Application of tranexamic acid in elderly patients during off-pump coronary artery bypass grafting: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QI Xiaotong ,  LIU Jinyuan , WEI Lei , WANG Xiaowei

Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P.R.China;

Corresponding author：

LIU Jinyuan, Email: dragonfly_ljy@njmu.edu.cn

Keywords：

Tranexamic acid; aged; off-pump; coronary artery bypass grafting

DOI：

10.7507/1007-4848.201611050

Video：

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Objective To investigate the efficacy and safety of tranexamic acid in patients with the age>70 years during off-pump coronary artery bypass grafting (OPCABG). Methods From June 2014 to August 2016, 340 patients undergoing elective OPCABG were included in this study. All the patients were more than 70 years old, among whom 282 were males and 58 were females. According to the random number generation method, the patients were randomly assigned to receive either tranexamic acid (30 mg/kg, infusion time was longer than 30 min after anesthesia induction; n=170) or a placebo (infusion equivalent volume of saline solution; n=170). The primary end point was chest tube drainage 6 h and 24 h postoperatively. The secondary end points were blood transfusion volumes, incidence of various thrombotic events, duration of mechanical ventilation, length of ICU and hospital stay. Results Compared with patients in the placebo group, the patients receiving tranexamic acid had a significant reduction in chest tube drainage at postoperative 6 h (275.6±105.1 ml vs. 459.6±110.2 ml, P<0.001) and 24 h (685.3±202.5 ml vs. 915.9±223.6 ml, P<0.001). There was also a significant reduction in allogeneic red blood cell transfusion (0.80±0.66 U vs. 1.60±1.30 U, P<0.001) and fresh frozen plasma transfusion (166±25 ml vs. 257±30 ml, P<0.001). There were no significant differences in incidence of various thrombotic events, duration of mechanical ventilation, length of ICU and hospital stay between the two groups. Conclusion Tranexamic acid can significantly reduce blood loss and transfusion in elderly patients 6 h and 24 h after OPCABG and the incidence of thrombotic events will not increase.

Citation： QI Xiaotong, LIU Jinyuan, WEI Lei, WANG Xiaowei. Application of tranexamic acid in elderly patients during off-pump coronary artery bypass grafting: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(8): 602-606. doi: 10.7507/1007-4848.201611050 Copy

1.	Robich MP, Koch CG, Johnston DR, et al. Trends in blood utilization in United States cardiac surgical patients. Transfusion, 2015, 55(4): 805-814.
2.	Biancari F, Mikkola R, Heikkinen J, et al. Estimating the risk of complications related to re-exploration for bleeding after adult cardiac surgery: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2012, 41(1): 50-55.
3.	Ranucci M, Bozzetti G, Ditta A, et al. Surgical reexploration after cardiac operations: Why a worse outcome? Ann Thorac Surg, 2008, 86(5): 1557-1562.
4.	Biglioli P, Cannata A, Alamanni F, et al. Biological effects of off-pump vs. on-pump coronary artery surgery: Focus on inflammation, hemostasis and oxidative stress. Eur J Cardiothorac Surg, 2003, 24(2): 260-269.
5.	Cheng DC, Bainbridge D, Martin JE, et al. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology, 2005, 102(1): 188-203.
6.	Wang G, Xie G, Jiang T, et al. Tranexamic acid reduces blood loss after off-pump coronary surgery: A prospective, randomized, double-blind, placebo-controlled study. Anesth Analg, 2012, 115(2): 239-243.
7.	Sigaut S, Tremey B, Ouattara A, et al. Comparison of two doses of tranexamic acid in adults undergoing cardiac surgery with cardiopulmonary bypass. Anesthesiology, 2014, 120(3): 590-600.
8.	Henry DA, Moxey AJ, Carless PA, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev, 2011(3): CD001886.
9.	Dowd NP, Karski JM, Cheng DC, et al. Pharmacokinetics of tranexamic acid during cardiopulmonary bypass. Anesthesiology, 2002, 97(2): 390-399.
10.	Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation, 2012, 126(16): 2020-2035.
11.	Fu SP, Zheng Z, Yuan X, et al. Impact of off-pump techniques on sex differences in early and late outcomes after isolated coronary artery bypass grafts. Ann Thorac Surg, 2009, 87(4): 1090-1096.
12.	Mangano DT, Tudor IC, Dietzel C. The risk associated with aprotinin in cardiac surgery. N Engl J Med, 2006, 354(4): 353-365.
13.	Garg J, Pinnamaneni S, Aronow WS, et al. St elevation myocardial infarction after tranexamic acid: First reported case in the United States. Am J Ther, 2014, 21(6): e221-224.
14.	Ngaage DL, Bland JM. Lessons from aprotinin: Is the routine use and inconsistent dosing of tranexamic acid prudent? Meta-analysis of randomised and large matched observational studies. Eur J Cardiothorac Surg, 2010, 37(6): 1375-1383.
15.	Manji RA, Grocott HP, Leake J, et al. Seizures following cardiac surgery: The impact of tranexamic acid and other risk factors. Can J Anaesth, 2012, 59(1): 6-13.
16.	Sharma V, Katznelson R, Jerath A, et al. The association between tranexamic acid and convulsive seizures after cardiac surgery: A multivariate analysis in 11529 patients. Anaesthesia, 2014, 69(2): 124-130.
17.	Keyl C, Uhl R, Beyersdorf F, et al. High-dose tranexamic acid is related to increased risk of generalized seizures after aortic valve replacement. Eur J Cardiothorac Surg, 2011, 39(5): e114-121.
18.	Baharoglu MI, Germans MR, Rinkel GJ, et al. Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev, 2013(8): CD001245.
19.	Myles PS, Smith JA, Forbes A, et al. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med, 2017, 376(2): 136-148.
20.	Ker K, Edwards P, Perel P, et al. Effect of tranexamic acid on surgical bleeding: Systematic review and cumulative meta-analysis. BMJ, 2012, 344: e3054.

