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PubMed · 8579642

Does tranexamic acid decrease bleeding in patients undergoing cardiopulmonary bypass?

N R Connelly·B M Kiessling·S J Brull
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Abstract

We reviewed the records of 66 patients who underwent cardiopulmonary bypass; half of these patients received the plasmin inhibitor, tranexamic acid. The demographics were not different between the group who received tranexamic acid and the group who did not (control group). There was no difference in the heparin or protamine requirements between the two groups. There was a significantly greater amount of 12-hr chest tube bleeding in the control group (495 +/- 484 vs. 863 +/- 655 in the control and tranexamic acid groups, respectively; p < .02). There was no difference between the groups in either the post-operative hematocrit, platelet count or the number of patients requiring transfusion. Although tranexamic acid decreased the amount of chest tube output, there was no demonstrable patient benefit derived from its use.

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Antifibrinolytic AgentsBlood Loss, SurgicalBlood Transfusion, AutologousCardiopulmonary BypassFibrinolysinHeparinHumansPlatelet CountProtaminesRetrospective StudiesTranexamic AcidJournal Article

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N R Connelly, B M Kiessling, S J Brull. Does tranexamic acid decrease bleeding in patients undergoing cardiopulmonary bypass?. https://pubmed.ncbi.nlm.nih.gov/8579642/

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PubMed1996

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PubMed1996

Reduction in requirements for allogeneic blood products: pharmacologic methods.

BACKGROUND: Numerous articles describe the reduction of perioperative bleeding by the therapeutic or prophylactic administration of drugs such as prostacyclin, desmopressin, and natural or synthetic antifibrinolytics. METHODS: A review of the literature was carried out to help the reader define the indications of these drugs during cardiopulmonary bypass operations, highlight the questions that remain concerning their indications and modes of action, and suggest future studies to answer these remaining questions. RESULTS: Prostacyclin reduces platelet trauma induced by extracorporeal circulation but does not effectively reduce postoperative bleeding and transfusion requirements. Desmopressin acts as a "glue," improving platelet adhesion, and may be effective when postoperative bleeding is excessive, but its routine use in cardiac operations cannot be recommended. Natural and synthetic antifibrinolytics inhibit plasmin and plasmin-induced platelet dysfunction. These agents have been shown to decrease bleeding and the need for allogeneic transfusions after open heart operations. However, with antifibrinolytic drugs, the risk of thromboembolic phenomena cannot be neglected. With aprotinin, this risk appears to be minimal when the drug is used at concentrations high enough to inhibit plasma kallikrein also. CONCLUSIONS: Prophylactic antifibrinolytics are efficacious, but their routine use remains controversial, both for economic reasons and for fear of thromboembolic complications.

Antifibrinolytic Agents↗