No abstract

Cardiac surgery, owing to its invasiveness, need of anticoagulation, exposure to extracorporeal circulation (CPB) and relatively longer duration, is known to be associated with an increased risk of perioperative blood loss and allogeneic blood transfusions. Excessive bleeding requiring allogenic blood and blood components transfusion after cardiopulmonary bypass (CPB) is a common complication of cardiac surgery imparting detrimental health and economic consequences. Many techniques like preoperative autologous blood collection (PAC), Acute normovolumic hemodilution (ANH), use of miniaturized CPB circuit and use of ultrafiltration during conduct of cardiopulmonary bypass (CPB) have been applied in the past to conserve the blood during perioperative period in cardiac surgery. Current study aimed to observe the efficacy of Tranexamic acid used during intraoperative period on post-operative blood loss and requirement of allogenic blood and blood products transfusion in cardiac surgical patients requiring cardiopulmonary bypass (CPB). Material and methods: 120 adult patients undergoing cardiac surgery requiring elective cardiopulmonary bypass (CPB) were categorized into 2 groups. Study ("TXA") group was subjected to administration of tranexamic acid (20 mg/ kg in divided doses). The 1 st dose (10 mg/kg) was given before initiation of CPB, 2 nd dose (5 mg/kg) was given during rewarming on CPB and 3 rd dose (5 mg/kg) was given after weaning off CPB along with protamine. The control ("NS") group patients received normal saline as a placebo. Statistical analysis was done using "z test". Results: "TXA" group had significantly lower post-operative bleeding and lesser requirement of allogenic blood and blood products transfusion. The mean post-operative blood loss in "TXA" group was 427.42+/-225.18 ml vs. 728.67+/-301.33ml in "NS" group. The mean PCV units transfused post operatively in 72 hours in "TXA" group was 0.20+/-0.44 units vs. 0.67+/-0.60 in "NS" group. Patients in "TXA" group did not require any FFP or platelets unit in contrast to "NS" group where few patients required these products. Conclusion: The use of Tranexamic acid during intraoperative period in patient undergoing cardiac surgery requiring cardiopulmonary bypass circuit significantly reduces the post-operative bleeding and requirement of allogenic blood and blood products transfusion.