Tranexamic acid administration after cardiac surgery: A prospective, randomized, double-blind, placebo-controlled study

Valter Casati, Ferdinando Bellotti, Chiara Gerli, Annalisa Franco, Michele Oppizzi, Mariangelo Cossolini, Giliola Calori, Stefano Benussi, Ottavio Alfieri, Giorgio Torri

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: Many different doses and administration schemes have been proposed for the use of the antifibrinolytic drug tranexamic acid during cardiac surgery. This study evaluated the effects of the treatment using tranexamic acid during the intraoperative period only and compared the results with the effects of the treatment continued into the postoperative period. Methods: Patients undergoing elective cardiac surgery with use of cardiopulmonary bypass (N = 510) were treated intraoperatively with tranexamic acid and then were randomized in a double-blind fashion to one of three postoperative treatment groups: group A: 169 patients, infusion of saline for 12 h; group B: 171 patients, infusion of tranexamic acid, 1 mg · kg -1 · h -1 for 12 h; group C: 170 patients, infusion of tranexamic acid, 2 mg · kg -1 · h -1 for 12 h. Bleeding was considered to be a primary outcome variable. Hematologic data, allogeneic transfusions, thrombotic complications, intubation time, and intensive care unit and hospital stay duration also were evaluated. Results: No differences were found among groups regarding postoperative bleeding and outcomes; however, the group treated with 1 mg · kg -1 · h -1 tranexamic acid required more units of packed red blood cells because of a significantly lower basal value of hematocrit, as shown by multivariate analysis. Conclusions: Prolongation of treatment with tranexamic acid after cardiac surgery is not advantageous with respect to intraoperative administration alone in reducing bleeding and number of allogeneic transfusions. Although the prevalence of postoperative complications was similar among groups, there is an increased risk of procoagulant response because of antifibrinolytic treatment. Therefore, the use of tranexamic acid during the postoperative period should be limited to patients with excessive bleeding as a result of primary fibrinolysis.

Original languageEnglish
Pages (from-to)8-14
Number of pages7
JournalAnesthesiology
Volume94
Issue number1
Publication statusPublished - 2001

Fingerprint

Tranexamic Acid
Thoracic Surgery
Placebos
Hemorrhage
Antifibrinolytic Agents
Postoperative Period
Intraoperative Period
Therapeutics
Fibrinolysis
Cardiopulmonary Bypass
Hematocrit
Intubation
Intensive Care Units
Length of Stay
Multivariate Analysis
Erythrocytes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Casati, V., Bellotti, F., Gerli, C., Franco, A., Oppizzi, M., Cossolini, M., ... Torri, G. (2001). Tranexamic acid administration after cardiac surgery: A prospective, randomized, double-blind, placebo-controlled study. Anesthesiology, 94(1), 8-14.

Tranexamic acid administration after cardiac surgery : A prospective, randomized, double-blind, placebo-controlled study. / Casati, Valter; Bellotti, Ferdinando; Gerli, Chiara; Franco, Annalisa; Oppizzi, Michele; Cossolini, Mariangelo; Calori, Giliola; Benussi, Stefano; Alfieri, Ottavio; Torri, Giorgio.

In: Anesthesiology, Vol. 94, No. 1, 2001, p. 8-14.

Research output: Contribution to journalArticle

Casati, V, Bellotti, F, Gerli, C, Franco, A, Oppizzi, M, Cossolini, M, Calori, G, Benussi, S, Alfieri, O & Torri, G 2001, 'Tranexamic acid administration after cardiac surgery: A prospective, randomized, double-blind, placebo-controlled study', Anesthesiology, vol. 94, no. 1, pp. 8-14.
Casati V, Bellotti F, Gerli C, Franco A, Oppizzi M, Cossolini M et al. Tranexamic acid administration after cardiac surgery: A prospective, randomized, double-blind, placebo-controlled study. Anesthesiology. 2001;94(1):8-14.
Casati, Valter ; Bellotti, Ferdinando ; Gerli, Chiara ; Franco, Annalisa ; Oppizzi, Michele ; Cossolini, Mariangelo ; Calori, Giliola ; Benussi, Stefano ; Alfieri, Ottavio ; Torri, Giorgio. / Tranexamic acid administration after cardiac surgery : A prospective, randomized, double-blind, placebo-controlled study. In: Anesthesiology. 2001 ; Vol. 94, No. 1. pp. 8-14.
@article{3e39c3ef084442e6b41bde06506d61ce,
title = "Tranexamic acid administration after cardiac surgery: A prospective, randomized, double-blind, placebo-controlled study",
abstract = "Background: Many different doses and administration schemes have been proposed for the use of the antifibrinolytic drug tranexamic acid during cardiac surgery. This study evaluated the effects of the treatment using tranexamic acid during the intraoperative period only and compared the results with the effects of the treatment continued into the postoperative period. Methods: Patients undergoing elective cardiac surgery with use of cardiopulmonary bypass (N = 510) were treated intraoperatively with tranexamic acid and then were randomized in a double-blind fashion to one of three postoperative treatment groups: group A: 169 patients, infusion of saline for 12 h; group B: 171 patients, infusion of tranexamic acid, 1 mg · kg -1 · h -1 for 12 h; group C: 170 patients, infusion of tranexamic acid, 2 mg · kg -1 · h -1 for 12 h. Bleeding was considered to be a primary outcome variable. Hematologic data, allogeneic transfusions, thrombotic complications, intubation time, and intensive care unit and hospital stay duration also were evaluated. Results: No differences were found among groups regarding postoperative bleeding and outcomes; however, the group treated with 1 mg · kg -1 · h -1 tranexamic acid required more units of packed red blood cells because of a significantly lower basal value of hematocrit, as shown by multivariate analysis. Conclusions: Prolongation of treatment with tranexamic acid after cardiac surgery is not advantageous with respect to intraoperative administration alone in reducing bleeding and number of allogeneic transfusions. Although the prevalence of postoperative complications was similar among groups, there is an increased risk of procoagulant response because of antifibrinolytic treatment. Therefore, the use of tranexamic acid during the postoperative period should be limited to patients with excessive bleeding as a result of primary fibrinolysis.",
author = "Valter Casati and Ferdinando Bellotti and Chiara Gerli and Annalisa Franco and Michele Oppizzi and Mariangelo Cossolini and Giliola Calori and Stefano Benussi and Ottavio Alfieri and Giorgio Torri",
year = "2001",
language = "English",
volume = "94",
pages = "8--14",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Tranexamic acid administration after cardiac surgery

