Effect of two low doses of tranexamic acid in post-operative bleeding after cardiac surgery

Authors

  • Osvaldo González Alfonso Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Pedro A. Hidalgo Menéndez Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Rudy Hernández Ortega Hospital Universitario Celestino Hernández Robau
  • Jorge Méndez Martínez Hospital Universitario Arnaldo Milián Castro
  • Juan M. Rodríguez Álvarez Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Leonel Fuentes Herrera Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Alina Ceballos Álvarez Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Rafael O. Rodríguez Hernández Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Alain Moré Duarte Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Shemanet García Cid Hospital Universitario Capitán Roberto Rodríguez Fernández

Keywords:

tranexamic acid, antifibrinolytic agents, cardiac surgery, extracorporeal circulation

Abstract

Introduction and objectives: In cardiovascular surgery an excessive bleeding can occur, both during the surgical procedure and after it.  The objective of this investigation was to assess the effects of a low dose protocol of tranexamic acid in the prevention of bleeding following cardiovascular surgery. Method: A descriptive, longitudinal, prospective and non-randomized study with 51 patients who underwent surgery with extracorporeal circulation and to whom two doses of one gram of tranexamic acid was administered, was performed in the Cardiology Hospital of Santa Clara. The following variables were assessed: extracorporeal circulation times, number of reinterventions due to fibrinolysis, number of administered transfusions and extent of hematic loss within 24 hours after surgery. Results: Post-operative bleeding averaged 1272,9 ± 1148,8 ml; 52,9 % of the patients suffered blood loss of 1000 ml within 24 hours after surgery, 58.8% of the patients did not need allogenic blood transfusions, and only an average of 1,7 ± 3,4 of packed red blood cell units was administered to transfused patients. Only two patients needed reintervention due to exaggerated fibrinolysis. Conclusions: The low doses of tranexamic acid proved to be useful in reducing post-operative bleeding after cardiac surgery and at the same time they keep low the number of allogenic transfusions.

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References

1. Mannucci MP, Levi M. Prevention and Treatment of Major Blood Loss. N Engl J Med. 2007;356(22):2301-11.

2. Kaneda T, Suzuki T, Yoshino T, Mizusawa K. Is blood lactate level reasonable parameter to start red blood cell transfusion? Anesthesia & Analgesia. 2008;106(35):S-14.

3. Duggan E, O’Dwyer JM, Caraher E, Diviney D, McGovern E, Kelleher D, et al. Coagulopathy after cardiac surgery may be influenced by a functional plasminogen. Anesth Analg. 2007;104(6):1343-7.

4. Palacios X, Castro JA, Meza R, Jaramillo JC, Quintero A. Transfusiones en cirugía cardíaca. Parte II. Rev Col Anest. 2007;35(4):1210-6.

5. Farmacias Ahumadas. Tranexámico, Ácido. [Consultado: 24 de Mayo de 2010. Disponible en: http://www.farmaciasahumada.cl/fasaonline/fasa/MFT/DROGAS/D2495.HTM

6. Levy JH. Antifibrinolytics: e-Aminocaproic acid, Tranexamic Acid and Aprotinin. J Anesthesiol [Internet ]. 1997 [citado 24 Mayo 2010];1(2):[aprox. 6 p.]. Disponible en: http://www.ispub.com/journals/IJA/Vol1N2/antifibr.htm

7. Zonis Z, Seear M, Reichert C, Sett S, Allen C. The effect of preoperative tranexamic acid on blood loss after cardiac operations in children. J Thorac Cardiovasc Surg. 1996;111(5):982-7.

8. Reid RW, Zimmerman AA, Laussen PC, Mayer JE, Gorlin JB, Burrows FA. The efficacy of tranexamic acid versus placebo in decreasing blood loss in pediatric patients undergoing repeat cardiac surgery. Anesth Analg.1997;84(5):990-6.

9. Bulutcu FS, Özbek U, Polat B, Yalcin Y, Karaci AR, Bayindir O. Which may be effective to reduce blood loss after cardiac operations in cyanotic children: tranexamic acid, aprotinin or a combination? Pediatr Anesth. 2005;15(1):41-6.

10. Reichert C, Zonis Z, Sears M. Effect of tranexamic acid on blood loss following cardiac surgery in children. Can J Anaesth. 1995;42:55.

11. Varela CA, Sanabria P, Palomero MA, Tormo de las Heras C, Rodríguez E, Goldman L. Efecto del ácido tranexámico en el sangrado postoperatorio de cirugía cardíaca en pediatría. Rev Esp Anestesiol Reanim. 2007;54:155-61.

12. Fernández E. Utilidad del ácido tranexámico para reducir las pérdidas sanguíneas en la cirugía coronaria sin circulación extracorpórea. REAR. 2009;(12):52.

13. Beattie WS, Karkouti K. Con: Aprotinin has a good efficacy and safety profile relative to other alternativesf or prevention of bleeding in cardiac surgery. [editorial]. Anesth Analg. 2006;103(6):1360-4.

14. Brown R. J, Birkmeyer N, O’Connor T. G. Meta-Analysis Comparing the Effectiveness and Adverse Outcomes of Antifibrinolytic agents in cardiac surgery Meta-Analysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery. Circulation. 2007;115:2801-13.

15. Fergusson AD, Hébert CP, Mazer D, Fremes S, MacAdams C, Murkin MJ, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med. 2008;358(22):2319-31.

16. Schneeweiss S, Seeger DJ, Landon J, Walker MA. Aprotinin during coronary-artery bypass grafting and risk of death. N Engl J Med. 2008;358(8):771-83.

17. Ray A. W. Learning from aprotinin. Mandatory trials of comparative efficacy and safety needed. N Engl J Med. 2008;358(8):3.

