Abstract
BackgroundTo study the effect of administration of tranexamic acid on the use of blood and blood products, return to theatre for post-operative bleeding and the length of intensive care stay after primary cardiac surgery, data for 4191 patients, of all priorities, who underwent primary cardiac operation during the period between 30/10/00 and 21/09/04 were analysed.MethodsRetrospective analysis of data collected prospectively during the study period. The main outcome measures were whether or not patients were transfused with red blood cells, fresh frozen plasma or any blood product, the proportion of patients returned to theatre for investigation for post-operative bleeding and length of stay in the intensive care unit. We performed univariate analysis to identify the factors influencing the outcome measures and multivariate analysis to identify the effect of administration of tranexamic acid on the outcome measures.ResultsAdministration of tranexamic acid was an independent factor affecting the transfusion of red blood cells, fresh frozen plasma or any blood product. It was also an independent factor influencing the rate of return to theatre for exploration of bleeding. The odds of receiving a transfusion or returning to theatre for bleeding were significantly lower in patients receiving tranexamic acid. The administration of tranexamic acid also significantly decreased blood loss. We did not find any association between the administration of tranexamic acid and the length of intensive care stay.ConclusionBased on the analysis of 4191 patients who underwent a primary cardiac operation, administration of tranexamic acid decreased the number of patients exposed to a transfusion or returned to theatre for bleeding in our institute.
Highlights
To study the effect of administration of tranexamic acid on the use of blood and blood products, return to theatre for post-operative bleeding and the length of intensive care stay after primary cardiac surgery, data for 4191 patients, of all priorities, who underwent primary cardiac operation during the period between 30/10/00 and 21/09/04 were analysed
Our aim was to identify whether administration of tranexamic acid, in our clinical setting, had an effect on blood transfusion and if its administration was an independent factor influencing whether a patient would be taken back to theatre for re-exploration or stay longer in the intensive care unit (ICU)
We identified data for 4191 patients who had undergone primary coronary artery bypass grafting surgery (CABG), single valve surgery or both procedures combined between 30/10/00 and 21/09/04
Summary
To study the effect of administration of tranexamic acid on the use of blood and blood products, return to theatre for post-operative bleeding and the length of intensive care stay after primary cardiac surgery, data for 4191 patients, of all priorities, who underwent primary cardiac operation during the period between 30/10/00 and 21/09/04 were analysed. Randomised prospective studies have shown that tranexamic acid can decrease exposure to blood transfusions [9,10,11,12,13,14]. Those studies used a variety of dose regimens and gave diverse conclusions, making it difficult to translate these findings to the clinical arena with confidence that it will be a useful treatment. In an effort to control the cost of transfusion and to ensure that all blood products are only used where appropriate, our hospital employs a clinical information analyst who is solely responsible for collecting prospectively, continuously and at the bedside, all data related to transfusions in connection with cardiac surgery. Compliance with guidelines is constantly assessed and reported and data reviewed by this analyst showed that the institutional antifibrinolytic guidelines were, not strictly adhered to (Table 1)
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