Impact of tranexamic acid on bleeding during coronary artery bypass for patients under treatment of low molecular weight heparin

Yıl 2020, , 309 - 313, 01.04.2020

Mevlüt Doğukan , Fahriye Güler Ayşe Baysal , Cengiz Güven , Öznur Uludag

https://doi.org/10.28982/josam.713471

Öz

Aim: Tranexamic acid (TA) is an antifibrinolytic agent that prevents the dissolution of fibrin clot. We investigated the impact of the use of tranexamic acid (TA) on bleeding for patients under treatment of low molecular weight heparin during coronary artery bypass graft (CABG) operations.
Methods: Among 82 patients, 60 patients undergoing CABG with cardiopulmonary bypass (CPB) were enrolled into a case-control study within a six month-period. On the first postoperative day, patients were divided into two groups depending on the intraoperative use of TA. TA was not administered to control group patients (n=30) while those in the study group (n=30) received TA intravenously at a dose of 10 mg/kg. Coagulation variables including complete blood cell count, D-Dimer, fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalized ratio (INR) values were collected preoperatively and 24 hours after surgery. Estimated blood loss, loss by drainage, total amounts of packed red blood cell and fresh frozen plasma transfusions were recorded. P-value <0.05 was considered statistically significant.
Results: Among 60 patients included in the study, there were 39 and 21 males and females, respectively. The mean age of all patients was 61.6 years. The two groups were similar in terms of use of fresh frozen plasma, age, height, and weight (P=0.268, P=0.586, P=0.787, P=0.641, respectively). The amount of postoperatively transfused packed red blood cells in units were lower in the study group (P=0.04). Total mediastinal drainage amounts in the 4th, 8th, 12th hours and overall were lower in the study group (P=0.016, P=0.006, P=0.013, P=0.04, respectively).
Conclusions: TA is a safe drug that reduces postoperative bleeding without side effects in patients using DMAH undergoing CABG operations.

Anahtar Kelimeler

Coronary bypass surgery, Low molecular weight heparin, Tranexamic acid, Bleeding, Blood products

Koroner arter bypass operasyonlarında düşük molekül ağırlıklı heparin tedavisi gören hastalarda traneksamik asidin kanama üzerine etkileri

Öz

Amaç: Traneksamik asit (TA), fibrin pıhtısının çözünmesini önleyen antifibrinolitik bir maddedir. Koroner arter bypass greft (KABG) operasyonları sırasında düşük moleküler ağırlıklı heparin tedavisi alan hastalarda TA kullanımının kanama üzerindeki etkisini araştırdık.
Yöntemler: Toplam 82 hastadan, kardiyopulmoner bypass (CPB) ile KABG uygulanan 60 hasta, altı aylık bir dönemde vaka-kontrol bir çalışmaya alındı. Ameliyat sonrası birinci günde, intraoperatif TA kullanımına bağlı olarak hastalar iki gruba ayrıldı. Kontrol grubunda (n=30) TA verilmezken, çalışma grubunda Grup 2'de (n=30) TA intravenöz 10 mg/kg dozda uygulandı. Pıhtılaşma değişkenleri; tam kan hücresi sayımı, D-Dimer, fibrinojen, protrombin zamanı (PT), aktive parsiyel tromboplastin zamanı (aPTT) ve uluslararası normalleştirilmiş oran (INR) değerleri ameliyat öncesi ve ameliyattan 24 saat sonra toplandı. Tahmini kan kaybı, drenaj kaybı, toplam eritrosit süspansiyonu ve taze donmuş plazma hacimleri kaydedildi. P-değeri <0.05 istatistiksel olarak anlamlı kabul edildi.
Bulgular: Çalışmaya alınan, 60 hastanın 39’si erkek, 21’i kadın, hastaların yaş ortalaması 61,6/ yıl idi. Hastaların yaş, boy, kilo verileri benzerdi (sırası ile; P=0,586, P=0,787, P=0,641). Postoperatif verilen taze donmuş plazna transfüzyonu iki grupta benzer iken (P=0,692), postoperatif verilen eritrosit süspansiyonu ünite miktarı çalışma grubunda daha düşüktü (P=0,04). Ameliyat sonrası, 4., 8., 12. ve total mediastinal drenaj miktarları çalışma grubunda daha düşüktü (sırasıyla; P=0,016, P=0,006, P=0,013, P=0,04).
Sonuç: TA, CABG operasyonları sırasında DMAH tedavisi alan hastalarda yan etki olmaksızın postoperatif kanamayı azaltan güvenli bir ilaçtır. 

Anahtar Kelimeler

Koroner bypass cerrahisi, Düşük molekül ağırlıklı heparin, Traneksamik asit, Kanama, Kan ürünleri

Kaynakça

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