Can local application of Tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial

Abstract

Background: Diffuse microvascular bleeding remains a common problem after cardiac procedures. Systemic use of antifibrinolytic reduces the postoperative blood loss. The purpose of this study was to examine the effectiveness of local application of tranexamic acid to reduce blood loss after coronary artery bypass grafting (CABG).

Methods: Thirty eight patients scheduled for primary isolated coronary artery bypass grafting were included in this double blind, prospective, randomized, placebo controlled study. Tranexamic acid (TA) group (19 patients) received 1 gram of TA diluted in 100 ml normal saline. Placebo group (19 patients) received 100 ml of normal saline only. The solution was purred in the pericardial and mediastinal cavities.

Results: Both groups were comparable in their baseline demographic and surgical characteristics. During the first 24 hours post-operatively, cumulative blood loss was significantly less in TA group (median of 626 ml) compared to Placebo group (median of 1040 ml) (P = 0.04). There was no significant difference in the post-op Packed RBCs transfusion between both groups (median of one unit in each) (P = 0.82). Significant less platelets transfusion required in TA group (median zero unit) than in placebo group (median 2 units) (P = 0.03). Apart from re-exploration for excessive surgical bleeding in one patient in TA group, no difference was found in morbidity or mortality between both groups.

Conclusion: Topical application of tranexamic acid in patients undergoing primary coronary artery bypass grafting led to a significant reduction in postoperative blood loss without adding extra risk to the patient.

Figure 1

Post-op Blood Loss/Hour. Our study demonstrates that pouring of one gram of TA into the pericardial cavity after CABG, significantly reduced post-operative blood loss in the first 24 hours after surgery (37%) with the maximum reduction at the 3rd hour (66%).

Figure 2

Post-op Blood Loss/24 hours and total. Chest tube drainage in the first 24 hours was significantly less in TA group (median of 626 ml) than in the placebo group (median of 1040 ml) (P = 0.04). This represented about 37% decrease in the blood loss. The median total post-operative chest tube drainage was 656 ml (range 248–2105) in TA group and 1056 ml (range 210–3010) in the placebo group, which represents 32% reduction in total bleeding.

Figure 3

Post-op Blood Products Transfusion. There was no significant difference in the post-op packed red blood cells (PRBCs) transfusion between both groups (median of one unit in each) (P = 0.82). Also there was no significant difference in regard Fresh Frozen Plasma (FFP) transfusion between both groups (Median of zero unit in TA vs. two units in placebo) (P = 0.42). Significant more platelets transfusion required in the Placebo group (median 2 units) than in TA group (median zero unit) (P = 0.03)