A Retrospective Analysis of Blood Loss with Combined Topical and Intravenous Tranexamic Acid after Coronary Artery Bypass Graft Surgery

OBJECTIVE:

Intravenous antifibrinolytics are the gold
standard for blood conservation during cardiac surgery. Recent evidence
suggests that topical tranexamic acid administration also is effective,
although the efficacy of combined topical and intravenous administration
has never been reported. Combined administration may offer superior
hemostasis while decreasing side effects. The current study explores the
use of combined topical and intravenous tranexamic acid as a blood
conservation strategy in cardiac surgery.

DESIGN:

Retrospective cohort.

SETTING:

A single-center, academic, tertiary care hospital.

PARTICIPANTS:

One hundred sixty elective coronary artery bypass graft patients.

INTERVENTION:

A
practice change allowed a retrospective comparison of postoperative
chest tube drainage in patients with intravenous or combined
(intravenous and topical) tranexamic acid.

MEASUREMENTS AND MAIN RESULTS:

Chest
tube drainage was decreased in the combined group at 3 (164.8 ± 102.2 v
242.7 ± 148.9 mL, p < 0.001), 6 (265.6 ± 163.7 v 358.8 ± 247.2 mL, p = 0.006), and 12 hours (374.3 ± 217.1 v 498.5 ± 336.6 mL, p = 0.006) postoperatively compared with the intravenous group. The tranexamic acid dose was higher in the combined group (5.1 ± 1.1 v 4.1 ± 1.3 g, p < 0.001), but less was administered intravenously (3.1 ± 1.1 v 4.1 ± 1.3 g, p < 0.001). No differences were observed in adverse events.

CONCLUSIONS:

This
study suggested that combined tranexamic acid administration may be
superior for blood conservation, but fully powered randomized controlled
trials will be required to confirm these findings and determine the
safety advantage and clinical relevance of adding topical tranexamic
acid to existing blood conservation strategies.