EFFICACY OF TOPICAL TRANEXAMIC ACID TO REDUCE BLOOD LOSS AFTER CORONARY ARTERY BYPASS GRAFTING (CABG)
Background: Coronary Artery Bypass Grafting (CABG) with the use of cardiopulmonary bypass technique has a coagulopathy issue. Many factors act on the coagulation process such as heparin level, thrombocytopenia, increased fibrinolysis and acquired platelet dysfunction. The human body responds to stress with dramatic resilience. For example, bleeding diathesis is common with on pump, after injury clotting mechanisms are immediately activated to reduce blood loss, the blood volume is restored by shifting the fluids from extracellular compartment and redistribution of blood flow occurs. Fibrinolytic cascade is activated with CPB usage. Before it was thought that excessive bleeding after CPB was due to platelet dysfunction and depletion. Recently, it was suggested by many lines of information that fibrinolytic cascade activation leads to bleeding during postoperative period. Multiple agents like Tranexamic acid and Aminocaproic acid etc are anti-fibrinolytic agents that can be administered to minimize the bleeding postoperatively.
Objectives: To compare the efficacy of topical application of Tranexamic acid to reduce blood loss after Coronary Artery Bypass Grafting (CABG).
Methods: It is randomized controlled trial. This research program was carried out at the Unit of Cardiothoracic & Vascular Surgery, Institute of Shaikh Zayed Hospital, Lahore from December 6th, 2017 to December 5th, 2018. First patient evaluated on 11th December 2017. Seventy patients were enrolled, who were eligible for this study, achieving the inclusion criteria. Two groups of the selected population were made by randomization. Group A comprised 35 patients to whom 1 gm of diluted Tranexamic Acid using 100 ml normal saline solution is poured to the pericardial cavity. Group B involved 35 patients as well, whom were given standard of care treatment which in this case is 100 ml normal saline. Since 100ml normal saline did not contain any active ingredient for treatment, therefore it was considered as placebo. Intervention (Placebo or TXA) was considered efficacious if it resulted in blood loss of less than 500ml in 72 hours from immediately post-op to 72 hours post-op. The efficacy of drugs within groups is compared by the use of Chi-square test. Independent sample t-test was applied for data analysis of blood loss with p-value ≤0.05 being taken as significant.
Results: In our study, total70patients were enrolled. Group-A (Tranexamic Acid) and Group-B (Placebo) were made. In group-A, there were 30 (85.7%) male and 5(14.3%) female patients. In group-B, 28(80.0%) were male and 7(20.0%) were female. In our study population, mean age of patients were 52.4±9.9 years and 53.6±10.1 years in group A&B respectively. In group-A, there were 22(62.9%) patients in which the intervention showed efficacy (blood loss <500ml), while only 09(25.7%) patients in group-B showed blood loss of <500ml, p-value of 0.002 being statistically significant.
Conclusion: Topical application of Tranexamic Acid reduces blood loss after Coronary Artery Bypass Grafting (CABG).