Pharmacokinetics of Tranexamic Acid during Cardiopulmonary Bypass

Dowd, N.; Karski, Jacek; Cheng, Davy; Carroll, Jo; Lin, Yonggu A.; James, Robert L.; Butterworth, John F.

doi:10.1097/00000542-200208000-00016

Cited by 184 publications

(205 citation statements)

References 28 publications

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“…Various studies have been performed with the aim of identifying the correct dosage of TnX-A. A bolus dose of 10 mg/kg in 20 min before cutaneous incision followed by infusion at the rate of 1 mg/kg per hour has been suggested as the ideal dosage for bleeding control, and increasing the dosage has been reported as having no additional beneficial effects on bleeding control (19)(20)(21). Similar to our study, the highest level of postoperative bleeding was observed in the postoperative first 3 h. We similarly initiated TnX-A infusion with skin incision at the dosage as described.…”

Section: Tnx-a (N = 18)mentioning

confidence: 99%

Emergency coronary bypass surgery in patients under the influence of dualantiplatelet therapy: effects of tranexamic acid and desmopressin acetate

Altun¹,

Hemsinli²,

Pulathan³

et al. 2017

Turk J Med Sci

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Background/aim: Bleeding in patients undergoing coronary artery bypass grafting (CABG) while using dual antiplatelet therapy (DAPT) is a cause of significant morbidity and mortality. The aim of this study is to examine the perioperative hemostatic effects of tranexamic acid (TnX-A) and desmopressin acetate (Des) in these patients. Materials and methods:This clinical study was planned in a prospective and randomized manner. Fifty-four patients were enrolled and classified into 4 different groups. They were compared in terms of various bleeding and transfusion parameters.Results: No significant differences were observed between the groups in pre/intraoperative data apart from closure times. Plasmin/α-2 antiplasmin complex values in the TnX-A and control groups were significantly higher than those in the Des and TnX-A+Des groups at the end of postoperative drug infusion. Mean duration of closure times, first 3-h and total postoperative amounts of drainage, administered volumes of erythrocyte suspension/fresh frozen plasma, cost of blood products, length of intubation, length of stay in the intensive care unit, and time to discharge were also significantly higher in the Des and control groups. Conclusion:Des had no significant effect on bleeding control and even delayed the hemostatic efficacy of TnX-A. Use of TnX-A infusion alone in these patient groups had a positive effect on hemostasis-related data.

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Section: Tnx-a (N = 18)mentioning

confidence: 99%

Emergency coronary bypass surgery in patients under the influence of dualantiplatelet therapy: effects of tranexamic acid and desmopressin acetate

Altun¹,

Hemsinli²,

Pulathan³

et al. 2017

Turk J Med Sci

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“…5,7 An initial TXA bolus of 30 mgÁkg -1 was infused over 15 min followed by a 16 mgÁkg -1 Áhr -1 infusion until chest closure with a 2 mgÁ kg -1 load in the pump prime. Blood samples were obtained at baseline, five minutes after the bolus, five minutes before and after commencing CPB, and at 30-min intervals whilst on CPB.…”

Section: Methodsmentioning

confidence: 99%

“…6 Optimal dosing of TXA is still unknown and several theoretical models have been developed and applied. One of the most popular dosing regimens is based on the pharmacokinetic model developed by Dowd et al 7 It has been used in a randomized controlled trial comparing the use of three antifibrinolytic agents in high-risk cardiac surgical patients [Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART)]. 5 The plasma concentrations of TXA in patients undergoing cardiac surgery with these antifibrinolytic doses have not been studied.…”

Section: Résumémentioning

confidence: 99%

Use of a novel technique, solid phase microextraction, to measure tranexamic acid in patients undergoing cardiac surgery

Wąsowicz

Jerath

Bojko

et al. 2011

Can J Anesth/J Can Anesth

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“…Em trabalho recente, publicado por Fiechtner e col. 65 , a dose descrita manteve níveis séricos adequados (↑ 10 µg.mL -1 ). Esse regime de administração foi questionado por estudo preliminar, realizado por Dowd e col. 66 …”

Section: áCido Tranexâmicounclassified

“…In a recent study by Fischer et al 65 , the dose described maintained adequate levels (↑ 10 µg.mL -1 ). This administration regimen was questioned by a preliminary study by Dowd et al 66 , who measured serum levels of TA during CPB. The administration of 10 mg.kg -1 of TA followed by the infusion of 1 mg.kg -1 .h -1 did not maintain therapeutic levels in isolated moments of CPB.…”

Section: Tranexamic Acidmentioning

confidence: 99%

Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

Santos¹,

Splettstosser²,

Warpechowski³

et al. 2007

Rev. Bras. Anestesiol.

