ABSTRACT
Introduction: Cardiac surgery, owing to its invasiveness,need of anticoagulation, exposure to extracorporeal circulation(CPB) and relatively longer duration, is known to be associatedwith an increased risk of perioperative blood loss and allogeneicblood transfusions. Excessive bleeding requiring allogenicblood and blood components transfusion after cardiopulmonarybypass (CPB) is a common complication of cardiac surgeryimparting detrimental health and economic consequences.Many techniques like preoperative autologous blood collection(PAC), Acute normovolumic hemodilution (ANH), use ofminiaturized CPB circuit and use of ultrafiltration duringconduct of cardiopulmonary bypass (CPB) have been appliedin the past to conserve the blood during perioperative periodin cardiac surgery. Current study aimed to observe the efficacyof Tranexamic acid used during intraoperative period onpost-operative blood loss and requirement of allogenic bloodand blood products transfusion in cardiac surgical patientsrequiring cardiopulmonary bypass (CPB).Material and methods: 120 adult patients undergoingcardiac surgery requiring elective cardiopulmonary bypass(CPB) were categorized into 2 groups. Study (“TXA”) groupwas subjected to administration of tranexamic acid (20 mg/kg in divided doses). The 1st dose (10 mg/kg) was givenbefore initiation of CPB, 2nd dose (5 mg/kg) was given duringrewarming on CPB and 3rd dose (5 mg/kg) was given afterweaning off CPB along with protamine. The control (“NS”)group patients received normal saline as a placebo. Statisticalanalysis was done using “z test”.Results: “TXA” group had significantly lower post-operativebleeding and lesser requirement of allogenic blood and bloodproducts transfusion. The mean post-operative blood lossin “TXA” group was 427.42+/- 225.18 ml vs. 728.67+/-301.33ml in “NS” group. The mean PCV units transfused postoperatively in 72 hours in “TXA” group was 0.20+/-0.44 unitsvs. 0.67+/-0.60 in “NS” group. Patients in “TXA” group didnot require any FFP or platelets unit in contrast to “NS” groupwhere few patients required these products.Conclusion: The use of Tranexamic acid during intraoperative period in patient undergoing cardiac surgeryrequiring cardiopulmonary bypass circuit significantly reducesthe post-operative bleeding and requirement of allogenicblood and blood products transfusion.