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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 70-74, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JC Horrow, J Hlavacek, MD Strong, W Collier, I Brodsky, SM Goldman and IP Goel
Thirty-eight patients undergoing a cardiac operation randomly received
either tranexamic acid, a potent inhibitor of plasminogen, or placebo in an
effort to determine whether prophylactic antifibrinolytic therapy reduces
chest tube drainage. Twelve-hour blood loss was 750 +/- 314 (standard
deviation) ml in the placebo group and 496 +/- 228 ml in the drug group (p
= 0.0057). Fibrin split products were present more frequently in patients
in the placebo group (17 of 20 compared with four of 18 in the drug group;
p = 0.0002). Tranexamic acid markedly decreased plasminogen availability
(112 +/- 104 units in the placebo group versus 36 +/- 18 units in the drug
group, p = 0.0058). Plasma fibrinogen concentrations were similar in the
placebo and drug groups. Patients in the placebo group received more
fresh-frozen plasma and more mediastinal shed blood than those in the drug
group. No coagulation-related complication occurred in the group receiving
tranexamic acid. We conclude that prophylactic tranexamic acid can be
administered safely to inhibit fibrinolysis during cardiac operations,
decrease postoperative bleeding, and possibly decrease the frequency of
blood product transfusion.
ARTICLES
Prophylactic tranexamic acid decreases bleeding after cardiac operations
Department of Anesthesiology, Hahnemann University, Philadelphia, Pa.
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