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.
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.
Authors: Lily Eaker; Stephen R Selverian; Laura N Hodo; Jonathan Gal; Sandeep Gangadharan; James Meyers; Sergei Dolgopolov; Baron Lonner Journal: Spine Deform Date: 2022-03-09