VALUE OF LOCAL ADMINISTRATION OF TRANEXAMIC ACID IN CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

Peri-operative bleeding in surgeries with cardiopulmonary bypass results in the increase of post-operative complications and mortality. Fibrinolysis hyperactivation is the common cause of non-operative bleeding. Materials and methods. 60 patients who had cardiac surgery with cardiopulmonary bypass were enrolled into the study. The antifibrinolytic agent (tranexamic acid) was administered to all patients: 32 patients (TA1) received an intravenous loading dose of tranexamic acid basing on 15 mg/kg during 20 min. with the consequent infusion of 1 mg/(kg × h^-1) + 500 mg during cardiopulmonary bypass; 28 patients (TA2) received intravenous loading dose of tranexamic acid (15 mg/kg for 20 minutes) with the consequent infusion of 1 mg/(kg × h^-1) + 500 mg during cardiopulmonary bypass + 1000 mg administered into the pericardial cavity and sternum before its closure. The peri-operative blood loss and volume of blood transfusion (erythrocyte suspension, fresh frozen plasma, platelet concentrate) were assessed. Results. Intra-operative blood loss made 815 (800–862) ml in TA1 group and 700 (650–735) ml in TA2 group. The volume of the post-operative blood loss in TA2 group was confidently lower compared to TA1 group: 170 (100–240) ml versus 275 (180–307) ml respectively. The frequency of erythrocyte suspension transfusion in the post-operative period did not differ significantly and the frequency of fresh frozen plasma transfusion was 2.5 lower in TA2 group compared to TA1 group. Conclusions. Blood-saving effect of the system administration of tranexamic acid is enhanced by local its administration into the pericardial cavity and sternum.

1. Morozov Yu.А., Charnaya M.А., Dementieva I.I. Fibrinolysis system in surgeries with cardiopulmonary bypass. Problemy Gematologii i Perelivaniya Krovi, 2005, no. 2, pp. 53-57. (In Russ.)

2. Yavorovskiy А.G., Zyulyaeva L.P., Charnaya M.А., Morozov Yu.А., Tolstova I.А., Gladysheva V.G., Bunyatyan А.А. Efficiency and safety of using tranexamic and aminocapronic acids in cardiac surgery with cardiopulmonary bypass. Anesteziologiya i Reanimatologiya, 2009, no. 5, pp. 10-15. (In Russ.)

3. Abrishamei A. et al. Topical application of antifibrinolytic drugs for on-pump cardiac surgery – a systemic review and meta-analysis. Can. J. Anesth., 2009, no. 56, pp. 202-212.

4. Armellin G., Vinciquerra A., Bonato R., Pittarello D., Giron G.P. Tranexamic acid in primery CABG surgery: high vs low dose. Minerva Anestesiol., 2004, 70, no. 3, pp. 97-107.

5. Aron K.V., Emery R.W. Decreased postoperative drainage with addition of epsilon-aminocapronic acid before cardiopulmonary bypass. Ann. Thoracic Surgery, 1994, vol. 57, no. 5, pp. 1108-1112.

6. Baric D., Biocina B., Unic D., Sutlic Z., Rudez I., Vrca V.B. Topical use of antifibrinolytic agents reduce postoperative bleeding: a double-blind, prospective, randomized study. Eur. J. Cardiothorac. Surg., 2007, vol. 31, no. 3, pp. 666-671.

7. Boyle E.M., Verrier E.D., Spiess B.D. The procoagulant response to injury. Ann. Thoracic Surgery, 1997, no. 64, pp. 16-23.

8. Brown J.R., Brikmeyer N.J.O., O´Connor G.T. Metaanalysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery. Circulation, 2007, no. 115, pp. 2801-2813.

9. Casati V. Tranexamic acid in off-pump coronary surgery: a preliminary, randomized, double-blind, placebo-controlled study. Ann. Thoracic Surgery, 2001, vol. 72, no. 2, pp. 470-475.

10. Casati V. Tranexamic and administration after cardiac surgery: a prospective, randomized, double-blind, placebo-controlled study. Aneshesiology, 2001, vol. 94, no. 1, pp. 8-14.

11. Ferqusson D.A., Hebert P.C., Mazer C.D., Eremes S., MacAdams C., Murkin J.M. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N. Engl. J. Med., 2008, vol. 358, no. 22, pp. 2319-2331.

12. Ferraris V.A., Brown J. 2011 update to the Society of Thoracic Surgeons and the Society Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann. Thorac Surg., 2011, vol. 91, no. 13, pp. 944-982.

13. Henry D.A., Moxey A.J., Carless P.A. Anti-fibrinolytic use for minimizing perioperative allogenic blood transfusion. Cochrane Database Syst. Rev., 2011, https://www.ncbi.nlm.nih.gov/m/pubmed/21249650/#fft

14. Lemaire R. Strategies for blood management in orthopaedic and trauma surgery. J. Bone Joint Surg. Br., 2008, vol. 90-B, no. 9, pp. 1128-1136.

15. Levrat A., Gros A., Rugery L. Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. Brit. J. Anaesthesiology, 2008, 100, pp. 289-295.

16. Maineri P., Covaia G., Realini M., Caccia G., Ucussich E., Luraschi M., Crosta A., Foresti B., Chiaranda M. Postoperative bleeding after coronary revascularizational. Comparision betwin tranexamic acid and epsilon-aminocapronic acid. Minerva Cardiangiol., 2000, vol. 48, no. 6, pp. 155-160.

17. Menkis A.H., Martin J., Cheng D.C. Drug. Devices, technologies, fnd techniques for blood management in minimally invasive and conventional cardiothoracic surgery: a consensus statement from the International Society for Minimally Iinvasive Cardiothoracic surgery. Innjvations (Phila), 2012, vol. 7, no. 34, pp. 229-241.

18. Miashita T. Kamibayashi T, Ohnish Y. Preservation of collagen-induced whole blood platelet aggregation by tranexamic acid therapy in primary cardiac valve surgery. Perfusion, 2000, vol. 15, no. 36, pp. 507-513.

19. Ozier Y. Pharmacological approaches to redusing blood loss and transfusions in the surgical patient. Can. J. Anesth., 2006, vol. 53, no. 6, pp. 21-29.

20. Ranucciu M. et al. The procoagulant response to injury. Ann. Thoracic Surgery, 2013, vol. 96, no. 2, pp. 478-485.

21. Sandeep C. Dosage of epsilon-aminocapronic acid to reduse postoperative blood loss. Asian Cardiovasc. Thorac. Ann., 2000, no. 8, pp. 15-18.

22. Sander M., Spies C.D., Martiny V. Mortality associated with administration of high dose tranexamic acid and aprotinin in primary open-heart procedures: a retrospective analysis. Crit. Care, 2010, vol. 14, no. 4, pp. 148.

23. Spiess B.D. The contribution of fibrinolysis to bypass bleeding. J. Cardiothor. Vasc. Anesthesia, 1991, no. 5, pp. 13-17.

24. Vacharaksa K., Prakanrattana U., Suksompong S., Chumparthong S. Tranexamic acid as a means of reducing the need for blood and blood component therapy in children undergoing open heart surgery for congenital cyanotic heart disease. J. Med. Assoc. Thai., 2002, vol. 85, suppl. 3, pp. 904-909.

25. Wong B.I. Syntetic antifibrinolytics anl aprotinin for cardiac surgery. Philadelphia, Hanley & Belfus Inc., 2002, 261, 278 p.