A retrospective analysis of blood loss with combined topical and intravenous tranexamic acid after coronary artery bypass graft surgery.
OBJECTIVE
Intravenous antifibrinolytics are the gold standard for blood conservation during cardiac surgery. Recent evidence suggests that topical tranexamic acid administration also is effective, although the efficacy of combined topical and intravenous administration has never been reported. Combined administration may offer superior hemostasis while decreasing side effects. The current study explores the use of combined topical and intravenous tranexamic acid as a blood conservation strategy in cardiac surgery.


METHODS
Retrospective cohort.


METHODS
A single-center, academic, tertiary care hospital.


METHODS
One hundred sixty elective coronary artery bypass graft patients.


METHODS
A practice change allowed a retrospective comparison of postoperative chest tube drainage in patients with intravenous or combined (intravenous and topical) tranexamic acid.


RESULTS
Chest tube drainage was decreased in the combined group at 3 (164.8 ± 102.2 v 242.7 ± 148.9 mL, p < 0.001), 6 (265.6 ± 163.7 v 358.8 ± 247.2 mL, p = 0.006), and 12 hours (374.3 ± 217.1 v 498.5 ± 336.6 mL, p = 0.006) postoperatively compared with the intravenous group. The tranexamic acid dose was higher in the combined group (5.1 ± 1.1 v 4.1 ± 1.3 g, p < 0.001), but less was administered intravenously (3.1 ± 1.1 v 4.1 ± 1.3 g, p < 0.001). No differences were observed in adverse events.


CONCLUSIONS
This study suggested that combined tranexamic acid administration may be superior for blood conservation, but fully powered randomized controlled trials will be required to confirm these findings and determine the safety advantage and clinical relevance of adding topical tranexamic acid to existing blood conservation strategies.
Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada. ryanmahaffey@gmail.com
Ryan
R
Mahaffey
Louie
L
Wang
Andrew
A
Hamilton
Rachel
R
Phelan
Ramiro
R
Arellano
D000287:Administration, Topical; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage*
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid