Effects of Tranexamic Acid and Autotransfusion in Coronary Artery Bypass

Abstract

The aim of this study was to compare the effects of intraoperative autotransfusion and tranexamic acid on postoperative bleeding and the need for allogeneic transfusion. In a prospective randomized study, 200 patients undergoing coronary artery bypass were divided into two groups: 100 patients received 1-2 units of autologous blood after termination of cardiopulmonary bypass; and 100 patients were given tranexamic acid 15 mg x kg(-1) before injection of heparin and again before injection of protamine. Postoperative bleeding was significantly lower in the tranexamic acid group (600 mL) than the autotransfusion group (1,100 mL). The percentage of patients transfused in the autotransfusion and tranexamic acid groups was 70% and 65%, respectively. Patients in the autotransfusion group received significantly more whole blood (2.82 vs 1.93 units). Intensive care and hospital stays were shorter in the tranexamic acid group. There was no hospital mortality and no difference in thrombotic complications between groups. Tranexamic acid was more effective than autotransfusion in reducing postoperative blood loss and allogeneic transfusions after coronary bypass.

Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss

“…Nine reports described multiarm trials involving a total of 23 eligible pair wise comparisons; each of these was included in the analysis as a separate trial. One hundred and four randomized comparisons, described in 90 articles, reported data on blood loss in a format suitable for this analysis. These trials involved a total of 8030 patients; 4224 received TXA and 3806 received a placebo or no intervention.…”

Documento «Sevilla» de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica

“…1B Los resultados de dos meta-análisis de 42 RCTs mostraron una pequeña reducción significativa de la tasa transfusional 18,36 . Sin embargo, la eficacia de la HAN quedó prácticamente eliminada cuando existía un protocolo de transfusión y cuando se asoció o se comparó con otras técnicas de ahorro de TSA (DPSA, ácido tranexámico e hipotensión controlada) 18,36,37 .…”

“…Las bolsas pueden conservarse en quirófano a temperatura ambiente durante un máximo de 6 horas y administrarse en orden inverso al de su extracción. Aunque en la mayor parte de los estudios analizados no se observó que la HAN se asociara a un aumento del riesgo de morbi-mortalidad, la calidad de la evidencia a este respecto es moderada-baja 36,37 . Se ha asociado el uso de HAN con incremento de las tasa de fracaso renal en adultos 39 y de alteraciones del desarrollo psicomotor en los niños 40 , ambos sometidos a cirugía cardiaca.…”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary

“…Digoxin and nondihydropyridine calcium channel blockers can be useful to control the ventricular rate in the setting of AF but are not indicated for prophylaxis(265). (Level of Evidence: B) Lysine analogues are useful intraoperatively and postoperatively in patients undergoing on-pump CABG to reduce perioperative blood loss and transfusion requirements(431)(432)(433)(434)(435)(436)(437)(438). (Level of Evidence: A) 2.…”