Comparison Effect of Tranexamic Acid (TA) and Tranexamic Acid Combined with Vitamin C (TXC) on Drainage Volume and Atrial Fibrillation Arrhythmia in Patients Undergoing Cardiac Bypass Surgery: Randomized Clinical Trial

Abstract

BackgroundTranexamic acid and vitamin C are potent antifibrinolytic and oxidative stress agents that reduce blood loss and transfusion blood in cardiopulmonary bypass (CPB).ObjectivesThe aim of this study was to evaluate the efficacy of tranexamic acid (TA) and tranexamic acid combined with vitamin C (TXC) on drainage volume (blood loss) and atrial fibrillation (AF) in patients undergoing cardiac bypass surgery in Gorgan, Shafa hospital, Iran.MethodsThis study is a double-blind randomized clinical trial. A sample size of 120 candidates of cardiac bypass surgery were included in this prospective study. Patients were randomly assigned to treatments in two groups. In both groups, 50 mg/kg tranexamic acid was administered intravenously directly before sternotomy: group A (N = 58) patients received tranexamic acid (TA) only and group B (N = 62) tranexamic acid with vitamin C (TXC) half an hour before surgery and 2 g vitamin C with 100 mL 0.9% saline were injected. Subsequently, during 4 days after surgery, 1000 mg of vitamin C and 100 cc 0.9% saline was infused every day. Intraoperative and postoperative blood loss (volume of blood in the drain) and atrial fibrillation complications were recorded for 24 hours after the operation.ResultsThe patients who received vitamin C had less bleeding during operation and in the early hours post-operation. Patients in (TA) group had mean drainage of 34.41 milliliter more than patients in (TXC) group (P < 0.001). Chi-square test showed that arrhythmia (AF) condition was the same in the two groups during 14 times of study (four times during operation and ten times up to 24 hours after the operation), and AF arrhythmia in the two groups was less than 5%.ConclusionsIn this study tranexamic acid with vitamin C have a positive effect on the amount of drainage (blood loss) and there was no significant difference in the incidence of AF between two groups.

The Effect of Perioperative Vitamin C on Postoperative Analgesic Consumption: A Meta-Analysis of Randomized Controlled Trials

“…Therefore, vitamin C deficiency should be included as a differential diagnosis for surgical patients with nonspecific bleeding especially in those with severe illnesses, prolonged hospitalization, and poor dietary intake, which are known contributors to vitamin C deficiency [ 48 ]. Consistently, previous randomized controlled trials have demonstrated a significant reduction in surgical blood loss among patients undergoing abdominal myomectomy [ 28 ] and cardiopulmonary bypass surgery [ 47 ] with intraoperative vitamin C supplementation compared to those without. Nevertheless, the current study did not demonstrate a significant association between perioperative vitamin C supplementation and surgical blood loss.…”

“…Besides antinociception, another issue regarding patient safety is the association between vitamin C deficiency and surgical bleeding. Vitamin C is pivotal to platelet aggregation and prevention of platelet depletion in the process of hemostasis [ 47 ]. Spontaneous hemorrhage has been reported in patients with plasma vitamin C concentrations less than 0.6 mg/dL [ 48 ] due to impaired vascular integrity from defective collagen formation [ 48 ].…”

Comparison of the Effect of Heparinized Normal Saline Solution Versus Saline Solutions in Arterial and Central Venous Catheters on Complete Blood Count After Cardiac Surgery

“…In cardiac surgery, central venous catheters are widely utilized to monitor central venous pressure and administer fluids, blood products, and medications (15)(16)(17)(18). A prolonged period of catheter use may result in catheter occlusion, leading to thrombosis and bloodstream infection (19,20).…”

Evaluation of the Relationship Between Changes in Potassium Concentration and Arrhythmia During Coronary Artery Bypass Grafting Surgery

“…Electrolyte disturbances are key factors in the occurrence of cardiac arrhythmias; therefore, it is essential to check serum electrolytes several times in the first 24 hours and at least once a day thereafter to prevent them. According to studies, the most common postoperative electrolyte disturbances are potassium abnormalities (1)(2)(3).…”