• D Katsaros, M Petricevic, N J Snow, D D Woodhall, and R Van Bergen.
• Division of Cardiothoracic Surgery, Fairview Hospital, Cleveland, Ohio, 44111, USA.
• Ann. Thorac. Surg. 1996 Apr 1;61(4):1131-5.

BackgroundPharmacologic intervention to minimize postbypass bleeding and blood product transfusions has received increasing attention for both medical and economic reasons.MethodsTwo hundred ten patients were entered into a double-blinded, prospective, randomized study to receive either 10 g of fibrinolytic inhibitor tranexamic acid before incision (n = 104) or 250 mL of placebo saline solution (n = 106). All subjects requiring cardiopulmonary bypass were deemed suitable, including those having first-time coronary bypass grafting, valve replacement, and reoperation.ResultsThere were no statistically significant differences between the groups with respect to demographic or operative characteristics. The tranexamic acid group had a 48% reduction in 24-hour blood drainage (p < 0.001) and received 69% fewer total units of packed red blood cells, 83% fewer total units of plasma, and 75% fewer platelet transfusion units than controls. Only 13 of 104 tranexamic acid patients received blood products versus 33 of 106 controls (p < 0.001). The incidences of thrombotic complications, perioperative myocardial infarction, renal failure, and neurologic complications were not significantly different between the two groups. The tranexamic acid group had 0% mortality versus 1.9% for controls (not significant).ConclusionsTranexamic acid is safe and effective in reducing blood loss and blood use in a wide variety of cardiac surgical patients.

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