HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Luca Sandrelli Giovanni Speziali Salvatore Spagnolo Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Casati, V. Articles by Spagnolo, S. Search for Related Content PubMed PubMed Citation Articles by Casati, V. Articles by Spagnolo, S. Related Collections Great vessels

J Thorac Cardiovasc Surg 2002;123:1084-1091
© 2002 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology (CSP)

Hemostatic effects of tranexamic acid in elective thoracic aortic surgery: A prospective, randomized, double-blind, placebo-controlled study

From the Division of Cardiac Anesthesia and Intensive Care,^a Division of Cardiac Surgery,^b Policlinico di Monza, Monza, and Epidemiology Unit, San Raffaele Hospital,^c Milan, Italy.

Received for publication July 18, 2001. Revisions requested Sept 17, 2001; revisions received Sept 26, 2001. Accepted for publication Oct 3, 2001. Address for reprints: Valter Casati, MD, Division of Cardiac Anesthesia and Intensive Care, Policlinico di Monza, via Amati 111, 20052, Monza (Milan), Italy (E-mail: valter.casati{at}tin.it).

Objective: We studied the hemostatic effects of tranexamic acid in patients undergoing elective surgery involving the thoracic aorta.
Methods: In a double-blind, randomized fashion, 60 consecutive patients were assigned to two treatment groups: 30 patients (placebo group) received infusion of saline solution, and 30 (treatment group) received tranexamic acid (1 g before skin incision, an infusion of 400 mg/h during the operation, and 500 mg in the pump priming). Perioperative bleeding was considered as a primary outcome. Perioperative allogeneic transfusions, major thrombotic complications (myocardial infarction, pulmonary embolism, renal insufficiency), and surgical outcomes were also considered.
Results: Patients treated with tranexamic acid showed significant reductions in postoperative bleeding, both in terms of the amount collected during the first 4 postoperative hours (median 307 mL, interquartile range 253-361 mL in the placebo group vs median 211 mL, interquartile range 108-252 mL in the treatment group, P = .002) and in terms of total bleeding (median 722 mL, interquartile range 574-952 mL in the placebo group vs median 411 mL, interquartile range 313-804 mL in the treatment group, P = .04). Consequently, the number of patients transfused differed significantly between groups (21 patients [72.4%] in the placebo group vs 13 [44.8%] in the treatment group, P = .033). Patients in the treatment group showed significant reductions in the total amount for the entire group of packed red cells transfused (13,500 mL in the treatment group vs 28,000 mL in the placebo group, P = .012) and in the total amount of allogeneic transfusions (23,400 mL in the treatment group vs 53,000 mL in the placebo group, P = .024). No differences in perioperative thrombotic complications were found.
Conclusions: In this initial series of patients undergoing thoracic aortic surgery, tranexamic acid appeared effective in reducing perioperative bleeding, with a significant reduction in the need for allogeneic transfusions and without any increased risk of thrombotic complications.

This article has been cited by other articles:

				K. Ker, P. Edwards, P. Perel, H. Shakur, and I. Roberts Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis BMJ, May 17, 2012; 344(may17_1): e3054 - e3054. [Abstract] [Full Text] [PDF]

				L. H. Edmunds Jr Managing Fibrinolysis Without Aprotinin Ann. Thorac. Surg., January 1, 2010; 89(1): 324 - 331. [Abstract] [Full Text] [PDF]

				C.-C. Chen, C.-C. Wang, C.-P. Wang, T.-H. Lin, W.-D. Lin, and S.-A. Liu Prospective, randomized, controlled trial of tranexamic acid in patients who undergo head and neck procedures Otolaryngology -- Head and Neck Surgery, June 1, 2008; 138(6): 762 - 767. [Abstract] [Full Text] [PDF]

				R. A. Kahn, M. E. Stone, and D. M. Moskowitz Anesthetic Consideration for Descending Thoracic Aortic Aneurysm Repair Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2007; 11(3): 205 - 223. [Abstract] [PDF]

				A. M. Mahdy and N. R. Webster Perioperative systemic haemostatic agents Br. J. Anaesth., December 1, 2004; 93(6): 842 - 858. [Abstract] [Full Text] [PDF]

				T. Bombeli and D. R. Spahn Updates in perioperative coagulation: physiology and management of thromboembolism and haemorrhage Br. J. Anaesth., August 1, 2004; 93(2): 275 - 287. [Abstract] [Full Text] [PDF]

				V. Casati, P. Della Valle, S. Benussi, A. Franco, C. Gerli, P. Baili, O. Alfieri, and A. D'Angelo Effects of tranexamic acid on postoperative bleeding and related hematochemical variables in coronary surgery: Comparison between on-pump and off-pump techniques J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 83 - 91. [Abstract] [Full Text] [PDF]

				V. Casati, S. Benussi, L. Sandrelli, M. A. Grasso, S. Spagnolo, and A. D'Angelo Intraoperative Moderate Acute Normovolemic Hemodilution Associated with a Comprehensive Blood-Sparing Protocol in Off-Pump Coronary Surgery Anesth. Analg., May 1, 2004; 98(5): 1217 - 1223. [Abstract] [Full Text] [PDF]

				V. Casati, H. Pleym, R. Stenseth, A. Wahba, L. Bjella, A. Karevold, and O. Dale Tranexamic Acid and Coronary Surgery * Response Anesth. Analg., January 1, 2004; 98(1): 275 - 275. [Full Text] [PDF]