18. Hogue W. C, London J. M. Aprotinin use during cardiac surgery: A new or continuing controversy? [editorial]. Anesth Analg. 2006;103(5):1067-70.

19. Lirio AT, Splettstosser JC, Warpechowski P, Pinto MM. Antifibrinolíticos y cirugía cardíaca con circulación extracorpórea. Rev Bras Anestesiol. 2007;57(5):315-324.

20. Ácido tranexámico. En: Wikipedia, la enciclopedia libre. España: Wikimedia Foundation, Inc; 2008. Disponible en: http://es.wikipedia.org/wiki/%C3%81cido_tranex%C3%A1mico#column-one#column-one

21. Taghaddomi RJ, Mirzaee A, Attar AS, Shirdel A. Tranexamic acid reduces blood loss in off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2009;23(3):312-5.

22. Casati V, Gerli C, Franco A, Torri G, D'Angelo A, Benussi S, et al. Tranexamic acid in off-pump coronary syrgery: A preliminary, randomized, double-blind, placebo-controlled study. Ann Thorac Surg. 2001;72(2):470-5.

23. Vanek T, Jares M, Fajt R, Straka Z, Jirasek K , Kolesar M , et al. Fibrinolytic inhibitors in off-pump coronary surgery. A prospective, randomized, double-blind TAP study. Eur J Cardiothorac Surg. 2005;28:563-8.

24. Wei M, Jian K, Guo Z, Wang L, Jiang D, Zhang L, et al. Tranexamic acid reduces postoperative bleeding in off-pump coronary artery bypass grafting. Scand Cardiovasc J. 2006;40(2):105-9.

25. Henry DA, Moxey AJ, Carless PA, O’Connell D, McClelland B, Henderson KM, et al. Anti-fibrinolytic use for minimising perioperative allogenic blood transfusion. (Cochrane Review). The Cochrane Library 2001, Issue 2.Art.

26. Laupacis A, Fergusson D. Drugs to minimize perioperative blood loss in cardiac surgery: meta-analyses using perioperative blood transfusion as the outcome. The International Study of Perioperative Transfusion (ISPOT) Investigators. Anesth Analg. 1997;85(6):1258-67.

27. Chauhan S, Das SN, Bisoi A, Kale S, Kiran U. Comparison of epsilon-aminocaproic acid and tranexamic acid in pediatric cardiac surgery. J Cardiothor Vasc Anesth. 2004;18(2):141-3.

28. Dowd NP, Karski JM, Cheng DC, Carroll JA, Lin Y, James RL, et al. Pharmacokinetics of tranexamic acid during cardiopulmonary bypass. Anesthesiology. 2002;97(2):390-9.

29. Soto A, Torres E, Caballero J, Azabache-Puente W, Malca-Polo, Marco CE, et al. Ensayo clínico pragmático en trauma: el estudio Crash-2 en el Perú. Rev Perú. Méd. Exp. Salud Pública [Internet]. 2008 [citado 24 Mayo 2009];25(1):[aprox. 6 p.]. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1726- 46342008000100017&lng=es&nrm=iso&tlng=es

30. Silvay G, Castillo GJ, Chikwe J, Flynn B, Filsoufi F. Cardiac anesthesia and surgery in geriatric patients. Semin Cardiothorac Vasc Anesth. 2008;12(1):18-28.

31. Jiménez Rivera JJ, Iribarren LJ, Raya M J, Nassar I, Lorente L, Pérez R, et al. Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study. Journal of Cardiothoracic Surgery. 2007;2(17):1-7

32. Rogers MA, Blumberg N, Saint SK, Kim C, Nallamothu BK, Langa KM. Allogeneic blood transfusions explain increased mortality in women after coronary artery bypass graft surgery. Am Heart J. 2006;152(6):1028-34.

33. Nuttall AG, Henderson N, Quinn M, Blair C, Summers L, Williams AB, et al. Excessive bleeding and transfusion in a prior cardiac surgery is associated with excessive bleeding and transfusion in the next surgery. Anesth Analg. 2006;102(4):1012-17.

34. Pleym H, Wahba A, Videm V, Åsberg A, Lydersen S, Bjella L, et al. Increased fibrinolysis and platelet activation in elderly patients undergoing coronary bypass surgery. Anesth Analg. 2006;102(3):660-7.

35. Collyer TC, Gray DJ, Sandhu R, Berridge J, Lyons G. Assessment of platelet inhibition secundary to clopidogrel and aspiring therapy in preoperative acute surgical patients measured by Thromboelastography Platelet Mapping. Br J Anaesth. 2009;102(4):492-8.

36. Ganter TM, Hofer KC. Coagulation Monitoring: Current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth Analg. 2008;106(5):1366-75.

37. Nuttall AG, Erchul TD, Haight JT, Ringhofer NS, Miller LT, Oliver CW, et al. A Comparison of Bleeding and Transfusion in Patients Who Undergo Coronary Artery Bypass Grafting Via Sternotomy With and Without Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2003;17(4):447-51.

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Published

2010-12-27

How to Cite

1.
González Alfonso O, Hidalgo Menéndez PA, Hernández Ortega R, Méndez Martínez J, Rodríguez Álvarez JM, Fuentes Herrera L, et al. Effect of two low doses of tranexamic acid in post-operative bleeding after cardiac surgery. CorSalud [Internet]. 2010 Dec. 27 [cited 2025 Sep. 11];2(4):263-72. Available from: https://revcorsalud.sld.cu/index.php/cors/article/view/1140

Issue

Vol. 2 No. 4 (2010)

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ORIGINAL ARTICLES

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