Effects of tranexamic acid on short‐term and long‐term outcomes of on‐pump coronary artery bypass grafting: Randomized trial and 7‐year follow‐up. Issue 6 (16th November 2018)

• Record Type: Journal Article
• Authors: Zhang, Yu; Gao, Xurong; Yuan, Su; Guo, Jingfei; Lv, Huanran; Zhou, Yong; Wang, Yuefu; Ji, Hongwen; Wang, Guyan; Li, Lihuan; Shi, Jia
• Is Part Of: Cardiovascular therapeutics. Volume 36:Issue 6(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-11-16
• Subjects: allogeneic transfusion -- bleeding -- coronary artery bypass grafting -- myocardial infarction -- tranexamic acid; Cardiovascular pharmacology -- Periodicals; Cardiovascular agents -- Periodicals; Cardiovascular system -- Diseases -- Chemotherapy -- Periodicals; Cardiovascular Agents -- Periodicals; Cardiovascular Diseases -- drug therapy -- Periodicals; Agents cardiovasculaires -- Périodiques; Appareil cardiovasculaire -- Maladies -- Chimiothérapie -- Périodiques; 616.1005
• DOI: 10.1111/1755-5922.12472
• Languages: English
• ISSNs: 1755-5914

Abstract

Summary: Aims: Safety evaluations of tranexamic acid (TXA) remain sparse, especially with respect to its impact on long‐term outcomes in patients undergoing on‐pump coronary artery bypass grafting (CABG). We hypothesized that the effects of TXA on perioperative bleeding and allogeneic transfusion and its impact on long‐term clinical outcomes of patients receiving on‐pump CABG are superior to those in the control group. Methods: In this prospective, randomized, placebo‐controlled trial, 210 patients undergoing primary and isolated on‐pump CABG were randomly assigned to receive TXA or a corresponding volume of saline solution. Randomly assigned patients were followed up at 1, 3, 5, and 7 years after hospital discharge. Finally, 163 patients fulfilled the 7‐year follow‐up. The primary outcome was allogeneic red blood cell (RBC) transfusion. Long‐term mortality and morbidity were also evaluated. Results: Compared with placebo, TXA reduced the allogeneic RBC requirement in terms of the volume transfused (4.20 ± 4.06 vs 6.25 ± 4.86 units; P < 0.01), ratio exposed (52.0% vs 71.6%; P < 0.01), and blood loss volume (879.0 ± 392.5 vs 1154.0 ± 582.8 mL; P < 0.01). Except for myocardial infarction, there were no significant differences in mortality or morbidity between the two groups during the 7‐year follow‐up. The TXA group had a lower rate of myocardial infarction than did the placebo group (0.0% vs 4.9% at 84 months; P = 0.03). Conclusions: Tranexamic acid significantly decreased postoperative bleeding and allogeneic transfusion in patients undergoing on‐pump CABG. The 7‐year follow‐up suggested that the use of TXA was safe and might play a potential role in the prevention of long‐term myocardial infarction.