The effects of tranexamic acid on postoperative bleeding in coronary artery bypass graft surgery

Perioperative administration of tranexamic acid (TA), decreases bleeding
and the need for transfusion after cardiac procedures. Hence, the results may vary in
different clinical settings and the most appropriate timing to get the best results is
unclear. The primary objectives of the present study were to determine the efficacy of
TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions
and the best timing for TA administration following primary, elective, coronary artery
bypass grafting (CABG) in patients with a low baseline risk of postoperative bleeding.
Methods: In this double-blind, prospective, placebo-controlled clinical trial in
Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for
elective, primary coronary revascularization. They were randomly divided into three
groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic
acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent
volume of saline solution. Blood requirement and postoperative chest tube drainage
were recorded.
Results: The placebo group (group C) had a greater postoperative blood loss 12 h after
surgery (501±288 vs. 395±184 in group B and 353±181 mL in group A, P=0.004). The
placebo group also had greater postoperative total blood loss (800±347 vs. 614±276 in
group B and 577±228 mL in group A, P=0.001). There was a significant increase in
allogeneic blood requirement in the placebo group (P=0.001).
Conclusion: For elective, first time coronary artery bypass surgery, a single dose of
tranexamic acid before or after cardiopulmonary bypass is equally effective