Tranexamic Acid Administration after Cardiac Surgery: A Prospective, Randomized, Double-blind, Placebo-controlled Study

Background: Many different doses and administration schemes have been proposed for the use of the antifibrinolytic drug tranexamic acid during cardiac surgery. This study evaluated the effects of the treatment using tranexamic acid during the intraoperative period only and compared the results with the effects of the treatment continued into the postoperative period.

Methods: Patients undergoing elective cardiac surgery with use of cardiopulmonary bypass (N = 510) were treated intraoperatively with tranexamic acid and then were randomized in a double-blind fashion to one of three postoperative treatment groups: group A: 169 patients, infusion of saline for 12 h; group B: 171 patients, infusion of tranexamic acid, 1 mg [middle dot] kg-1 [middle dot] h-1 for 12 h; group C: 170 patients, infusion of tranexamic acid, 2 mg [middle dot] kg-1 [middle dot] h-1 for 12 h. Bleeding was considered to be a primary outcome variable. Hematologic data, allogeneic transfusions, thrombotic complications, intubation time, and intensive care unit and hospital stay duration also were evaluated.

Results: No differences were found among groups regarding postoperative bleeding and outcomes; however, the group treated with 1 mg[middle dot]kg-1[middle dot]h-1 tranexamic acid required more units of packed red blood cells because of a significantly lower basal value of hematocrit, as shown by multivariate analysis.