Topical application of tranexamic acid as a surgical hemostat in primary coronary artery bypass graft surgery: a comparative study

Background Antifibrinolytics are widely used in cardiac surgery to reduce bleeding and allogenicblood transfusion. The aim of this study was to compare the efficacy of local application of tranexamic acid (TXA) with its intravenous route in patients during coronary artery bypass graft (CABG) surgery. Methods A total of 106 patients undergoing primary CABG were assigned to one of two groups. Group ITXA received intravenous TXA: initially, a bolus of 1 g, followed by continuous infusion of 400 mg/h during the surgical procedure. Group LTXA received 1 g of TXA diluted in 100 ml of isotonic saline delivered into the pericardium and mediastinal cavities before closure of sternotomy. The primary end-point was 24-h postoperative blood loss. Results The total amount of blood loss postoperatively was similar in both groups (379 ± 20.73 vs. 384± 23.57ml in the LTXA and the ITXA group, respectively, P= 0.235). The number of packed red blood cell unit transfusion per patient was comparable in both groups (1.0± 0.86 vs. 1.16± 0.89U in LTXA and ITXA, respectively, P= 0.425). No incidences of postoperative myocardial infarction were encountered in either groups.Troponin I levels were similar in both groups. Reoperation for nonspecific bleeding was three of 50 patients (6%) in the ITXA group and two of 52 patients (4%) in the LTXA group. Conclusion Local application of TXA is considered effectively similar in reducing postoperative bleeding and transfusion requirements as its intravenous route in patients undergoing on-pump CABG, with the advantage of providing lower doses of the drug.