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

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

The Annals of Thoracic Surgery

Volume 61, Issue 4, April 1996, Pages 1131-1135

https://doi.org/10.1016/0003-4975(96)00022-7 Get rights and content

Background.

Pharmacologic intervention to minimize postbypass bleeding and blood product transfusions has received increasing attention for both medical and economic reasons.

Methods.

Two hundred ten patients were entered into a double-blinded, prospective, randomized study to receive either 10 g of the fibrinolytic inhibitor tranexamic acid before incision (n = 104) or 250 mL of placebo saline solution (n = 106). All subjects requiring cardiopulmonary bypass were deemed suitable, including those having first-time coronary bypass grafting, valve replacement, and reoperation.

Results.

There were no statistically significant differences between the groups with respect to demographic or operative characteristics. The tranexamic acid group had a 48% reduction in 24-hour blood drainage (p < 0.001) and received 69% fewer total units of packed red blood cells, 83% fewer total units of plasma, and 75% fewer platelet transfusion units than controls. Only 13 of 104 tranexamic acid patients received blood products versus 33 of 106 controls (p < 0.001). The incidences of thrombotic complications, perioperative myocardial infarction, renal failure, and neurologic complications were not significantly different between the two groups. The tranexamic acid group had 0% mortality versus 1.9% for controls (not significant).

Conclusions.

Tranexamic acid is safe and effective in reducing blood loss and blood use in a wide variety of cardiac surgical patients.

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Severe hemorrhage has posed a serious threat to the health and even life of civilian and military populations and brought serious economic losses. Consequently, it is imperative to develop effective hemostatic materials and strategies. However, numerous hemostatic agents are unable to perfectly meet the requirements of ideal hemostatic agents, and hence strenuous efforts need to be made to develop safe and efficacious hemostatic materials. Recently, the booming achievements have been witnessed in the hemostatic material field. In this review, the general coagulation process, the hemostatic mechanisms, and the design strategies of hemostatic materials are briefly discussed. Subsequently, we introduce the latest investigations on the various external (local) hemostatic materials and internal (intravenous) hemostatic agents including external inorganic hemostatic materials, peptides/proteins with hemostatic activity, polysaccharide hemostats, synthetic hemostatic polymers, and intravenous hemostatic technologies, and summarize the preparation methods, the physical, chemical, and biological properties, and the hemostatic applications of these different materials. This review also briefly discusses some major problems and challenges in the research of various hemostatic materials, hoping to provide valuable insights for the development of new hemostatic materials.
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In randomized studies, no marked increase in thrombosis after administration of TXA was observed, even in cases in which a thrombotic complication was anticipated and even when the agent was given during an operation.23,24 The plasma TXA concentration found to be effective in obtaining antifibrinolysis has been reported to range from 5 to 15 mg/L, and when 1300 mg TXA was given orally for 5 days, the peak plasma concentration was 16.4 mg/L.24 In Japan, TXA is available in 250-mg capsules, and patients in the TXA group in our study took six of these daily. Overall, these patients had significantly greater aneurysm shrinkage than those not given TXA.
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From May 2007 to May 2012, EVAR was performed in 187 patients, 165 of whom had an enhanced computed tomographic evaluation 6 months after their procedure. Six of the 165 patients were excluded from the study because they had a type Ia endoleak or coil embolization to treat a type II endoleak ≤6 months after EVAR. Of the remaining 159 patients, 110 underwent EVAR before we started to use TXA in our centers. TXA therapy (1500 mg/d for 6 months) began in January 2011, and 48 patients completed the treatment regimen. Patients not treated with TXA were compared with those given TXA. Analyses to identify risk factors for lack of aneurysm shrinkage were performed.
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Over a 4-month period, our CCP flight crews used TXA a total of 13 times. Patients had an average HR of 111 bpm [95% CI 90.71–131.90], SBP of 91 mmHg [95% CI 64.48–118.60], and Glascow Coma Score of 7 [95% CI 4.65–9.96]. For primary AME, average response time was 33 minutes [95% CI 19.03–47.72], scene time 22 minutes [95% CI 20.23–24.27], and time to TXA administration 32 minutes [95% CI 25.76–38.99] from first patient contact. There were no reported complications with the administration of TXA in any patient.
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: Presented at the Forty-second Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 9–11, 1995.

View full text

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

Background.

Methods.

Results.

Conclusions.

Ann Thorac Surg

J Thorac Cardiovas Surg

J Thorac Cardiovasc Surg

Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Am J Surg

J Thorac Cardiovasc Surg

Lancet

Lancet

Am J Opth

Predisposing factors and management of hemorrhage following open-heart surgery

J Cardiovasc Surg

The pathogenesis and control of the hemorrhagic defect in open heart surgery

Surg Gynecol Obstet

Treatment with desmopressin acetate to reduce blood loss after cardiac surgery: a double-blind randomized trial

N Engl J Med