title: Effectiveness of pericardial lavage with or without tranexamic acid in cardiac surgery patients receiving intravenous tranexamic acid: a randomized controlled trial.
abstract: OBJECTIVE
  Pericardial lavage with saline, with or without tranexamic acid (TA), is still not evidence-based within current clinical practice as a part of a blood conservation strategy in cardiac surgery patients receiving intravenous TA administration. The objective was to determine whether intravenous TA combined with pericardial lavage with saline, with or without TA, reduces blood loss by 25% after cardiac surgery measured in the first 12 h postoperatively.
  
  
  METHODS
  In this single-centre, randomized controlled, multiple-armed, parallel study, individual patients were randomly assigned to receive either topical administration of 2 g TA diluted in 200 ml of saline (TA group), 200 ml of saline (placebo group) or no topical administration at all (control group). Eligible participants were all adults aged 18 or older and scheduled for elective cardiac surgery on cardiopulmonary bypass. All patients received 2 g TA intravenously before sternal incision and 2 g TA after cardiopulmonary bypass. The main outcome measure was the 12-h postoperative blood loss.
  
  
  RESULTS
  In total, 739 individuals were analysed according to intention-to-treat analyses (TA group, n = 245 patients; placebo group, n = 249 patients; control group, n = 245 patients). There was no difference in the median 12-h postoperative blood loss between the three groups [TA group, 290 (IQR 190-430) ml; placebo group, 290 (IQR 210-440) ml; control group, 300 (IQR 190-450) ml, P= 0.759].
  
  
  CONCLUSIONS
  Pericardial lavage, with or without TA, does not result in a statistically significant difference in the 12-h postoperative blood loss in cardiac surgery patients receiving intravenous TA administration. Pericardial lavage with saline, with or without TA, should not be a part of a blood conservation strategy.
authors.affiliation: Department of Extracorporeal Circulation, Amphia Hospital, Breda, Netherlands.
authors.forename: Dorien M
authors.initials: DM
authors.lastname: Kimenai
authors.affiliation: Department of Anesthesiology, Amphia Hospital, Breda, Netherlands.
authors.forename: Bastiaan M
authors.initials: BM
authors.lastname: Gerritse
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical University Centre of Amsterdam, Amsterdam, Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: Lucas
authors.affiliation: Department of Anesthesiology, Amphia Hospital, Breda, Netherlands.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rosseel
authors.affiliation: Department of Cardiothoracic Surgery, Amphia Hospital, Breda, Netherlands.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bentala
authors.affiliation: Department of Clinical Pharmacology, Amphia Hospital, Breda, Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: van Hattum
authors.affiliation: Department of Anesthesiology, Amphia Hospital, Breda, Netherlands.
authors.forename: Nardo J M
authors.initials: NJ
authors.lastname: van der Meer
authors.affiliation: Department of Anesthesiology, Amphia Hospital, Breda, Netherlands tscohy@amphia.nl.
authors.forename: Thierry V
authors.initials: TV
authors.lastname: Scohy
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D007507:Therapeutic Irrigation / Q000379:methods*; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Blood loss; Cardiac surgery; Tranexamic acid