T2 - A prospective, randomized, double-blind, placebo-controlled study

AU - Casati, Valter

AU - Bellotti, Ferdinando

AU - Gerli, Chiara

AU - Franco, Annalisa

AU - Oppizzi, Michele

AU - Cossolini, Mariangelo

AU - Calori, Giliola

AU - Benussi, Stefano

AU - Alfieri, Ottavio

AU - Torri, Giorgio

PY - 2001

Y1 - 2001

N2 - Background: Many different doses and administration schemes have been proposed for the use of the antifibrinolytic drug tranexamic acid during cardiac surgery. This study evaluated the effects of the treatment using tranexamic acid during the intraoperative period only and compared the results with the effects of the treatment continued into the postoperative period. Methods: Patients undergoing elective cardiac surgery with use of cardiopulmonary bypass (N = 510) were treated intraoperatively with tranexamic acid and then were randomized in a double-blind fashion to one of three postoperative treatment groups: group A: 169 patients, infusion of saline for 12 h; group B: 171 patients, infusion of tranexamic acid, 1 mg · kg -1 · h -1 for 12 h; group C: 170 patients, infusion of tranexamic acid, 2 mg · kg -1 · h -1 for 12 h. Bleeding was considered to be a primary outcome variable. Hematologic data, allogeneic transfusions, thrombotic complications, intubation time, and intensive care unit and hospital stay duration also were evaluated. Results: No differences were found among groups regarding postoperative bleeding and outcomes; however, the group treated with 1 mg · kg -1 · h -1 tranexamic acid required more units of packed red blood cells because of a significantly lower basal value of hematocrit, as shown by multivariate analysis. Conclusions: Prolongation of treatment with tranexamic acid after cardiac surgery is not advantageous with respect to intraoperative administration alone in reducing bleeding and number of allogeneic transfusions. Although the prevalence of postoperative complications was similar among groups, there is an increased risk of procoagulant response because of antifibrinolytic treatment. Therefore, the use of tranexamic acid during the postoperative period should be limited to patients with excessive bleeding as a result of primary fibrinolysis.

AB - Background: Many different doses and administration schemes have been proposed for the use of the antifibrinolytic drug tranexamic acid during cardiac surgery. This study evaluated the effects of the treatment using tranexamic acid during the intraoperative period only and compared the results with the effects of the treatment continued into the postoperative period. Methods: Patients undergoing elective cardiac surgery with use of cardiopulmonary bypass (N = 510) were treated intraoperatively with tranexamic acid and then were randomized in a double-blind fashion to one of three postoperative treatment groups: group A: 169 patients, infusion of saline for 12 h; group B: 171 patients, infusion of tranexamic acid, 1 mg · kg -1 · h -1 for 12 h; group C: 170 patients, infusion of tranexamic acid, 2 mg · kg -1 · h -1 for 12 h. Bleeding was considered to be a primary outcome variable. Hematologic data, allogeneic transfusions, thrombotic complications, intubation time, and intensive care unit and hospital stay duration also were evaluated. Results: No differences were found among groups regarding postoperative bleeding and outcomes; however, the group treated with 1 mg · kg -1 · h -1 tranexamic acid required more units of packed red blood cells because of a significantly lower basal value of hematocrit, as shown by multivariate analysis. Conclusions: Prolongation of treatment with tranexamic acid after cardiac surgery is not advantageous with respect to intraoperative administration alone in reducing bleeding and number of allogeneic transfusions. Although the prevalence of postoperative complications was similar among groups, there is an increased risk of procoagulant response because of antifibrinolytic treatment. Therefore, the use of tranexamic acid during the postoperative period should be limited to patients with excessive bleeding as a result of primary fibrinolysis.

UR - http://www.scopus.com/inward/record.url?scp=0035171865&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035171865&partnerID=8YFLogxK

M3 - Article

C2 - 11135716

AN - SCOPUS:0035171865

VL - 94

SP - 8

EP - 14

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 1

ER -