Topical use of tranexamic acid in coronary artery bypass operations: A double-blind, prospective, randomized, placebo-controlled study

Michele De Bonis, Franco Cavaliere, Francesco Alessandrini, Elisabetta Lapenna, Filippo Santarelli, Umberto Moscato, Rocco Schiavello, Gian Federico Possati

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: We sought to investigate the effect of topical application of tranexamic acid into the pericardial cavity in reducing postoperative blood loss in coronary artery surgery. Methods: A prospective, randomized, double-blind investigation with parallel groups was performed. Forty consecutive patients undergoing primary coronary surgery were randomly assigned to group 1 (tranexamic acid group) or group 2 (placebo group). Tranexamic acid (1 g in 100 mL of saline solution) or placebo was poured into the pericardial cavity and over the mediastinal tissues before sternal closure. The drainage of mediastinal blood was measured hourly. Results: Chest tube drainage in the first 24 hours was 485 ± 166 mL in the tranexamic acid group and 641 ± 184 mL in the placebo group (P = .01). Total postoperative blood loss was 573 ± 164 mL and 739 ± 228 mL, respectively (P = .01). The use of banked donor blood products was not significantly different between the two groups. Tranexamic acid could not be detected in any of the blood samples blindly collected from 24 patients to verify whether any systemic absorption of the drug occurred. There were no deaths in either group. None of the patients required reoperation for bleeding. Conclusions: Topical application of tranexamic acid into the pericardial cavity after cardiopulmonary bypass in patients undergoing primary coronary bypass operations significantly reduces postoperative bleeding. Further studies must be carried out to clarify whether a more pronounced effect on both bleeding and blood products requirement might be seen in procedures with a higher risk of bleeding.

Original languageEnglish
Pages (from-to)575-580
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume119
Issue number3
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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