title: A randomized trial of tranexamic acid in combination with cell salvage plus a meta-analysis of randomized trials evaluating tranexamic acid in off-pump coronary artery bypass grafting.
abstract: OBJECTIVE
  We sought to evaluate the effectiveness of tranexamic acid in off-pump coronary artery bypass grafting surgery, either when used in combination with mechanical cell salvage or when used alone.
  
  
  METHODS
  One hundred patients were randomized to either 2 g of tranexamic acid as an intravenous bolus before sternotomy or to placebo. Intraoperative and postoperative cell salvage was used in all patients. The primary end point was early postoperative blood loss (within 4 hours). To evaluate the efficacy of tranexamic acid in isolation, we also performed a meta-analysis of 4 randomized trials identified from a systematic literature search. The primary end point of the meta-analysis was red cell transfusion.
  
  
  RESULTS
  In our randomized trial patients in the tranexamic acid group had a significant reduction in early postoperative blood loss, (median difference, 50 mL; 95% confidence interval, 15-100 mL; P < .01); however, there was no reduction in the frequency of blood component transfusion. Patients in the placebo group received a significantly larger volume of autotransfused red cells (median difference, 120 mL; 95% confidence interval, 0-220 mL; P = .02). The meta-analysis demonstrated a significant reduction in red cell transfusions in patients receiving tranexamic acid compared with those receiving placebo (risk ratio, 0.48; 95% confidence interval, 0.24-0.97; P = .041). There was also a reduction in the frequency of any allogeneic blood component transfusion, as well as a highly significant reduction in postoperative blood loss, in patients receiving tranexamic acid (P < .001).
  
  
  CONCLUSIONS
  Tranexamic acid reduces blood loss and transfusion requirements in off-pump coronary artery bypass grafting surgery. A reduction in allogeneic blood transfusion was not evident in the presence of perioperative cell salvage. These data support the routine use of tranexamic acid in off-pump coronary artery bypass grafting surgery.
authors.affiliation: Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom.
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Murphy
authors.forename: Emilio
authors.initials: E
authors.lastname: Mango
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Lucchetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Battaglia
authors.forename: Donato
authors.initials: D
authors.lastname: Catapano
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
mesh_terms: D000328:Adult; D001804:Blood Transfusion, Autologous; D003131:Combined Modality Therapy; D047549:Coronary Artery Bypass, Off-Pump; D017707:Erythrocyte Transfusion; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D014148:Tranexamic Acid