Tranexamic acid and early saphenous vein graft patency in conventional coronary artery bypass graft surgery: a prospective randomized controlled clinical trial.
OBJECTIVE
Use of antifibrinolytic agents reduces the risk of bleeding and decreases the need for blood product use in patients undergoing cardiac surgery. The purpose of this study was to determine whether perioperative use of tranexamic acid decreases the rate of saphenous vein graft patency in the early postoperative period after conventional coronary artery bypass grafting surgery.


METHODS
A total of 312 patients scheduled for elective coronary artery bypass grafting surgery with cardiopulmonary bypass were randomized to receive either tranexamic acid 100 mg/kg (n = 147) or placebo (n = 165) in a double-blinded fashion before the initiation of cardiopulmonary bypass. Saphenous vein graft patency was assessed with magnetic resonance imaging 5 to 30 days after surgery.


RESULTS
Both groups were comparable with respect to baseline demographic data and surgical characteristics. A total of 237 (76%) patients underwent magnetic resonance imaging assessment. A total of 297 saphenous vein grafts were performed and 253 (85.2%; 95% confidence interval, 83.5%-86.9%) were seen in the tranexamic acid group, and 265 saphenous vein grafts were performed and 231 (87.2%; 95% confidence interval, 85.5%-88.9%) were seen in the placebo group (P = .4969). The blood loss and blood product transfusion rates in the tranexamic acid group were significantly lower than in the placebo group. There was no difference between groups with respect to postoperative morbidity and mortality.


CONCLUSIONS
The administration of tranexamic acid before cardiopulmonary bypass did not seem to compromise early venous graft patency rates but reduced perioperative blood product transfusion rates. Consequently, tranexamic acid could be advocated for routine use in patients undergoing conventional coronary artery bypass grafting surgery.
Karski
Jacek
J
Department of Anesthesia, Toronto General Hospital, Ontario, Canada. jacek.karski@uhn.on.ca
Djaiani
George
G
Carroll
Jo
J
Iwanochko
Mark
M
Seneviratne
Priya
P
Liu
Peter
P
Kucharczyk
Walter
W
Fedorko
Ludwik
L
David
Tirone
T
Cheng
Davy
D
D000368:Aged; D000933:Antifibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D014148:Tranexamic Acid / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects*
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid