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J Thorac Cardiovasc Surg 2005;130:309-314
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Tranexamic acid and early saphenous vein graft patency in conventional coronary artery bypass graft surgery: A prospective randomized controlled clinical trial

Jacek Karski, MD a , * , George Djaiani, MD a , Jo Carroll, RN a , Mark Iwanochko, MD d , Priya Seneviratne, MD a , Peter Liu, MD d , Walter Kucharczyk, MD c , Ludwik Fedorko, MD a , Tirone David, MD b , Davy Cheng, MD a

a Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
b Division of Cardiac Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
c Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
d Department of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

Received for publication July 21, 2004; revisions received November 3, 2004; accepted for publication November 5, 2004.

* Address for reprints: Jacek Karski, MD, FRCPC, Department of Anesthesia, Toronto General Hospital, 200 Elizabeth St, 3EN-400, Toronto, Ontario M5G 2C4, Canada (Email: jacek.karski{at}uhn.on.ca).

OBJECTIVE: Use of antifibrinolytic agents reduces the risk of bleeding and decreases the need for blood product use in patients undergoing cardiac surgery. The purpose of this study was to determine whether perioperative use of tranexamic acid decreases the rate of saphenous vein graft patency in the early postoperative period after conventional coronary artery bypass grafting surgery.

METHODS: A total of 312 patients scheduled for elective coronary artery bypass grafting surgery with cardiopulmonary bypass were randomized to receive either tranexamic acid 100 mg/kg (n = 147) or placebo (n = 165) in a double-blinded fashion before the initiation of cardiopulmonary bypass. Saphenous vein graft patency was assessed with magnetic resonance imaging 5 to 30 days after surgery.

RESULTS: Both groups were comparable with respect to baseline demographic data and surgical characteristics. A total of 237 (76%) patients underwent magnetic resonance imaging assessment. A total of 297 saphenous vein grafts were performed and 253 (85.2%; 95% confidence interval, 83.5%-86.9%) were seen in the tranexamic acid group, and 265 saphenous vein grafts were performed and 231 (87.2%; 95% confidence interval, 85.5%-88.9%) were seen in the placebo group (P = .4969). The blood loss and blood product transfusion rates in the tranexamic acid group were significantly lower than in the placebo group. There was no difference between groups with respect to postoperative morbidity and mortality.

CONCLUSIONS: The administration of tranexamic acid before cardiopulmonary bypass did not seem to compromise early venous graft patency rates but reduced perioperative blood product transfusion rates. Consequently, tranexamic acid could be advocated for routine use in patients undergoing conventional coronary artery bypass grafting surgery.




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