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Ann Thorac Surg 2001;72:470-475
© 2001 The Society of Thoracic Surgeons
a Department of Anesthesiology, University of Milan, Division of Cardiac Anesthesia and Intensive Care, San Raffaele Hospital, Milan, Italy
b Coagulation Service and Thrombosis Research Unit, San Raffaele Hospital, Milan, Italy
c Division of Cardiac Surgery, San Raffaele Hospital, Milan, Italy
Accepted for publication April 27, 2001.
Address reprint requests to Dr Casati, Division of Cardiac Anesthesia and Intensive Care, Policlinico di Monza, via Amati 111, 20052 Monza (Milano), Italy
e-mail: valter.casati{at}tin.it
Background. We evaluated the hemostatic effects of tranexamic acid, a synthetic antifibrinolytic drug, in patients undergoing beating-heart coronary surgery.
Methods. Forty consecutive patients were in a double-blind manner, prospectively randomized into two groups: 20 patients received tranexamic acid (bolus of 1 g before skin incision, followed by continuous infusion of 400 mg/hr during surgery), and 20 patients received saline. As primary outcomes, bleeding and allogeneic transfusions were considered. D-dimer and fibrinogen plasma levels were also evaluated to monitor the activation of fibrinolysis. Major postoperative thrombotic events, as a potential consequence of antifibrinolytic treatment, were recorded.
Results. The treatment group had significantly lower postoperative bleeding (median [25th to 75th percentiles]: 400 mL [337 to 490 mL] vs 650 ml [550 to 862 mL], p < 0.0001), lower need for allogeneic blood products (1,200 vs 5,300 mL, p < 0.001), and lower postoperative D-dimer plasma levels. No postoperative thrombotic complications were observed in either group.
Conclusions. In this initial series of patients undergoing off-pump coronary surgery, tranexamic acid appears to be effective in reducing postoperative bleeding and the need for allogeneic blood products.
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