Tranexamic acid in cardiac surgery: Are low doses enough?

OBJECTIVES: Tranexamic acid is used to prevent hyperfibrinolysis and reduce postoperative bleeding and blood transfusions in on-pump cardiac surgery. We evaluate the efficacy of low or high dose tranexamic acid in a prospective cohort study conducted in Valencia. MATERIALS AND METHODS: A total of 427 patients were recruited between January 2019 and January 2020, 207 in the Hospital General Universitario (low dose [LD]) and 220 in the Hospital Universitario y Politécnico La Fe (high dose [HD] and intermediate dose [ID]). We recorded the presence of hyperfibrinolysis on rotational thromboelastometry, intra- and postoperative administration of blood products, chest tube output within the first 12 h, and incidence of convulsions. Univariate and multivariate comparisons were performed. Univariate analysis of all categories was performed after propensity score matching between LD and HD and between LD and ID. RESULTS: There were no statistically significant differences in: appearance of hyperfibrinolysis, administration of blood products, postoperative chest tube output within the first 12 h, or occurrence of convulsions. Group LD received less fibrinogen than group HD (P = .014) and ID (P = .040) but more fresh frozen plasma than group ID (P = .0002). CONCLUSIONS: Administration of low-dose tranexamic acid is as effective as higher doses in hyperfibrinolysis prophylaxis and the prevention of postoperative bleeding in cardiac surgery.

Tranexamic acid in cardiac surgery: Are low doses enough? / Ácido tranexámico en cirugía cardíaca: ¿las dosis bajas son suficientes?

OBJECTIVES: Tranexamic acid is used to prevent hyperfibrinolysis and reduce postoperative bleeding and blood transfusions in on-pump cardiac surgery. We evaluate the efficacy of low or high dose tranexamic acid in a prospective cohort study conducted in Valencia. MATERIALS AND METHODS: A total of 427 patients were recruited between January 2019 and January 2020, 207 in the Hospital General Universitario (low dose [LD]) and 220 in the Hospital Universitario y Politécnico La Fe (high dose [HD] and intermediate dose [ID]). We recorded the presence of hyperfibrinolysis on rotational thromboelastometry, intra- and postoperative administration of blood products, chest tube output within the first 12h, and incidence of convulsions. Univariate and multivariate comparisons were performed. Univariate analysis of all categories was performed after propensity score matching between LD and HD and between LD and ID. RESULTS: There were no statistically significant differences in: appearance of hyperfibrinolysis, administration of blood products, postoperative chest tube output within the first 12h, or occurrence of convulsions. Group LD received less fibrinogen than group HD (P=.014) and ID (P=.040) but more fresh frozen plasma than group ID (P=.0002). CONCLUSIONS: Administration of low-dose tranexamic acid is as effective as higher doses in hyperfibrinolysis prophylaxis and the prevention of postoperative bleeding in cardiac surgery.

[Comparative study of the efficacy and tolerance of 2 types of colon cleansing]. / Estudio comparativo de la eficacia y tolerancia de dos tipos de limpieza colónica.

OBJECTIVE: To examine if (hypothesis): orally administered colon cleansing with 3 liters of balanced electrolyte/polyethylene glycol solution is superior to the standard method of bowel preparation with senna laxatives and sodium phosphate enemas. STUDY FACTORS: 1st) Quality of colon cleansing estimated by the attending endoscopist. 2nd) Patient tolerance. DESIGN: prospective randomized trial, blind to the endoscopist, comparing two methods of bowel preparation: group A received 3 L of the balanced electrolyte/polyethylene glycol solution the night before the procedure and group B was instructed to ingest 75 ml of a senna laxative the day before the colonoscopy and sodium phosphate enemas per rectum b.i.d. starting 2 days before the examination and again the morning of the procedure. Assessing criteria: 1st) Questionnaire filled by the attending endoscopist immediately after the completion of the colonoscopy. 2nd) Questionnaire filled by the patient the day after the procedure. INCLUSION CRITERIA: all the patients addressed to our Unit for colonoscopy (18 patients refused to participate). EXCLUSION CRITERIA: severe cardiovascular disease, decompensated diabetes mellitus and severe disease or neurological derangement that prevented collaboration (35 patients). Two hundred and sixteen patients were initially included, 110 in group A and 106 in group B; in 39 patients (18 in group A and 21 in group B) colonoscopy could not be completed for causes others than bowel preparation and were excluded for further evaluation by the endoscopist, thus, quality of bowel preparation was evaluated in 92 patients in group A and in 85 patients in group B; 83 patients (43 in group A and 40 in group B) did not answer the questionnaire, or did it incorrectly, thus, tolerance was evaluated in 67 patients in group A and in 66 patients in group B. RESULTS: In 2 patients in group A (2.2%) and in 9 patients in group B (10.6%) colonoscopy could not be completed because of solid stool (p = 0.045). Mucosal visualization was better in group A than in group B (p = 0.0108). A total of 11.9% of the patients in group A and 25.8% of the patients in group B found the preparation hard or very hard to tolerate (p = 0.0001), patients in this latter group presented more frequently abdominal cramps (p = 0.0004), and distress (p < 0.00001), and dizziness (p = 0.0031). Bad tolerance in group B was primarily due to the rectal enemas (p < 0.0001). CONCLUSIONS: Bowel preparation for colonoscopy with 3 L of orally administer balanced electrolyte/polyethylene glycol solution (PEG) results in a better colon cleansing and is better tolerated than the classical preparation consisting in oral purge and rectal enemas.