Usefulness of Intraoperative Continuous Infusion of Tranexamic Acid during Emergency Surgery for Type A Acute Aortic Dissection

Abstract

IntroductionStanford type A acute aortic dissection is one of the diseases requiring emergency surgery. In acute aortic dissection, a large number of thrombi are rapidly formed in the false lumen immediately after onset, which activates the fibrinolytic system. Moreover, the surgery is performed using extracorporeal circulation with haparin, under hypothermic conditions. Both use of extracorporeal circulation and hypothermia are known to activate the fibrinolytic system. Thus, perioperative bleeding is a major problem in surgery for acute aortic dissection, often necessitating blood transfusion in large amounts during surgery. Aprotinin, which had been used to reduce Purpose: We investigated the influence of intraoperative continuous tranexamic acid (TA) infusion on the amount of blood transfusion required in emergency surgery for type A acute aortic dissection. Methods: The study was based on the data of 55 consecutive patients who underwent surgery for type A acute aortic dissection. The patients were divided into 2 groups for comparison: Group T, consisting of 26 patients who received intraoperative continuous infusion of TA, and Group N, consisting of 29 patients who did not receive TA infusion during the surgery. Results: The mean amounts of blood transfusion required during and after surgery were compared between the 2 groups: they were 10.5 ± 8.7 and 16.2 ± 10.0 units of mannitoladenine-phosphate-added red cell concentrate, 9.3 ± 8.6 and 17.1 ± 10.0 units of fresh frozen plasma, and 20.4 ± 12.2 and 29.7 ± 14.9 units of platelet concentrate, respectively, in Groups T and N. Thus, the amount of each of these blood products required was significantly reduced in Group T. Conclusions: During emergency surgery for type A acute aortic dissection, continuous infusion of TA resulted in a significant reduction in the amount of blood transfusion required. Usefulness of Intraoperative Continuous Infusion of Tranexamic Acid during Emergency

Intravenous Tranexamic Acid Reduces Post-Operative Bleeding and Blood Transfusion in Patients Undergoing Aortic Surgery: A PRISMA-Compliant Systematic Review and Meta-Analysis

“…It has been certified that TXA can reduce blood loss and transfusion requirements effectively in cardiac [20] and non-cardiac surgical patients [21,22]. Similar results were obtained by Ahn et al [5] in a study which retrospectively studied data from 55 adult patients who underwent acute aortic dissection surgery between April 2008 and April 2010. Moreover, Makhija et al [7] also reported TXA had equal effect in reducing the perioperative bleeding and transfusion requirements in patients undergoing surgery for thoracic aortic compared with epsilonamino-caproic acid.…”

High-Dose Tranexamic Acid in Patients Underwent Surgical Repair of Aortic Dissection Might Reduce Postoperative Blood Loss: A Cohort Analysis

“…Our study showed that blood loss, not blood transfusion, was decreased in the high-dose group compared to the low-dose group. In acute aortic dissection, a large number of thrombi are rapidly formed in the false lumen immediately after onset, which activates the fibrinolytic system ( 18 ). Surgical factors also contribute to the activation of fibrinolytic system, such as aortic cross clamp ( 20 ), cardiopulmonary bypass ( 21 ), and hypothermia ( 22 ).…”

Blood conservation in cardiac surgery

“…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).…”