Does Tranexamic Acid Reduce Blood Loss in Off-Pump Coronary Artery Bypass?

Mehraein, A; Sadeghi, Mostafa; Madani-Civi, Manouchehr

doi:10.1177/021849230701500404

Cited by 22 publications

(28 citation statements)

References 19 publications

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“…[1] Though OPCAB surgeries are associated with fewer complications, bleeding continues to be an issue that requires to be addressed. [2,3] Hemodynamic management during OPCAB by the administration of boluses of intravenous fluids and the properties of these fluids contributing to hemorheological stability remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…[5,6] The search for the newer modes to facilitate reduction in perioperative blood loss continues, the use of fibrinolytic inhibitors such as TA may be an effective method to promote blood conservation; but, the possible complications of thrombosis of coronary artery graft, precludes their regular use in coronary artery bypass graft surgeries. [1,6,7] In this study we assessed the hemostatic effects of concomitant use of HES and TA. Thromboelastogram (TEG) was used to assess the hemostatic effect of the combination of HES and TA.…”

Section: Introductionmentioning

confidence: 99%

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A randomized prospective analysis of alteration of hemostatic function in patients receiving tranexamic acid and hydroxyethyl starch (130/0.4) undergoing off pump coronary artery bypass surgery

et al. 2012

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Postoperative hemorrhagic complications is still one of the major problems in cardiac surgeries. It may be caused by surgical issues, coagulopathy caused by the side effects of the intravenous fluids administered to produce plasma volume expansion such as hydroxyl ethyl starch (HES). In order to thwart this hemorrhagic issue, few agents are available. Fibrinolytic inhibitors like tranexamic acid (TA) may be effective modes to promote blood conservation; but the possible complications of thrombosis of coronary artery graft, precludes their generous use in coronary artery bypass graft surgery. The issue is a balance between agents that promote coagulation and those which oppose it. Therefore, in this study we have assessed the effects of concomitant use of HES and TA. Thromboelastogram (TEG) was used to assess the effect of the combination of HES and TA. With ethical committee approval and patient's consent, 100 consecutive patients were recruited for the study. Surgical and anesthetic techniques were standardized. Patients fulfilling our inclusion criteria were randomly allocated into 4 groups of 25 each. The patients in group A received 20 ml/kg of HES (130/0.4), 10 mg/kg of T.A over 30 minutes followed by infusion of 1 mg/kg/hr over the next 12 hrs. The patients in group B received Ringer's lactate + TA at same dose. The patients in the Group C received 20 ml/kg of HES. Group D patients received RL. Fluid therapy was goal directed. Total blood loss was assessed. Reaction time (r), α angle, maximum amplitude (MA) values of TEG were assessed at baseline, 12, 36 hrs. The possible perioperative myocardial infraction (MI) was assessed by electrocardiogram (ECG) and troponin T values at the baseline, postoperative day 1. Duration on ventilator, length of stay (LOS) in the intensive care unit (ICU) were also assessed. The demographical profile was similar among the groups. Use of HES increased blood loss significantly (P < 0.05). Concomitant use of TA reduced blood loss when used along with HES. r value was prolonged at 12 hours in all the groups and α angle was reduced at 12 hours in all the groups, where as MA value was reduced at 12 th hour in the HES group compared to the baseline and increased in TA + HES group. These findings were statistically significant. No significant change in Troponin T values/ECG, duration of ventilation and LOS ICU was observed. No adverse events was noticed in any of the four groups. HES (130/0.4) used at a dose of 20 ml/kg seems to produce coagulopathy causing increased blood loss perioperatively. Hemodilution produced by fluid therapy seems to produce Coagulopathy as observed by TEG parameters. Concomitant use of TA with HES appears to reverse these changes without causing any adverse effects in patients undergoing OPCAB surgery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A randomized prospective analysis of alteration of hemostatic function in patients receiving tranexamic acid and hydroxyethyl starch (130/0.4) undergoing off pump coronary artery bypass surgery

et al. 2012

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“…Tranexamic acid has been widely and successfully used to reduce bleeding in cardiac [4][5][6], orthopaedic [7,8], prostate [9] and caesarean sections surgeries [10,11]. In this study we plan to verify the efficacy of tranexamic acid in reducing tonsillectomy bleeding.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Control Trial to Verify the Efficacy of Pre-Operative Intra Venous Tranexamic Acid in the Control of Tonsillectomy Bleeding

George

Kumar

et al. 2011

Indian J Otolaryngol Head Neck Surg

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Tonsillectomy is an age old surgery which is still very commonly done. Bleeding related to surgery is the major problem. This study is done to verify by randomized control trial the efficacy of preoperative intravenous tranexamic acid in the control of tonsillectomy bleeding. Hundred cases undergoing tonsillectomy were randomized into two groups, one of which received preoperatively intra venous tranexamic acid, 10 mg kg -1. The other group patients were given a placebo. Amount of bleeding was assessed in each case. The study group had statistically highly significant reduction in bleeding. There were no side effects of the drug. This finding is similar to that in other studies for tonsillectomy, other surgeries and other hemorrhagic conditions. Tranexamic acid in the dose of 10 mg kg -1 given intra venous pre-operatively is effective in the control of tonsillectomy bleeding.

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“…[3][4][5][6][7][8][9][10] Each of these randomized trials compared tranexamic acid with placebo or inactive control, and each measured blood loss or transfusions as a primary endpoint. Only 1 of the 8 trials of tranexamic in OPCAB found a significant reduction in the risk of allogeneic blood product exposure.…”

mentioning

confidence: 99%