Tranexamic acid decreased postoperative bleeding and systemic inflammatory response syndrome associated with cardiopulmonary bypass: a prospective, randomized, double-blind controlled study

Background

Postoperative bleeding reflects haemostatic alterations associated with cardiopulmonary bypass (CPB), which may lead to systemic inflammatory response syndrome (SIRS). We evaluated the efficacy of tranexamic acid (TA) for SIRS and postoperative bleeding.

Patients and methods

We performed a prospective, randomized, double-blind controlled study of 50 consecutive patients who underwent elective CPB. Twenty-four patients received TA, and 26 received saline solution before and after CPB. We performed an intention-to-treat analysis, comparing SIRS incidence, postoperative 24-hour bleeding, and the need for haemoderivatives. We used SPSS-12.2 software for statistical purposes.

Results

No significant differences were found between groups for demographic, biochemical, and surgical characteristics. The incidence of post-CPB SIRS was significantly lower in the TA group than in the placebo group (17% vs 42%; P = 0.048). Fifty-three per cent of SIRS patients had vasoplegic shock vs 0% in non-SIRS patients (P < 0.001), and SIRS patients required more red blood cell (RBC) transfusions (P = 0.013), and more fresh plasma (P = 0.014) in the first 4 postoperative hours. The SIRS group showed an hyperfibrinolytic state, TA reduced fibrinolysis parameters such as D-dimer (P < 0.001). The TA group lost less blood than the placebo group (492 ± 387 ml vs 1036 ± 147 ml; P = 0.001) and required less RBC (475 ± 146 ml vs 962 ± 165 ml; P = 0.021) and less fresh plasma (33 ± 33 ml vs 409 ± 144 ml; P = 0.012). In the TA group the incidence of vasoplegic shock was significantly lower (P = 0.013), as was the use of norepinephrine (P = 0.029) and the mechanical ventilation time (P = 0.018).

Conclusion

We observed a significant reduction of SIRS and postoperative bleeding in the group of CPB patients who received tranexamic acid.