Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery

In a randomized trial, over 4500 patients undergoing cardiac surgery were assigned to receive tranexamic acid or placebo. There was no difference between groups in the rate of death or thrombotic complications. The tranexamic acid group had less bleeding and more seizures. Excessive bleeding and blood transfusions are common in patients undergoing cardiac surgery, 1 and in some of these patients, there is a need for reoperation because of life-threatening bleeding. 2 Both blood transfusion and reoperation are strongly associated with poor outcomes after cardiac surgery. 2 , 3 Antifibrinolytic therapy reduces the risk of blood loss and transfusion among patients undergoing cardiac surgery, 4 , 5 but it is unclear whether such therapy reduces the risk of reoperation for bleeding. 4 Antifibrinolytic agents that have been used in patients undergoing cardiac surgery include aprotinin 6 , 7 and the lysine analogues tranexamic acid and aminocaproic acid. 8 – 11 These agents may . . .