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Results of a large study suggest that tranexamic acid can reduce the need for blood transfusion without increasing the risk of thrombotic complications or death in patients undergoing coronary artery surgery.
Patients who received tranexamic acid had a lower risk of excessive bleeding, required fewer units of blood products, and had a lower risk of emergency reoperation after surgery than patients who received placebo.
In addition, patients who received tranexamic acid had no higher risk of death or thrombotic complications than those who received placebo.
Paul S. Myles, MBBS, MD, of Alfred Hospital in Melbourne, Australia, and his colleagues conducted this study and reported the results in NEJM. The study was also presented at the ANESTHESIOLOGY® 2016 annual meeting.
The study included 4631 patients who underwent surgery and had available outcomes data, 2311 who were assigned to receive tranexamic acid and 2320 who were assigned to receive placebo.
The study’s primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after surgery.
There was no significant difference in the primary outcome between the 2 treatment groups. Thrombotic complications/death occurred in 16.7% of patients in the tranexamic acid group and 18.1% in the placebo group (relative risk=0.92; P=0.22).
Patients who received placebo required significantly more units of blood products than patients who received tranexamic acid—7994 and 4331 units, respectively (P<0.001).
And significantly fewer patients in the tranexamic acid group than the placebo group had major hemorrhage or cardiac tamponade leading to emergency reoperations—1.4% and 2.8%, respectively (P=0.001).
However, patients in the tranexamic group had a significantly higher incidence of seizures—0.7% and 0.1%, respectively (P=0.002).
Dr Myles said that although this study was conducted in patients undergoing coronary artery surgery, the results are relevant for patients having many other types of surgery where bleeding and the need for blood transfusion may occur.