1. Robich MP, Koch CG, Johnston DR, et al. Trends in blood utilization in United States cardiac surgical patients. Transfusion, 2015, 55(4): 805-814.
2. Biancari F, Mikkola R, Heikkinen J, et al. Estimating the risk of complications related to re-exploration for bleeding after adult cardiac surgery: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2012, 41(1): 50-55.
3. Ranucci M, Bozzetti G, Ditta A, et al. Surgical reexploration after cardiac operations: Why a worse outcome? Ann Thorac Surg, 2008, 86(5): 1557-1562.
4. Biglioli P, Cannata A, Alamanni F, et al. Biological effects of off-pump vs. on-pump coronary artery surgery: Focus on inflammation, hemostasis and oxidative stress. Eur J Cardiothorac Surg, 2003, 24(2): 260-269.
5. Cheng DC, Bainbridge D, Martin JE, et al. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology, 2005, 102(1): 188-203.
6. Wang G, Xie G, Jiang T, et al. Tranexamic acid reduces blood loss after off-pump coronary surgery: A prospective, randomized, double-blind, placebo-controlled study. Anesth Analg, 2012, 115(2): 239-243.
7. Sigaut S, Tremey B, Ouattara A, et al. Comparison of two doses of tranexamic acid in adults undergoing cardiac surgery with cardiopulmonary bypass. Anesthesiology, 2014, 120(3): 590-600.
8. Henry DA, Moxey AJ, Carless PA, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev, 2011(3): CD001886.
9. Dowd NP, Karski JM, Cheng DC, et al. Pharmacokinetics of tranexamic acid during cardiopulmonary bypass. Anesthesiology, 2002, 97(2): 390-399.
10. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation, 2012, 126(16): 2020-2035.
11. Fu SP, Zheng Z, Yuan X, et al. Impact of off-pump techniques on sex differences in early and late outcomes after isolated coronary artery bypass grafts. Ann Thorac Surg, 2009, 87(4): 1090-1096.
12. Mangano DT, Tudor IC, Dietzel C. The risk associated with aprotinin in cardiac surgery. N Engl J Med, 2006, 354(4): 353-365.
13. Garg J, Pinnamaneni S, Aronow WS, et al. St elevation myocardial infarction after tranexamic acid: First reported case in the United States. Am J Ther, 2014, 21(6): e221-224.
14. Ngaage DL, Bland JM. Lessons from aprotinin: Is the routine use and inconsistent dosing of tranexamic acid prudent? Meta-analysis of randomised and large matched observational studies. Eur J Cardiothorac Surg, 2010, 37(6): 1375-1383.
15. Manji RA, Grocott HP, Leake J, et al. Seizures following cardiac surgery: The impact of tranexamic acid and other risk factors. Can J Anaesth, 2012, 59(1): 6-13.
16. Sharma V, Katznelson R, Jerath A, et al. The association between tranexamic acid and convulsive seizures after cardiac surgery: A multivariate analysis in 11529 patients. Anaesthesia, 2014, 69(2): 124-130.
17. Keyl C, Uhl R, Beyersdorf F, et al. High-dose tranexamic acid is related to increased risk of generalized seizures after aortic valve replacement. Eur J Cardiothorac Surg, 2011, 39(5): e114-121.
18. Baharoglu MI, Germans MR, Rinkel GJ, et al. Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev, 2013(8): CD001245.
19. Myles PS, Smith JA, Forbes A, et al. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med, 2017, 376(2): 136-148.
20. Ker K, Edwards P, Perel P, et al. Effect of tranexamic acid on surgical bleeding: Systematic review and cumulative meta-analysis. BMJ, 2012, 344: e3054.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of tranexamic acid in elderly patients during off-pump coronary artery bypass grafting: A randomized controlled trial

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