Tranexamic acid reduces blood loss and transfusion in reoperative cardiac surgery.
OBJECTIVE
The objective of this study was to assess the effect of tranexamic acid (TA), a synthetic antifibrinolytic, on blood loss and the need for transfusion of blood products following repeat cardiac valve surgery.


METHODS
After ethics committee approval, 41 patients scheduled for reoperative valve replacement were enrolled in this randomized, double blind, placebo controlled study. Patients were randomized to receive TA (10 g in 500 ml NSaline) or placebo (NSaline) as an iv bolus over 30 min, after anaesthesia induction and prior to skin incision. Intraoperative blood loss was assessed by estimating blood volume on drapes, weighing surgical sponges, and measuring suction bottle returns. Postoperative blood loss was measured from mediastinal chest tube drainage following surgery. Blood products were transfused according to a standardized protocol.


RESULTS
Patient demographics were similar for age, sex, cardiopulmonary bypass pump time, cross clamp time, surgical time, preoperative haemoglobin, coagulation profile, and the number of valves replaced during surgery. Tranexamic acid administration reduced intraoperative blood loss [median (range)] from 1656 (575-6270) to 720 ml (355-5616) (P < 0.01) and postoperative blood loss from 1170 (180-4025) to 538 ml (135-1465) (Intent to Treat n = 41, P < 0.01). The total red blood cells transfused (median, range) was reduced from 1500 (0-9300) ml to 480 (0-2850) ml (P < 0.01) in the TA group. In hospital complications and mortality rates were not reduced in the TA group.


CONCLUSIONS
Tranexamic acid reduced blood loss and the need for blood product transfusion and appears to be an effective treatment for patients undergoing reoperative cardiac valvular surgery.
Dryden
P J
PJ
Department of Anaesthesia, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, Canada.
O'Connor
J P
JP
Jamieson
W R
WR
Reid
I
I
Ansley
D
D
Sadeghi
H
H
Burr
L H
LH
Munro
A I
AI
Merrick
P M
PM
D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001777:Blood Coagulation; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001810:Blood Volume; D002315:Cardiopulmonary Bypass; D015505:Chest Tubes; D004311:Double-Blind Method; D004322:Drainage / Q000295:instrumentation; D017707:Erythrocyte Transfusion; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D012086:Reoperation; D013396:Suction / Q000295:instrumentation; D015503:Surgical Sponges; D015996:Survival Rate; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D010919:Placebos; D014148:Tranexamic Acid