Postoperative bleeding in cardiac surgery: the role of tranexamic acid in patients homozygous for the 5G polymorphism of the plasminogen activator inhibitor-1 gene.
BACKGROUND
Plasminogen activator inhibitor 1 (PAI-1) attenuates the conversion of plasminogen to plasmin. Polymorphisms of the PAI-1 gene are associated with varying PAI-1 levels and risk of prothrombotic events in nonsurgical patients. The purpose of this study, a secondary analysis of a clinical trial, was to investigate whether PAI-1 genotype affects the efficacy of tranexamic acid (TA) in reducing postoperative chest tube blood loss of patients undergoing cardiopulmonary bypass.


METHODS
Fifty patients were classified according to PAI-1 genotype (4G/4G, 4G/5G, or 5G/5G). Twenty-four received 2 g TA before and after cardiopulmonary bypass, whereas 26 received placebo. The authors recorded data related to coagulation, fibrinolysis, and bleeding before surgery, at admission to the intensive care unit (0 h), and 4 and 24 h later.


RESULTS
In patients not receiving TA, those with the 5G/5G genotype had significantly higher chest tube blood loss and transfusion requirements compared with patients with the other genotypes at all time points. Patients with the 5G/5G genotype receiving TA showed significantly lower blood loss compared with the placebo group. There were no significant differences in blood loss or transfusion requirements between patients with the 4G/4G genotype when TA was used.


CONCLUSIONS
Plasminogen activator inhibitor-1 5G/5G homozygotes who did not receive TA showed significantly greater postoperative bleeding than patients with other PAI-1 genotypes. 5G/5G homozygotes who received TA showed the greatest blood-sparing benefit.
Iribarren
Jose L
JL
Intensive Care Department, University Hospital of the Canary Islands, University of La Laguna, Tenerife, Spain. joseluis.iribarren@gmail.com
Jimenez
Juan J
JJ
Hernández
Domingo
D
Brouard
Maitane
M
Riverol
Debora
D
Lorente
Leonardo
L
de La Llana
Ramiro
R
Nassar
Ibrahim
I
Perez
Rosalia
R
Martinez
Rafael
R
Mora
Maria L
ML
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005260:Female; D006720:Homozygote; D006801:Humans; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics*; D011110:Polymorphism, Genetic / Q000187:drug effects / Q000235:genetics*; D019106:Postoperative Hemorrhage / Q000235:genetics* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D014148:Tranexamic Acid / Q000494:pharmacology / Q000627:therapeutic use*
D017395:Plasminogen Activator Inhibitor 1; D014148:Tranexamic Acid