EFFECTIVE REGIMEN OF TRANEXAMIC ACID(TA) TO REDUCE BLOOD LOSS AND HOMOLOGOUS TRANSFUSION IN PATIENTS UNDERGOING CARDIOPULMONARY BYPASS

Abstract

Introduction: Substantial bleeding after cardiopulmonary bypass(CPB) complicates postoperative patients care. Recently antifibrinolytic agents have been used as pharmacologic means of reducing blood loss and tranexamic acid(TA) has been known to have a great efficacy. However, the effective dose of TA is not well established and variable doses of TA have been tried. We compared the hemostatic effectiveness of three commonly recommended doses of TA in patients undergoing CPB. Methods: With IRB approval, 88 patients undergoing valvular replacement were randomly divided into four groups; a control group(GI), received a 10 mg/kg infusion of TA followed by an infusion of 1 mg/kg for 10 hours(GII), received 6 gram load of TA(GIII) and 10 gram load of TA(GIV). Homologous blood was transfused when hematocrit was lower than 20% during CPB or lower than 25% after CPB. Amount of homologous transfusion(HT) and blood loss(BL) for 24 hours were measured. Results: Eight patients were excluded due to reoperation and abnormal preoperative coagulation profile. There was no specific complications. (Table 1)Table 1Discussion: None of TA regimen did reduce the amount of postoperative BL. However the amount of HT was decreased in patients with loading large dose of TA. Reduction of HT might be attributed to decrease in intraoperative BL which could not be measured. Therefore loading large dose of TA may be more effective and convenient than loading and infusion of a small dose of TA.