Tranexamic acid reduces postoperative bleeding in off-pump coronary artery bypass grafting.
OBJECTIVE
Tranexamic acid (TA) reduces blood loss in coronary artery surgery with cardiopulmonary bypass. The present prospective study was designed to investigate its hemostatic effect in off-pump coronary artery bypass (OPCAB).


METHODS
Seventy-six patients undergoing elective OPCAB were randomized into two groups, received TA (0.75 g loading dose before surgery and 250 mg/h during surgery, gross dose: 1.5 g, n=36) and saline solution (control, n=40), respectively. Perioperative blood samples were collected. Hematochemical parameters including platelet adhesion rate, D-dimer and fibrinopeptide-A (FPA) were analysis. Volume of blood loss, blood transfusion and other clinical data were recorded throughout the perioperative period.


RESULTS
Cumulative blood loss was significantly reduced in the TA group as compared to the controls postoperatively (6 hrs (median [25th-75th]): TA: 200.0 [140.0-230.0] ml,


METHODS
225.0 [200.0-347.5.0] ml, p=0.009; 24 hrs: TA: 440.0 [270.0-605.0] ml,


METHODS
655.0 [500.0-920.0] ml, p<0.001). Number of patients received blood transfusion in each group was similar. Levels of D-dimer rose significantly after surgery, and were significantly lower in the TA group than that in controls. Platelet adhesion rate and FPA levels remained at baseline levels after the operation in two groups. Early clinical outcomes were similar between groups.


CONCLUSIONS
The results indicated that tranexamic acid limits fibrinolysis and reduces blood loss after off-pump coronary artery bypass surgery.
Wei
Minxin
M
Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, P.R. China. minxinw@yahoo.com
Jian
Kaitao
K
Guo
Zhigang
Z
Wang
Lianqun
L
Jiang
Dazhong
D
Zhang
Lianxiang
L
Tarkka
Matti
M
D000368:Aged; D000787:Angina Pectoris / Q000601:surgery*; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018890:Chemoprevention; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005344:Fibrinopeptide A / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D010973:Platelet Adhesiveness; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005344:Fibrinopeptide A; D014148:Tranexamic Acid