EFFECTS OF BOLUS DOSE AND CONTINUOUS INFUSION OF TRANEXAMIC ACID ON BLOOD LOSS AFTER CORONARY ARTERY BYPASS GRAFTING

Imtiaz Ahmad, Mujahid -ul- Islam, Ansa Islam, Azmat Ali Shah

Abstract


Background: Cardiac surgery is associated with excessive bleeding that is as a result of coagulopathy caused by cardiopulmonary bypass. We evaluated the effect of two different modalities for administering similar doses of tranexamic acid on bleeding following primary elective coronary artery bypass grafting (CABG). Methods: In the randomized control trial. 137 patients scheduled for CABG were randomized to two groups applying different modalities of tranexamic acid administration (bolus injection of 30 mg/kg vs. continuous infusion). Blood loss until removal of chest tubes was the primary outcome measure; we also recorded and assessed blood products transfused, and length of ICU stay. Results: Both the groups were comparable at baseline. Trends toward transfusion differences between groups were not statistically significant. No differences in length of ICU stay, morbidity or mortality were found. Conclusion: In CABG surgery, the use of either method for administering similar doses of tranexamic acid leads to a similarl reduction in postoperative mediastinal bleeding.

Keywords: Tranexamic acid, CABG, cardiac surgery, antifibrinolytic

Full Text:

PDF

References


Mehr-Aein A, Davoodi S, Madani-Civi M. Effects of tranexamic acid and autotransfusion in coronary artery bypass. Asian cardiovasc thorac Ann 2007;15:49-53.

Laupacis A, Fergusson D. Drugs to minimize perioperative blood loss in cardiac surgery, meta analyses using perioperative blood transfusion as the outcome. The International Study of Peri-operative Transfusion Investigators. Anesth Analg 1997;85:1258–67.

Levi M, Cromheecke ME, de Jonge E, Prins MH, de Mol BJ, Briët E, et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet 1999;354:1940–7.

Karkouti K, Wijeysundera DN, Yau TM, Beattie WS, Abdelnaem E, McCluskey SA, et al. The independent association of massive blood loss with mortality in cardiac surgery. Transfusion 2004;44:1453–62.

Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg 1996;111:1037–46.

Mangano DT, Tudor IC, Dietzel C; Multicenter Study of Perioperative Ischemia Research Group, Ischemia Research and Education Foundation. The risk associated with aprotinin in cardiac surgery. N Engl J Med 2006;354:353–65.

Karkouti K, Beattie WS, Dattilo KM, McCluskey SA, Ghannam M, Hamdy A, et al. A propensity score case-control comparison of aprotinin and tranexamic acid in high-transfusion-risk cardiac surgery. Transfusion 2006;46:327–38.

Casati V, Guzzon D, Oppizzi M, Bellotti F, Franco A, Gerli C, et al. Tranexamic acid compared with high dose aprotinin in primary elective heart operations: effects on perioperative bleeding and allogeneic transfusion. J Thorac Cardiovasc Surg 2000;120:520–7.

Klindworth J.T., MacVeigh I., Ereth M.H. The platelet activated clotting test (PACT) predicts platelet dysfunction associated with cardiopulmonary bypass (CPB). Anesth Analg 1982; 82:SCA1-S130.

Dunn CJ, Goa KL. Tranexamic acid, a review of its use in surgery and other indications. Drugs 1999;57:1005–32.

Armellin G, Casella S, Guzzinati S, Pasini L, Marcassa A, Giron G. Tranexamic acid in aortic valve replacement. J Cardiothorac Vasc Anesth 2001;15:331–5.

Kuitunen A, Hiippala S, Vahtera E, Rasi V, Salmenpera M. The effects of aprotinin and tranexamic acid on thrombin generation and fibrinolytic response after cardiac surgery. Acta Anaesthesiol Scand 2005;49:1272–9.

Porte RJ, Leebeek WG. Pharmacological strategies to decrease transfusion requirements in patients undergoing surgery. Drugs 2002;62 2193–211.

Pleym H, Stenseth R, Wahba A, Bjella L, Karevold A, Dale O. Single-dose tranexamic acid reduces postoperative bleeding after coronary surgery in patients treated with aspirin until surgery. Anesth Analg 2003;96:923–8.

Gerhardt MA. Postoperative care of the cardiac surgical patients. In: Fradric A, Hensle J, Martin DE, Gravlee PG, editors. Practical approach to cardiac anaesthesia. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2008.p. 261–85.

Whitlock R, Crowther MA, Ng HJ. Bleeding in cardiac surgery: its prevention and treatment – an evidence-based review. Crit Care Clin 2005;21:589–610.

Horrow JC, Hlavacek J, Strong MD, Collier W, Brodsky I, Goldman SM, et al. Prophylactic tranexamic acid decreases bleeding after cardiac operations. J Thorac Cardiovasc Surg 1990;99:70–4.

Ferraris VA, Ferraris SP, Saha SP, Hessel EA 2nd, Haan CK, Royston BD, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 2007;83:S27–86.

Gombotz H, Rehak PH, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark study. Transfusion 2007;47:1468–80.

Henry DA, Carless P, Moxey A, O'Connell D, Stokes BJ, McClelland B, et al. Anti-fibrinolytic use for minimizing perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2007:4:CD001886.

Dietrich W, Spannagl M, Boehm J, Hauner K, Braun S, Schuster T, et al. Tranexamic Acid and Aprotinin in Primary Cardiac Operations: An Analysis of 220 Cardiac Surgical Patients Treated with Tranexamic Acid or Aprotinin. Anesth Analg 2008;107:1469–78.

Horrow JC, Van Riper DF, Strong MD, Grunewald KE, Parmet JL. The dose response relationship of tranexamic acid. Anesthesiology 1995;82:383–92.

Dowd NP, Karski JM, Cheng DC, Carroll JA, Lin Y, James RL, et al. Pharmacokinetics of tranexamic acid during cardiopulmonary bypass. Anesthesiology 2002;97:390–9.

Lambert W, Brisebois FJ, Wharton TJ, Carrier RC, Boyle D, Rowe BH.The effectiveness of low dose tranexamic acid in primary cardiac surgery. Can J Anaesth 1998;45:571–4.

Andreasen JJ, Nielsen C. Prophylactic tranexamic acid in elective, primary coronary artery bypass surgery using cardiopulmonary bypass. Eur J Cardiothorac Surg 2004;26:311–7.

Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg. 2004;78:527–34.

Dacey LJ, Munoz JJ, Baribeau YR, Johnson ER, Lahey SJ, Leavitt BJ, et al. Reexploration for hemorrhage following coronary artery bypass grafting: incidence and risk factors. Northern New England Cardiovascular Disease Study Group. Arch Surg 1998; 133: 442–7.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]