The Effect of Tranexamic Acid on Transfusion Requirement in Dual Antiplatelet-Treated Anemic Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

Abstract

Background: Anemia is not rare in patients presenting for coronary artery bypass graft surgery (CABG). As these patients are frequently on dual antiplatelet therapy, the two coexisting conditions could potentially increase the risk of bleeding and transfusion. The aim of this study was to evaluate the effect of tranexamic acid (TA) on blood loss and transfusion in preoperatively anemic patients who continued their dual antiplatelet therapy until within 5 days of off-pump CABG (OPCAB).

Methods and Results: Seventy-six anemic patients were randomized into two groups: a TA group receiving TA (1 g bolus followed by infusion at 200 mg h-1) and a Control group receiving the same volume of saline. The amount of blood loss at 4h and 24h after operation were measured. And transfusion requirement during operation, 4h and 24 h after the operation were assessed. Patients’ characteristics and operative data were similar between the groups. During the perioperative period combining the intraoperative and postoperative 24 h, TA group received significantly less amounts of packed red blood cells and fresh frozen plasma. The blood loss during the postoperative 4 h was significantly less in the TA group.

Conclusions: TA infusion could reduce the amount of transfusion during perioperative period in patients with preoperative anemia who continued their dual antiplatelet therapy until within 5 days of OPCAB.