Is tranexamic acid safe in patients undergoing coronary endarterectomy?

• Published in: The Annals of thoracic surgery Vol. 71; no. 5; pp. 1508 - 1511
• Main Authors: Ruel, Marc A., Wang, Feng, Bourke, Michael E., Dupuis, Jean-Yves, Robblee, James A., Keon, Wilbert J., Rubens, Fraser D.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2001; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Coronary Artery Bypass; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Endarterectomy; Female; Graft Occlusion, Vascular - chemically induced; Graft Occlusion, Vascular - mortality; Graft Occlusion, Vascular - prevention & control; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - chemically induced; Myocardial Infarction - mortality; Myocardial Infarction - prevention & control; Postoperative Complications - chemically induced; Postoperative Complications - mortality; Postoperative Complications - prevention & control; Retrospective Studies; Risk; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Tranexamic Acid - administration & dosage; Tranexamic Acid - adverse effects; Human; Infarct; Treatment efficiency; Coronary artery; Cardiovascular disease; Coronary heart disease; Myocardial disease; Prevention; Chemotherapy; Treatment; Aortocoronary; Bypass; Surgery; Blood loss; Tranexamic acid; Myocardium; Complication; Graft; Antifibrinolytic; Endarteriectomy
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(01)02459-6

Background. Patients undergoing coronary endarterectomy during coronary artery bypass grafting (CABG) are at increased risk of perioperative myocardial infarction due to coronary intimal disruption. Data assessing the safety of the antifibrinolytic drug tranexamic acid (TA) in patients undergoing this procedure are lacking. Methods. From September 1997 to December 1999, 221 patients underwent nonemergency primary CABG with endarterectomy of the right coronary artery alone in 149, the left anterior descending in 35, or both right and left anterior descending in 27. TA was administered intraoperatively to 87 patients (TA group: average total dose 62 ± 4.4 mg/kg; range 20 to 109 mg/kg), and was not administered to 134 patients (No TA group). Results. The patient characteristics of the 2 groups were similar. In-hospital mortality consisted of 2 patients in the TA group and 4 patients in the No TA group. Perioperative myocardial infarction rates were 2% and 5% in the TA and No TA groups, respectively (p = 0.49). The relative risk for any type of perioperative cardiac ischemic event in the TA group versus the No TA group was 0.77 (95% CI; 0.4, 1.2). Patients in the TA group had a significant reduction in postoperative chest tube drainage (685 versus 894 mL in the TA versus No TA groups, respectively) and in the use of fresh-frozen plasma (p = 0.03). Conclusions. These results suggest that the clinical effectiveness of tranexamic acid in reducing postoperative blood loss in patients undergoing coronary endarterectomy is not associated with a higher incidence of myocardial ischemia-related complications.