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ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2003 April;44(2):205-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Tranexamic acid reduces bleeding after off-pump coronary artery bypass grafting

Jares M., Vanek T., Straka Z., Brucek P.

Department of Cardiac Surgery 3rd Medical School of Charles University Kralovske Vinohrady University Hospital Prague, Czech Republic


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Aim. To ­assess the ­ability of tran­ex­amic ­acid, com­pared ­with an ­untreated con­trol ­group, to ­decrease ­bleeding and trans­fu­sion require­ments in ­patients under­going cor­o­nary ­artery ­bypass ­grafting on the ­beating ­heart.
­Methods. ­Forty-nine ran­domly ­selected ­patients ­were ­enrolled to elec­tive cor­o­nary ­artery ­bypass ­grafting ­without the use of car­di­o­pul­mo­nary ­bypass. Of ­these, 23 ­received tran­ex­amic ­acid (­bolus of 1 g ­before sur­gical inci­sion, fol­lowed by infu­sion 200 mg/­hour ­during sur­gery) and 26 ­patients ­were ­enrolled ­into a con­trol ­group. Pre­op­er­a­tive hemat­o­log­ical var­i­ables, post­op­er­a­tive ­blood ­loss at 4 and 24 ­hours, trans­fu­sion require­ments of ­packed red ­blood ­cells,and post­op­er­a­tive throm­botic ­events ­such as a myo­car­dial infarc­tion, ­stroke and pul­mo­nary embo­lism ­were ­recorded.
­Results. The two ­groups ­were sim­ilar in ­terms of ­patients’ char­ac­ter­is­tics. Post­op­er­a­tive ­bleeding was sig­nif­i­cantly ­lower in the tran­ex­amic ­acid ­group com­pared ­with the con­trol ­group (­median [25th-75th per­cen­tiles]): 115 [92-148] vs 230 [170-260] mL at 4 ­hours, p<0.001; 420 [330-523] vs 550 [500-650] mL at 24 ­hours, p<0.01). Trans­fu­sion require­ments ­were ­lower in the tran­ex­amic ­acid ­group com­pared ­with the con­trol ­group (RBC 9% vs 28%), but the dif­fer­ence was not sta­tis­ti­cally sig­nif­i­cant. Treat­ment ­with tran­ex­amic ­acid was not asso­ciated ­with a ­higher inci­dence of myo­car­dial ­ischemia or ­other throm­botic ­events.
Con­clu­sion. Tran­ex­amic ­acid ­reduces post­op­er­a­tive ­blood ­loss ­after cor­o­nary ­artery ­bypass ­grafting on the ­beating ­heart. Eval­u­a­tion of trans­fu­sion require­ments war­rants fur­ther ­study.

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