Dual-route tranexamic acid to reduce blood loss in coronary artery bypass graft surgery: a randomized controlled trial

Autor: Mark Rosin, Hyun J. Lim, Kelsey Brose, Oksana Prokopchuk-Gauk, Taras Mycyk
Rok vydání: 2016
Předmět:
Zdroj: Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 63:1110-1111
ISSN: 1496-8975
0832-610X
Popis: To the Editor, A 2009 systematic review and meta-analysis suggested that topical anti-fibrinolytic agents can reduce postoperative bleeding and transfusion requirements in patients undergoing on-pump cardiac surgery. Systemic administration of lysine analogues, including tranexamic acid (TXA), has become the standard of care in patients undergoing on-pump coronary artery bypass graft (CABG) surgery to diminish perioperative blood loss and transfusion requirements. Here, we report the findings of a double-blind, randomized trial in low-risk CABG surgical patients that evaluated whether co-administration of intravenous and topical TXA has a significant impact on blood loss and transfusion requirements. Approval from our institutional ethics board was obtained, and written informed consent was given by each participant. Between December 1, 2011 and April 30, 2012 all patients scheduled for cardiac surgery at our institution were prospectively screened for trial participation. To limit participant heterogeneity, we recruited low-risk surgical candidates defined according to EUROScore criteria scheduled for elective or urgent CABG. Our primary outcome was the total volume of postoperative blood loss, determined by measuring mediastinal chest tube drainage. We calculated that a total sample size of 74 participants allowed 80% power to detect a 200 mL difference in total blood loss (type I error of 0.05) between groups. Secondary outcomes included chest tube losses at six and 12 hr, postoperative red blood cell transfusion requirement, and length of intensive care unit (ICU) stay. Adverse events of a thrombotic nature were recorded. Participants were randomized to receive an intraoperative topical TXA solution (study arm) or normal saline (control arm) prepared by our institutional clinical trials pharmacy according to a non-blocked randomization list generated before patient enrollment began. After general anesthesia, but prior to initiation of cardiopulmonary bypass, the study participants received a single intravenous bolus dose of TXA 30 mg kg over two minutes. Following removal of retractors and sponges prior to sternotomy closure, participants in the study arm received a cardiac bath of TXA solution containing 2 g TXA (1 g in 10 mL; Pfizer Canada, Saint-Laurent, QC, Canada) plus 50 mL of pre-warmed (42 C) normal saline. The control arm received 70 mL of pre-warmed normal saline only. This fluid remained within the pericardial cavity during placement of mediastinal chest tubes and chest closure. It was subsequently drained to the intraoperative cell-salvage machine by suction. The chest O. Prokopchuk-Gauk, MD Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
Databáze: OpenAIRE
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