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Postoperative thrombotic effects of tranexamic acid in open heart surgery

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Abstract

Background

Following the administration of tranexamic acid, the occurrence of thromboembolic events is a controversial issue.

Aims

In this retrospective cohort study, we aimed to determine the possible thromboembolic complications due to tranexamic acid as a prophylactic method in patients undergoing open heart surgery.

Methods

The data of 172 adult patients undergoing open heart surgery were analyzed. All patients received tranexamic acid at a dose of 50 mg/kg. The patients were divided into 3 groups as multiple-valve surgery (group 1), coronary bypass alone (group 2), and coronary bypass with valve surgery (group 3). The amount of blood transfusion, bleeding in intra- and postoperative period, and the presence of thromboembolic events including myocardial infarction, stroke, pulmonary embolism, and deep vein thrombosis were investigated.

Results

Patient demographics and duration of surgery were not significantly different in groups (p > 0.05). Hb, Htc, INR, and platelet levels of all groups did not differ significantly (p > 0.05). In total, 7 patients underwent reexploration. Postoperative DVT, stroke, and seizure were not seen at all. There was no statistically significant difference between groups in terms of the amount of blood transfusion, drainage, or peritoneal hematoma. The length of hospital stay and the mortality rate did not differ (p > 0.05).

Conclusions

In patients receiving tranexamic acid infusion at 50 mg/kg dose, reexploration rates remained at 4.1% even after major cardiac surgeries. No thrombosis, stroke, or seizure were reported. Our findings support that tranexamic acid is a safe drug which has positive effect on reducing perioperative bleeding.

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References

  1. Tengborn L, Blombäck M, Berntorp E (2015) Tranexamic acid–an old drug still going strong and making a revival. Thromb Res 135:231–242

    Article  CAS  Google Scholar 

  2. Tang M, Wierup P, Rea CJ, Ingerslev J, Hjortdal VE, Sørensen B (2017) Temporal changes in clot lysis and clot stability following tranexamic acid in cardiac surgery. Blood Coagul Fibrinolysis 28:295–302

    Article  CAS  Google Scholar 

  3. Okamoto S, Sato S, Takada Y, Okamoto U (1964) An active stereo-isomer (trans-form) of AMCHA and its antifibrinolytic (antiplasminic) action in vitro and in vivo. Keio J Med 13:177–185

    Article  CAS  Google Scholar 

  4. Melander B, Gliniecki G, Granstrand B, Hanshoff G (1965) Biochemistry and toxicology of amikapron; the antifibrinolytically active isomer of AMCHA. (A comparative study with epsilon-aminocaproic acid). Acta Pharmacol Toxicol (Copenh) 22:340–352

    Article  CAS  Google Scholar 

  5. Hutton B, Joseph L, Fergusson D, Mazer CD, Shapiro S, Tinmouth A (2012) Risks of harms using antifibrinolytics in cardiac surgery: systematic review and network metaanalysis of randomised and observational studies. BMJ 345:e5798

    Article  Google Scholar 

  6. White RH, Zhou H, Romano PS (2010) Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost 90:446–455

    Google Scholar 

  7. Montroy J, Hutton B, Moodley P et al (2018) The efficacy and safety of topical tranexamic acid: a systematic review and meta-analysis. Transfus Med Rev 19

  8. Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussières JS, McGuinness S, Byrne K, Chan MT, Landoni G, Wallace S, ATACAS Investigators of the ANZCA Clinical Trials Network (2017) ATACAS investigators of the ANZCA clinical trials network. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med 376:136–148

    Article  CAS  Google Scholar 

  9. Davidson SJ, McGrowder D, Roughton M, Kelleher AA (2008) Can ROTEM thromboelastometry predict postoperative bleeding after cardiac surgery? J Cardiothorac Vasc Anesth 22:655–661

