Tranexamic acid in primary CABG surgery: high vs low dose.
OBJECTIVE
Prophylactic administration of tranexamic acid decreases bleeding and transfusions after cardiac procedures but it is still unclear what the best dose and the most appropriate timing to get the best results are.


METHODS
We enrolled 250 patients scheduled for elective, primary coronary revascularization. They were randomly divided into 2 groups. Group H received tranexamic 30 mg x kg(-1) soon after the induction of anaesthesia and a further same dose was added to the prime solution of cardiopulmonary bypass (CPB). Group L received tranexamic acid 15 mg x kg(-1) after systemic heparinization followed by an infusion of 1 mg x kg(-1) h(-1) till the end of the operation. Transfusions of bank blood products, bleeding in the postoperative period and coagulation profile were recorded.


RESULTS
We did not find any difference between the groups either with respect to transfusion requirements or with respect to blood loss.


CONCLUSIONS
For elective, first time coronary artery bypass surgery, both dosages of tranexamic acid are equally effective. Theoretically, it seems safer to administer it when patients are protected from thrombus formation by full heparinization.
Department of Pharmacology and Anesthesiology Egidio Meneghetti, University of Padua, Padua, Italy. gabriarmellin@libero.it
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Armellin
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Pittarello
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D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D014148:Tranexamic Acid / Q000008:administration & dosage*
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid