THE EFFICACY OF ADMINISTRATION OF TRANEXAMIC ACID PRE AND POST CARDIOPULMONARY BYPASS VERSUS PLACEBO IN REDUCING BLOOD LOSS TRANSFUSION IN CARDIAC SURGERY: A PROSPECTIVE, RANDOMIZED, PLACEBO- CONTROLLED, DOUBLE-BLIND TRIAL
Loading...
Date
2022-12-21
Authors
Mariam Sharakah
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Cardiopulmonary Bypass (CBP) provides a blood–free field surgery, but it has complications. One of these complications is blood loss and bleeding. Therefore, to save blood in cardiac surgery, antifibrinolytics, agent, like Tranexamic Acid (TXA), can be used.
The Study aim to assess TXA clinical efficacy and safety to reduce blood loss, and the need for blood transfusions of the patient during Coronary Artery Bypass Grafting (CABG), using CPB.
A sample of Ninety -nine patient was included in this study. A prospective, randomized, placebo–controlled, double-blind study of patients received placebo (n= 33) or TXA 15 mg/ kg before CPB, then was infused 1 mg\kg\h and stopped after termination of CBP and reversal of heparin. This was followed by a TXA infusion of 1 mg /kg / h for 5 hours (n = 33) or TXA 15 mg\kg after CPB, and by infusion TXA 1mg\kg\h for 5 h.
The results showed that the mean of the RBC units in control group (Mean=1.42) was significantly higher than both the means of the RBC units in Pre –CPB TXA group (Mean=0.61) and Post- CPB TXA group (Mean=0.64), p<0.001. Pertaining to the 48 h. post-op (Mediastinal chest drainage (MCTD)).
The results showed that the mean of the 48 h. post-op (MCTD) in the control group (Mean=209.45) was only significantly higher than the mean of the 48 h. post-op (MCTD) in Post-CPB TXA group (Mean=110.52), P= 0.005. Concerning 72 h. post-op MCTD), the results showed that the mean of the 72 h. post-op (MCTD), in control group, (Mean=41.67) was only significantly higher than the mean of the 72 h. post-op (MCTD) in Post-CPB TXA group (Mean=14.87), P= 0.006.
In patients undergoing cardiac surgery and at risk for postoperative bleeding, the study has demonstrated that post-CPB TXA has profoundly favorable hemostatic and blood conservation benefits. Giving TXA post CPB has the best hemostatic effects. When compared to placebo, it reduces both blood loss over the course of 48 and 72 hours and the need for blood product administration. Pre-CPB TXA's positive impact, however, is less obvious.
Keywords: Cardiopulmonary Bypass; Coronary Artery Bypass Grafting; Tranexamic Acid; bleeding; blood transfusion.