    Article  Google Scholar 

  10. Whiting D, Dinardo JA (2014) TEG and ROTEM: technology and clinical applications. Am J Hematol 89:228–232

    Article  CAS  Google Scholar 

  11. Gielen CLI, Brand A, van Heerde WL, Stijnen T, Klautz RJM, Eikenboom J (2016) Hemostatic alterations during coronary artery bypass grafting. Thromb Res 140:140–146

    Article  CAS  Google Scholar 

  12. Frank SM, Thakkar RN, Podlasek SJ, Ken Lee KH, Wintermeyer TL, Yang WW, Liu J, Rotello LC, Fleury TA, Wachter PA, Ishii LE, Demski R, Pronovost PJ, Ness PM (2017) Implementing a health system-wide patient blood management program with a clinical community approach. Anesthesiology 127:754–764

    Article  Google Scholar 

  13. CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R et al (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 376:23–32

    Article  Google Scholar 

  14. Kagoma YK, Crowther MA, Douketis J, Bhandari M, Eikelboom J, Lim W (2009) Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res 123:687–696

    Article  CAS  Google Scholar 

  15. Gurusamy KS, Pissanou T, Pikhart H et al (2011) Methods to decrease blood loss and transfusion requirements for liver transplantation. Cochrane Database Syst Rev 12:CD009052

    Google Scholar 

  16. Adler Ma SC, Brindle W, Burton G, Gallacher S, Hong FC, Manelius I, Smith A, Ho W, Alston RP, Bhattacharya K (2011) Tranexamic acid is associated with less blood transfusion in off-pump coronary artery bypass graft surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth 25:26–35

    Article  CAS  Google Scholar 

  17. Ortmann E, Besser MW, Klein AA (2013) Antifibrinolytic agents in current anaesthetic practice. Br J Anaesth 111:549–563

    Article  CAS  Google Scholar 

  18. Thachil J (2016) Disseminated intravascular coagulation–new pathophysiological concepts and impact on management. Expert Rev Hematol 9:803–814

    Article  CAS  Google Scholar 

  19. Ghadimi K, Levy JH, Welsby IJ (2016) Perioperative management of the bleeding patient. Br J Anaesth 117:18–30

    Article  Google Scholar 

  20. Chakravarthy M, Muniraj G, Patil S et al (2012) A randomized prospective analysis of alteration of hemostatic function in patients receiving tranexamic acid and hydroxyethyl starch (130/0.4) undergoing off pump coronary artery bypass surgery. Ann Card Anaesth 15:105–110

    Article  Google Scholar 

  21. Bhukar RK, Gowda D, Rao JN, Desai N (2017) Management of atrial thrombus formation following surgical closure of an atrial septal defect. J Card Surg 32:476–478

    Article  Google Scholar 

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Acknowledgements

The authors state no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The abstract of the manuscript was presented in Euroanaesthesia 2018 in Copenhagen, Denmark.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, Istanbul Marmara University Medical School, Istanbul, Turkey

    Ayten Saracoglu

  2. Marmara University Medical School Fevzi Cakmak Mah, Muhsin Yazicioglu Cad. No:10 34899 Ust Kaynarca Pendik, Istanbul, Turkey

    Ayten Saracoglu

  3. Department of Cardiovascular Surgery, Istanbul Bilim University Medical School, Istanbul, Turkey

    Mehmet Ezelsoy

  4. Department of Anesthesiology and Intensive Care, Health Sciences University Medical School, Istanbul, Turkey

    Kemal Tolga Saracoglu

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  1. Ayten Saracoglu
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  2. Mehmet Ezelsoy
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  3. Kemal Tolga Saracoglu
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Correspondence to Ayten Saracoglu.

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Author A.S. declares that she has no conflict of interest. Author M.E. declares that he has no conflict of interest. Author K.T.S. declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Saracoglu, A., Ezelsoy, M. & Saracoglu, K.T. Postoperative thrombotic effects of tranexamic acid in open heart surgery. Ir J Med Sci 188, 1373–1378 (2019). https://doi.org/10.1007/s11845-019-01991-z

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  • DOI: https://doi.org/10.1007/s11845-019-01991-z

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