Determining the Optimal Tranexamic Acid Dose for Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Controlled Trial

Abstract

\n Background: Tranexamic acid (TXA) has been widely used to reduce the risk of bleeding in patients undergoing cardiac surgery. However, the clinical TXA dose that best reduces postoperative bleeding has not been determined. We evaluated the efficacy of two different doses of TXA using Thromboelastography (TEG) in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods: One hundred and eleven patients who underwent primary cardiac valve replacement with CPB were enrolled in this study. Patients were randomly divided into three groups: T1, T2, and the control group. Patients in the TXA group would receive different TXA doses: 15 mg/kg loading dose followed by an infusion of 5 mg/kg/h until the completion of surgery (T1 group) or 6 mg/kg loading dose followed by an infusion of 3 mg/kg/h until the completion of surgery (T2 group). Pre-operative patient characteristics, intraoperative data, transfusions between and after surgery, chest tube output after surgery within two days, and outcome data were recorded.Results: Transfusion of blood products, blood loss, and chest tube output were significantly reduced in the T1 group compared with the control group (P< 0.05). Compared to the control group, the T2 group had similar results. Surgical time and length of intensive care unit (ICU) stay were significantly lower in the T1 and T2 groups compared to the control group (P< 0.05). No postoperative seizures occurred in all three patient groups.Conclusions: The use ofTranexamic acid was associated with a lower risk of bleeding compared to the control group. Both doses of tranexamic acid were effective to reduce blood loss as well as transfusions compared to the control group.