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RESUMOSantos ATL, Splettstosser JC, Warpechowski P, Gaidzinski MMPAntifibrinolíticos e Cirurgia Cardíaca com Circulação Extracorpórea. JUSTIFICATIVA E OBJETIVOS:A cirurgia cardíaca é a especialidade cirúrgica que com mais freqüência está associada a sangramento, coagulopatia e necessidade de derivados de sangue. Os agentes farmacológicos aprotinina, ácido epsilon-aminocapróico e ácido tranexâmico são os mais utilizados para auxiliar na hemostasia dos pacientes submetidos à circulação extracorpórea. O objetivo deste trabalho foi apresentar a fisiopatologia do sangramento em cirurgia cardíaca e a atual situação dos antifibrinolíticos quanto à sua eficácia e complicações quando usados nesses procedimentos, dando maior ênfase ao ácido tranexâmico e à aprotinina. CONTEÚDO:São discutidos os mecanismos pelos quais a circulação extracorpórea provoca alteração na hemostasia e de que maneira os antifibrinolíticos agem para diminuir o sangramento e o uso de sangue alogênico em cirurgia cardíaca. É dada ênfase ao problema do tromboembolismo que pode ocorrer com o emprego desses antifibrinolíticos, com revisão da literatura. CONCLUSÃO:A fibrinólise é um dos principais fatores relacionados com o aumento do sangramento em cirurgia cardíaca com circulação extracorpórea. A inibição da fibrinólise, juntamente com a preservação da função plaquetária, é, provavelmente, o mecanismo pelo qual os antifibrinolíticos diminuem o sangramento. O emprego desses fármacos reduz o sangramento em cirurgia cardíaca com circulação extracorpórea num percentual que pode chegar a 50%. Com relação à preocupação com o tromboembolismo, os áci-dos tranexâmico e epsilon-aminocapróico são opções que oferecem maior segurança que a aprotinina.Unitermos: CIRURGIA, Cardíaca: circulação extracorpórea, DRO-GAS, Antifibrinolíticos: aprotinina, ácido epsilon-aminocapróico, áci-do tranexâmico; SANGUE: coagulação. SUMMARYSantos ATL, Splettstosser JC, Warpechowski P, Gaidzinski MMPAntifibrinolytics and Cardiac Surgery with Cardiopulmonary Bypass. BACKGROUND AND OBJECTIVES:Cardiac surgery is the surgical subspecialty most often associated with bleeding, bleeding disorders, and the need of blood products. Agents such as aprotinin, episilon-aminocaproic acid, and tranexamic acid are frequently used to aid the hemostasis of patients undergoing cardiopulmonary bypass. The objective of this report is to present the physiopathology of bleeding during cardiac surgeries and the current role of antifibrinolytics regarding their efficacy and complications when used in those procedures, with emphasis on tranexamic acid and aprotinin. CONTENTS:The mechanisms of changes in hemostasis caused by cardiopulmonary bypass, how antifibrinolytics decrease bleeding, and the use of alogenic blood in cardiac surgery are discussed. A review of the literature emphasizes the thromboembolism secondary to the use of those antifibrinolytics. CONCLUSION:Fibrinolysis is one of the main factors related with increased bleeding during cardiac surgery with cardiopulmonary bypass. Inhibition of fibrinol...

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Pharmacokinetics of Tranexamic Acid during Cardiopulmonary Bypass

Cited by 184 publications

References 28 publications

Emergency coronary bypass surgery in patients under the influence of dualantiplatelet therapy: effects of tranexamic acid and desmopressin acetate

Emergency coronary bypass surgery in patients under the influence of dualantiplatelet therapy: effects of tranexamic acid and desmopressin acetate

Use of a novel technique, solid phase microextraction, to measure tranexamic acid in patients undergoing cardiac surgery

Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

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