Efficacy Of Topical Tranexamic Acid Research Articles

Decreasing blood loss and the need for transfusion after CABG surgery: a double-blind randomized clinical trial of topical tranexamic acid

Reopening sternotomy to control bleeding after coronary artery bypass grafting surgery (CABG) has been reported in 2%-7% of cases. Platelet dysfunction and activation of fibrinolytic cascade are the common causes of bleeding after on-pump CABG. Different antifibrinolytic drugs have been used to reduce bleeding. In this study, we aimed to investigate the efficacy of topical tranexamic acid in reducing postoperative mediastinal bleeding after CABG. Materials and methods: This was a double-blind placebo-controlled randomized clinical trial on 40 patients as the control and another 40 patients as the study group. On completion of CABG before sternotomy wound closure, tranexamic acid (2 g/20 mL) or placebo (20 mL of saline) was diluted in 500 mL of warm saline (37 °C), poured into the pericardial cavity, and left for 5 min. Results: There was no significant difference in baseline demographic data and laboratory results between the 2 groups (P > 0.05). Mediastinal bleeding and packed red cell transfusion requirements were significantly lower in the study group (P =< 0.01). There were no complications related to topical tranexamic such as mortality, myocardial infarction, cerebrovascular accident, seizure, or renal failure. Conclusion: Topical tranexamic acid can reduce mediastinal bleeding and packed red cell transfusion requirements after CABG.

Commentary on an article by Jean Wong, MD, FRCPC, et al.: “Topical Application of Tranexamic Acid Reduces Postoperative Blood Loss in Total Knee Arthroplasty: A Randomized, Controlled Trial”

Blood loss following total knee replacement is a major concern of both patients and surgeons. The authors of this study are to be commended for designing a rigorous study that is clinically relevant to this topic. The objective of the study was to evaluate the efficacy of topical tranexamic acid in decreasing blood loss following total knee replacement. This prospective, double-blinded, controlled study was performed to evaluate the relative efficacy of two different dosages of tranexamic acid, delivered topically at the end of total knee replacement, in decreasing blood loss postoperatively. The authors controlled as many variables as possible, with all patients being enrolled in a similar blood-conservation program and deep-vein thrombosis (DVT) prophylaxis protocol. Patients were randomized to one of three groups and …