Background and Goal of Study:Tranexamic acid (TXA) has been widely used after induction of anaesthesia to reduce bleeding in cardiac surgery with cardiopulmonary bypass (CPB). Whereas, TXA was reported to be associated with increased incidence of thrombotic complications. To reduce the risk of adverse outcomes associated with TXA, we began administrating TXA after CPB since July 1, 2011. This retrospective study was to observe whether the administration of TXA after CPB could reduce postoperative complications.
Materials and Methods:After the approval of ethics committee of West China Hospital (No. 256, 2017), clinical data of adult patients (>18 years) who underwent elective valve surgery and/or coronary artery bypass grafting between July 1, 2011 and December 31, 2016 were screened. Exclusion criteria included aorta replacement, death within 24 hours after surgery and incomplete data. Primary outcome was postoperative death from all cause and requirement for the blood products during the hospital stay. The second outcome was ischemic events and bleeding related events after the surgery.
Results and Discussion:Of all eligible patients, 2,062 received TXA after CPB (the TXA group); 4236 did not receive any TXA (the control group). The demographic characteristics were similar between groups, but the CPB time was longer in TXA group than control group (median, 115 vs. 113 minutes; P=0.007). Incidences of postoperative death, ischemic events and bleeding related events were similar between groups (mortality, 0.9% in TXA vs. 1.4% in control, p=0.058; ischemic events, 13.8% in TXA vs. 15.3% in control, p=0.105; bleeding related events: 1.0% in TXA vs. 1.5% in control, p=0.146). However, the requirements of any blood product in TXA (2.48±4.22 units per person) was fewer than those in control group (2.74±5.21 units per person, p=0.001). In multivariate logistic analysis, TXA after CPB reduced the risk of death (OR, 0.54; 95%CI, 0.29 to 0.99; p=0.047), and exposure for any blood product (OR, 0.82; 95%CI, 0.72 to 0.93; p=0.001), but not ischemic events (OR, 0.92; 95%CI, 0.78 to 1.09; p=0.314) and bleeding related events (OR, 0.65; 95%CI, 0.39 to 1.08; p=0.095). Our results need to be verified in multi- center, randomized, double-blind, controlled studies.
Conclusion(s):TXA after CPB reduced the risk of death and requirement for any blood product, but did not influence the ischemic events and bleeding related events.

09 / Tranexamic acid after cardiopulmonary bypass and perioperative outcomes after cardiac surgery