk ratio = 1.02; 95% CI, 0.94-1.11; P = .56) and without (risk ratio = 1.03; 95% CI, 0.95-1.12; P = .52) studies with double-zero events revealed robust effect size estimates. Sensitivity analysis with studies judged at low risk for selection bias showed similar results. Administration of TXA was associated with a significant reduction in overall mortality and bleeding mortality but not with nonbleeding mortality. In addition, an increased risk for vascular occlusive events was not found in studies including patients with a history of thromboembolism. Comparison of studies with sample sizes of less than or equal to 99 (risk difference = 0.004; 95% CI, −0.006 to 0.014; P = .40), 100 to 999 (risk difference = 0.004; 95% CI, −0.003 to 0.011; P = .26), and greater than or equal to 1000 (risk difference = −0.001; 95% CI, −0.003 to 0.001; P = .44) showed no association between TXA and incidence of total TEs. Meta-regression of 143 intervention groups showed no association between TXA dosing and risk for venous TEs (risk difference, −0.005; 95% CI, −0.021 to 0.011; P = .53).CONCLUSIONS AND RELEVANCE Findings from this systematic review and meta-analysis of 216 studies suggested that intravenous TXA, irrespective of dosing, is not associated with increased risk of any TE. These results help clarify the incidence of...

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Tranexamic acid reduces postbypass blood use: A double-blinded, prospective, randomized study of 210 patients

Cited by 101 publications

References 22 publications

Additional effects of topical tranexamic acid in on-pump cardiac surgery

Additional effects of topical tranexamic acid in on-pump cardiac surgery

<![CDATA[<B>Use of aprotinin in thoracic aortic operations associated with deep hypothermic circulatory arrest</B>: <B>a meta-analysis</B>]]>

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

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