Hostname: page-component-5c6d5d7d68-vt8vv Total loading time: 0.001 Render date: 2024-08-18T16:51:04.185Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of topical tranexamic acid in open heart surgery

Published online by Cambridge University Press:  27 January 2006

A. Abul-Azm  and
K. M. Abdullah
A. Abul-Azm
Affiliation:
Cairo University, Kasr El Ainy Faculty of Medicine, Department of Cardiothoracic Surgery, Cairo, Egypt
K. M. Abdullah
Affiliation:
Ain Shams University, Faculty of Medicine, Department of Anaesthesiology, Cairo, Egypt
Get access

Abstract

Summary

Background and objective: Cardiopulmonary bypass is known to induce postoperative coagulopathy including fibrinolysis. We have evaluated the effect of the topical use of tranexamic acid in the pericardial cavity on postoperative bleeding following open heart surgery. Methods: One hundred patients, scheduled for elective open heart surgery, were included in this double-blind, prospective, randomized, controlled study. They were allocated to a treatment group (Group I), or placebo group (Group II). Patients with coagulopathies, renal failure, re-do surgery, or recent anti-platelet treatment were excluded. In Group I, tranexamic acid (2 g in 100 mL of saline solution) was poured into the pericardial cavity before sternal closure. Placebo patients received 100 mL of saline. Postoperative blood loss, need for transfusion of blood products and the rate of re-sternotomy for bleeding were documented. Results: During the first postoperative 24 h, cumulative blood loss was significantly higher in Group II compared to Group I (1208 ± 121 mL vs. 733 ± 93 mL, respectively) (P < 0.001). More blood transfusions were administered to Group II patients (4.54 ± 1.4 units) as compared to Group I patients (2.64 ± 1.5 units) (P < 0.01). Conclusion: Topical application of tranexamic acid in patients undergoing primary open heart surgery led to a significant reduction of both postoperative mediastinal bleeding, and rate of re-exploration for haemostasis.

Keywords

CRITICAL CARECARDIOPULMONARY BYPASS, TRANEXAMIC ACIDANTIFIBRINOLYTIC AGENTSPOSTOPERATIVE HAEMORRHAGECARDIAC SURGICAL PROCEDURES
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 5 , May 2006 , pp. 380 - 384
Copyright
2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Daily PO, Lamphere JA, Dembitsky WP, Adamson RM, Dans NF. Effect of prophylactic epsilon aminocaproic acid on blood loss and transfusion requirements in patients undergoing first time coronary artery bypass grafting: a randomized prospective double-blind study. J Thorac Cardiovasc Surg 1994; 108: 99–106.Google Scholar
Lemmer JH, Stanford W, Bonney SLet al. Aprotinin for coronary artery bypass operations: efficacy, safety, and influence on early saphenous graft patency. A multicenter, randomized, double blind, placebo-controlled study. J Thorac Cardiovasc Surg 1994; 107: 543–553.Google Scholar
De Bonis M, Cavaliere F, Alessandrini Fet al. Topical use of tranexamic acid in coronary artery bypass operations: a double-blind, prospective, randomized, placebo-controlled study. J Thorac Cardiovasc Surg 2000; 119: 575–580.Google Scholar
Yasim A, Asik R, Atahan E. Effects of topical applications of aprotinin and tranexamic acid on blood loss after open heart surgery [Abstract]. Anadolu Kardiyol Derg 2005; 5: 36.Google Scholar
Khalil PN, Ismail M, Kalmar P, von Knobelsdorff G, Marx G. Activation of fibrinolysis in the pericardial cavity after cardiopulmonary bypass. Thromb Haemost 2004; 92: 568–574.Google Scholar
Tabuchi N, de Haan J, Boonstra PW, van Oeveren W. Activation of fibrinolysis in the pericardial cavity during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1993; 106: 828–833.Google Scholar
Fremes SE, Wong BI, Lee Eet al. Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding. Ann Thorac Surg 1994; 58: 1580–1588.Google Scholar
Longstaff C. Studies on the mechanisms of action of aprotinin and tranexamic acid as plasmin inhibitors and antifibrinolytic agents. Blood Coagul Fibrinol 1994; 5: 537–542.Google Scholar
Tatar H, Cicek S, Demirkilic Uet al. Topical use of aprotinin in open heart operations. Ann Thorac Surg 1993; 55: 659–661.Google Scholar
O’Regan DJ, Giannopoulos N, Mediratta Net al. Topical aprotinin in cardiac operations. Ann Thorac Surg 1994; 58: 778–781.Google Scholar
Alderman EL, Levy JH, Rich JBet al. Analyses of coro-nary graft patency after aprotinin use: results from the International Multicenter Aprotinin Graft Patency Experience Study (IMAGE) trial. J Thorac Cardiovasc Surg 1998; 116: 716–730.Google Scholar
Ovrum E, Holen EA, Abdelnoor M, Oystese R, Ringdal ML. Tranexamic acid (Cyclokapron) is not necessary to reduce blood loss after coronary artery bypass operations. J Thorac Cardiovasc Surg 1993; 105: 78–83.Google Scholar