Single-Dose Tranexamic Acid Reduces Postoperative Bleeding After Coronary Surgery in Patients Treated with Aspirin Until Surgery

Pleym, Hilde; Stenseth, Roar; Wahba, Alexander; Bjella, Lise; Karevold, Asbjørn; Dale, Ola

doi:10.1213/01.ane.0000054001.37346.03

Cited by 70 publications

(58 citation statements)

References 25 publications

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“…In line with the results of this research, a study by Pleym et al (20) in 2003 and a meta-analysis (21) in 2012 revealed that antifibrinolytic drugs such as aprotinin were effective in bleeding reduction during surgery.…”

Section: Discussionsupporting

confidence: 80%

Comparison of Aprotinin and Controlled Hypotension on Blood Loss in the Herniated Intervertebral Disc Surgery

Fathi¹,

Jahanbakhsh²,

Bameshki³

et al. 2015

Razavi Int J Med

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Background: Methods of reducing blood loss in surgical procedures such as spinal disc herniation, which are characterized by severe bleeding, can reduce the need for blood transfusion and thereby the risk of infectious diseases transmission, transfusion reactions, acute lung injury, graft-versus-host disease (GVHD), hypothermia, coagulation disorders and metabolic complications. Anti-fibrinolytic drugs (e.g. Aprotinin, aminocaproic acid, desmopressin and tranexamic acid) and controlled hypotension (monitored reduction by medication) are among these methods. Objectives: In our clinical trial, two methods of aprotinin and controlled hypotension are compared in terms of their efficacy in reducing blood loss. Patients and Methods: 70 patients undergoing spinal disc herniation were randomly divided into two groups of controlled hypotension (treated with nitroglycerin: starting with 5 µg/minute to reach an MAP of 55 -60 mmHg, with an increase of 5 µg/minute of the drug in every 3 -5 minutes) and aprotinin (0.5 million units injection before surgery). The anesthesia was administered similarly to both groups and blood pressure and heart rate were recorded every 5 to 15 minutes. Moreover, the amount of bleeding and the surgeon satisfaction were measured. Results: 70 patients were identical in terms of demographics and the length of surgery. The two groups were not statistically different in terms of mean change in systolic, diastolic and mean blood pressure and heart rate at different times. The severity of blood loss measured on Boezarrt scale for low, medium and severe bleeding was respectively 21 (30%), 27 (39%), and 12 (31%). The extent of surgeon satisfaction with the operation room measured on a 3-point Likert scale (poor, medium and good) was 18 (26%), 40 (57%), and 12 (17%), respectively. The results were almost corresponding in both groups. Also, the two groups were identical in terms of calculated blood loss and the need for additional intraoperative medication. Conclusions: In intervertebral herniated disc surgery, aprotinin and controlled hypotension treatments yielded similar results in terms of reducing blood loss and surgeon satisfaction with the field of operation.

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Section: Discussionsupporting

confidence: 80%

Comparison of Aprotinin and Controlled Hypotension on Blood Loss in the Herniated Intervertebral Disc Surgery

Fathi¹,

Jahanbakhsh²,

Bameshki³

et al. 2015

Razavi Int J Med

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“…2 However, significant reductions in the number of patients transfused have been noted in patients who underwent various cardiac surgical procedures requiring cardiopulmonary bypass when lysine analogues were compared with placebo. [12][13][14][15][16][17] Reexploration for bleeding occurs in Ͻ5% of patients after cardiac surgery, but it usually is indicative of clinically significant surgical bleeding and is associated with an increase in operative mortality and morbidity. In 17 studies comparing high-dose aprotinin with control and 11 studies comparing TXA with control, aprotinin but not TXA was consistently associated with a significant reduction in the need for reexploration.…”

Section: Article P 2801mentioning

confidence: 99%

Valid Comparisons of Antifibrinolytic Agents Used in Cardiac Surgery

Bridges

2007

Circulation

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“…However, a study by Pleym et al (12) showed that TA given over 5 min immediately before the start of CPB reduces postoperative bleeding in first-time CABG patients. The ideal dosage of TA remains controversial.…”

Section: Discussionmentioning

confidence: 99%

A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting

Santos

Kalil

Bauemann

et al. 2006

Braz J Med Biol Res

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Cardiopulmonary bypass is frequently associated with excessive blood loss. Platelet dysfunction is the main cause of non-surgical bleeding after open-heart surgery. We randomized 65 patients in a double-blind fashion to receive tranexamic acid or placebo in order to determine whether antifibrinolytic therapy reduces chest tube drainage. The tranexamic acid group received an intravenous loading dose of 10 mg/ kg, before the skin incision, followed by a continuous infusion of 1 mg kg -1 h -1 for 5 h. The placebo group received a bolus of normal saline solution and continuous infusion of normal saline for 5 h. Postoperative bleeding and fibrinolytic activity were assessed. Hematologic data, convulsive seizures, allogeneic transfusion, occurrence of myocardial infarction, mortality, allergic reactions, postoperative renal insufficiency, and reopening rate were also evaluated. The placebo group had a greater postoperative blood loss (median (25th to 75th percentile) 12 h after surgery (540 (350-750) vs 300 (250-455) mL, P = 0.001). The placebo group also had greater blood loss 24 h after surgery (800 (520-1050) vs 500 (415-725) mL, P = 0.008). There was a significant increase in plasma D-dimer levels after coronary artery bypass grafting only in patients of the placebo group, whereas no significant changes were observed in the group treated with tranexamic acid. The D-dimer levels were 1057 (1025-1100) µg/L in the placebo group and 520 (435-837) µg/L in the tranexamic acid group (P = 0.01). We conclude that tranexamic acid effectively reduces postoperative bleeding and fibrinolysis in patients undergoing first-time coronary artery bypass grafting compared to placebo.

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Single-Dose Tranexamic Acid Reduces Postoperative Bleeding After Coronary Surgery in Patients Treated with Aspirin Until Surgery

Cited by 70 publications

References 25 publications

Comparison of Aprotinin and Controlled Hypotension on Blood Loss in the Herniated Intervertebral Disc Surgery

Comparison of Aprotinin and Controlled Hypotension on Blood Loss in the Herniated Intervertebral Disc Surgery

Valid Comparisons of Antifibrinolytic Agents Used in Cardiac Surgery

A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting

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