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Tranexamic Acid and Primary Coronary Artery Bypass Surgery: a Prospective Study

Departments of Anesthesia and Cardiothoracic Surgery, Royal Hospital, Muscat, Oman

For reprint information contact:Madan M Maddali, MD Tel/Fax: 968 2459 0192 Email: madan{at}omantel.net.om, Royal Hospital, PB No. 1331, PC: 111, Seeb, Muscat, Sultanate of Oman.

Tranexamic acid was used to reduce postoperative drainage and allogenic blood transfusion requirements in patients undergoing on-pump primary coronary bypass surgery. Over 12 months, 222 patients participated in this prospective, randomized, placebo-controlled, double-blind study conducted at a tertiary center. Half of the patients were randomly allocated to receive tranexamic acid as a bolus (10 mg·kg^–1) prior to sternotomy, followed by an infusion (1 mg·kg^–1·hr^–1) up to the time of starting of protamine. The other 111 patients received a saline bolus and infusion. Postoperative drainage and transfusion requirements were measured in all patients. Markers of graft patency, hemostasis, hemodynamic stability, and fibrinolysis were evaluated. Chest closure time, renal function parameters, allergic reactions, incidence of stroke, re-exploration, and hospital mortality were also noted. Postoperative drainage was significantly less and blood conservation considerably better when tranexamic acid was used. Post-bypass hemostasis was achieved faster, fibrinolysis was less, and there was no evidence of increased incidence of graft occlusion in the group given tranexamic acid.