• Paul S Myles, Julian A Smith, Jessica Kasza, Brendan Silbert, Mohandas Jayarajah, Thomas Painter, D James Cooper, Silvana Marasco, John McNeil, Jean S Bussières, Shay McGuinness, Kelly Byrne, Chan Matthew T V MTV Department of Anesthesiology and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China., Giovanni Landoni, Sophie Wallace, Andrew Forbes, and ATACAS investigators and the ANZCA Clinical Trials Network.
• Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Australia; Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia. Electronic address: p.myles@alfred.org.au.
• J. Thorac. Cardiovasc. Surg. 2019 Feb 1; 157 (2): 644-652.e9.

BackgroundTranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes.MethodsUsing a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery.ResultsThe rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053).ConclusionsIn this trial of patients having coronary artery surgery, tranexamic acid did not affect death or severe disability through to 1 year after surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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