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. 2021 Oct 7;72(6):795–812. doi: 10.1016/j.bjane.2021.08.022

Table 3.

Tranexamic acid in cardiac surgery.

Author, year, Level of evidence (Jadad8) Patients and intervention groups Objectives & Results Comments
Myles PS et al.42 4631 adults.ÇÖ patients bypass coronary surgery Objective 1..: Mortality and thrombotic complications during the first 30 days (p.á=.á0.22): Well-designed study with a very good sample size
(2017) - 2320 Placebo
  • .Çó

    386(16. 7%) Placebo
RCT - 2311 TXA.
  • .Çó

    420 (18.1%) TXA

 High doses (to 1.ámL.kg-1 and 0,5.ámL.kg-1, according to Table S8 of the Supplemental material of Myles study 100.ámg.kg-1), significantly reduces bleeding (p.á=.á0,026) and number of units transfused of blood products (p.á=.á0.017)
Jadad 4 Initially 100.ámg.kg-1 more than 30.ámin post anaesthesia induction Objective 2..: Total number of blood products transfused during hospitalization (p.á<.á0.001).
After, 50.ámg.kg-1 due to the high incidence of seizures
  • .Çó

    7994 Placebo

 The incidence of seizures is low in both groups.
  • .Çó

    4331 TXA
Re-intervention for major bleeding or cardiac tamponade (p.á=.á0.001):
  • .Çó

    2.8% Placebo
  • .Çó

    1.4% TXA
Seizures (p.á=.á0.002)
  • .Çó

    0.1% Placebo
  • .Çó

    0.7% TXA
Sigaut et al.48 569 Adult.ÇÖs patients Objective 1..: Incidence of transfusion up to 7 postoperative days (p.á=.á0.3) Well-designed study with correct size
(2014) Coronary by-pass surgery
  • .Çó

    180 low doses TXA
RCT - 284 low doses TXA
  • .Çó

    170 high doses TXA

 No differences in mortality or transfusion rate
Jadad 5  10.ámg.kg-1 bolus + Objective 2..: Blood products transfusion (p.á=.á0.02)
(level 1b)  1.ámg.kg-1.h-1 +
  • .Çó

    4.1.á...á0.39 low doses TXA

 Significant differences in blood loss, blood products transfused, and re-interventions for bleeding control
 1.ámg.kg-1 priming OP
  • .Çó

    2.5.á...á0.38.áhigh doses TXA
- 285 high doses TXA Blood loss first 24h (mL) (p.á=.á0,01) Incidence of seizures also low compared to other series reporting 3-7% of seizures
 30.ámg.kg-1 bolus +
  • .Çó

    820.á...á50.7 low doses TXA
 16.ámg.kg-1.h-1 +
  • .Çó

    590.á...á50.4 high doses TXA
 2.ámg.kg-1priming OP Re-surgical for bleeding (p.á=.á0.03)
  • .Çó

    17 low doses TXA
  • .Çó

    14 high doses TXA
Seizures (p.á=.á0.7)
  • .Çó

    2 low doses TXA
  • .Çó

    4 high doses TXA
Mortality from day 0 to day 28 (p.á=.á0.2)
  • .Çó

    14 low doses TXA
  • .Çó

    8 high doses TXA
Kuiper et al.47 355 Adults 1st Objective:
(2019) Cardiac surgery Blood loss the day of the surgery (p.á<.á0.001)
Observational, prospective open cohort database - 204 blood products administration of and haemostatic medication according to medical criteria
  • .Çó

    890.ámL. Medical criteria
Jadad 5 - 151 blood products administration of and ROTEM-guided haemostatic medication
  • .Çó

    565.ámL. Guided by ROTEM
Use red blood cell transfusion and haemostatic medication.
Decreased absolute risk of:
  • .Çó

    17% by red blood cell transfusion (p.á=.á0.024)
  • .Çó

    12% for fresh frozen plasma (p.á=.á0.019)
  • .Çó

    12% for fresh frozen plasma (p.á=.á0.019)
  • .Çó

    4% by platelet transfusion (p.á=.á0.582)
In general, more TXA was administered but not more fibrinogen
2nd Objective:
Re-surgical intervention for bleeding and mortality
  • .Çó

    No statistically significant difference
In hospital stay
  • .Çó

    A mean of 4 days was reduced (p.á<.á0.001)
Economic costs
  • .Çó

    .é¼4.8 million ($5.6 million) per year for the authors.ÇÖ hospital with about 1,000 procedures annually.

RCT, Randomized control trial; OP, On-Pump coronary artery bypass surgery.