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J Thorac Cardiovasc Surg 1995;110:835-0842
© 1995 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Prevention of bleeding after cardiopulmonary bypass with high-dose tranexamic acidDouble-blind, randomized clinical trial

Jacek M. Karski, MD^a, Sally J. Teasdale, MD^a, Peter Norman, MD^a, Jo Carroll, RN, Karl VanKessel, BSc, Peter Wong, BSc, M. F. X. Glynn, MD^b

Toronto, Ontario, Canada

Supported in part by the Heart and Stroke Foundation of Ontario, grant A2063, and Kabi-Pharmacia, Mississauga, Ontario, Canada.

Received for publication Jan. 27, 1995. Accepted for publication Feb. 10, 1995. Address for reprints: Jacek Karski, MD, Department of Anesthesia, The Toronto Hospital General Division, 200 Elizabeth St., Toronto, Ontario, Canada, M5G 2C4.

Abstract

This prospective, double-blind, randomized trial assessed the effectiveness of high-dose tranexamic acid given in the preoperative period on blood loss in patients undergoing cardiopulmonary bypass. One hundred fifty patients scheduled to undergo cardiac operations with cardiopulmonary bypass were randomized into three groups of equal size. The first group received 10 gm of tranexamic acid intravenously over 20 minutes before sternotomy and a placebo infusion over 5 hours. The second group received 10 gm of tranexamic acid over 20 minutes and then another 10 gm infused intravenously over 5 hours. The control group received a placebo bolus and a placebo infusion over 5 hours (0.9% normal saline solution). The blood loss after the operation was measured at 6 hours and 24 hours. The homologous blood and blood products given during and up to 48 hours after operation were recorded. Eighteen percent of the control group patients shed more than 750 ml blood in 6 hours compared with only 2% in both tranexamic acid groups. Patients who shed more than 750 ml blood required 93% more red blood cell transfusions than patients without excessive bleeding. Tranexamic acid (10 gm) given intravenously in the period before cardiopulmonary bypass reduced blood loss over 6 hours by 50% and over 24 hours by 35%. Continued tranexamic acid infusion (10 gm over 5 hours) did not reduce bleeding further. There was no difference in the coagulation profile before operation between patients with and without excessive bleeding. However, coagulation tests done in the postoperative period indicated ongoing fibrinolysis and platelet dysfunction in patients with excessive bleeding. (J THORACCARDIOVASCSURG95;110:835-42)

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