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Postoperative dose of tranexamic acid decreases postoperative bleeding and inflammatory response associated with cardiopulmonary bypass: a randomized, double-blind study

Introduction

Postoperative bleeding reflects haemostatic alterations associated with cardiopulmonary bypass (CPB), which may lead to inflammatory response (IR). We evaluated the efficacy of different doses of tranexamic acid (TA) (before versus before and after CPB) for IR and postoperative bleeding.

Methods

We performed a randomized, double-blind study with consecutive Caucasian adult patients undergoing elective CPB surgery from January 2006 to January 2007 in a 24-bed ICU at a university hospital. From 209 consecutive patients, 49 met the criteria for exclusion. After obtaining informed written consent, patients were randomized to receive coded infusions of a single pre-CPB dose (40 mg/kg) of TA (n = 80), and 40 mg/kg TA before and after (twice) CPB (n = 80). We performed an analysis, comparing IR incidence (defined as core body temperature higher than 38°C (100.4°F) in the first 4 hours after intervention, systemic vascular resistance index <1,600 dyn·s·cm-5·m-2 and cardiac index higher than 3.5 l·min-1·m-2) and postoperative 24-hour bleeding. We also analyzed several biological parameters related to inflammation, coagulation, fibrinolysis and hemoderivative requirements. SPSS version 15 was used.

Results

The incidence of post-CPB IR was significantly lower in the twice-TA group than in the single-TA group (7.5% vs 20%; P = 0.037). The twice-TA group had lower D-dimer at 4 and 24 hours after CPB (both, P < 0.001). The twice-TA group lost less blood at 24 hours after CPB than the single-TA group: 670 (95% CI = 543–798) ml vs 827 (95%CI = 704–950) ml (P = 0.007). No differences in blood transfusions were observed.

Conclusion

We observed a significant reduction of IR and postoperative bleeding with lower postoperative fibrinolysis in the group of CPB patients who received TA before and after CPB.

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Brouard, M., Jimenez, J., Iribarren, J. et al. Postoperative dose of tranexamic acid decreases postoperative bleeding and inflammatory response associated with cardiopulmonary bypass: a randomized, double-blind study. Crit Care 12, P222 (2008). https://doi.org/10.1186/cc6443

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Keywords

  • Inflammatory Response
  • Cardiopulmonary Bypass
  • Cardiac Index
  • Resistance Index
  • Systemic Vascular Resistance