title: Topical application of tranexamic acid reduces postoperative bleeding in open-heart surgery: myth or fact?
abstract: OBJECTIVE
  To determine the efficacy of topical application of Tranexamic acid in controlling postoperative bleeding in open-heart surgery.
  
  
  METHODS
  Double blind randomized control trial.
  
  
  METHODS
  Departments of Cardiac Surgery and Intensive Care of Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan, from May to October 2011.
  
  
  METHODS
  A total of 100 consecutive adult patients fulfilling the inclusion criteria undergoing elective on-pump cardiac surgeries were randomly divided in groups 'A' and 'B'. A study solution that contained 2.5 g of Tranexamic acid in 250 ml normal saline in group-A and equal amount of normal saline (placebo) in group-B was poured in the pericardial cavity over the mediastinal tissues before sternal closure. Postoperative bleeding was measured in both groups for 24 hours in the cardiac surgical ICU. Efficacy of Topical Tranexamic Acid / Placebo was measured in terms of mean postoperative bleeding in ml. Kindly again include these lines which seem to have been omitted in the final proof.
  
  
  RESULTS
  There was significant difference in the mean postoperative bleeding within 24 hours among the two groups 340.1 ± 112.4 ml in Tranexamic acid group vs. 665 ± 187.28 ml in placebo group (p < 0.001).
  
  
  CONCLUSIONS
  Patients who did not have topical Tranexamic acid before chest closure had a significantly higher postoperative bleeding. Topical Tranexamic acid application is an effective and economical way for controlling non-surgical bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass.
authors.affiliation: Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi.
authors.forename: Muhammad Usman
authors.initials: MU
authors.lastname: Ali Shah
authors.affiliation: Department of Cardiac Surgeon, Armed Forces Institute of Cardiology (AFIC-NIHD), Rawalpindi.
authors.forename: Muhammad Imran
authors.initials: MI
authors.lastname: Asghar
authors.affiliation: Department of Anesthesia, Armed Forces Institute of Cardiology (AFIC-NIHD), Rawalpindi.
authors.forename: Rashad
authors.initials: R
authors.lastname: Siddiqi
authors.affiliation: Department of Cardiac Surgeon, Armed Forces Institute of Cardiology (AFIC-NIHD), Rawalpindi.
authors.forename: Muhammad Sohail
authors.initials: MS
authors.lastname: Chaudhri
authors.affiliation: Department of Cardiac Surgeon, Armed Forces Institute of Cardiology (AFIC-NIHD), Rawalpindi.
authors.forename: Asif Mahmood
authors.initials: AM
authors.lastname: Janjua
authors.affiliation: Department of Cardiac Surgeon, Armed Forces Institute of Cardiology (AFIC-NIHD), Rawalpindi.
authors.forename: Afsheen
authors.initials: A
authors.lastname: Iqbal
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D011183:Postoperative Complications / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid