Topical application of tranexamic acid versus systemic injection during coronary artery bypass graft surgery:a comparative study

Background Diffuse microvascular bleeding remains a common problem after myocardial revascularization with cardiopulmonary bypass.ObjectivesThe effi cacy of locally administered tranexamic acid (topical application) was compared with systemically administered tranexamic acid to reduce postoperative bleeding after cardiopulmonary bypass in elective nonredo coronary artery bypass grafting ( CABG).MethodsThe study included 60 patients of both sexes, aged between 35 and 65 years, and scheduled for elective CABG; patients were randomly assigned to two groups: group I (the intravenous tranexamic acid group; 30 patients) and group II (the topical tranexamic acid group; 30 patients).For each patient in each group, postoperative blood loss, number of units of packed red blood cells (RBCs) and fresh frozen plasma ( FFP) transfused, frequency of resternotomy, duration of hospital and ICU stay, and mortality were recorded.ResultsThere were statistically significant differences between the two groups with regard to total postoperative blood loss and need for packed RBCs and FFP transfusion, being much greater in group I than in group II. There was no mortality in either group. Frequency of resternotomy was higher in group I than in group II, although the difference was statistically nonsignificant.The duration of hospital and ICU stay revealed no statistically significant differences between the two groups.Conclusion Intraoperative topical administration of tanexamic acid into the pericardial cavity before sternal closure during CABG surgery has reduced the incidence of postoperative blood loss and the need for postoperative packed RBCs and FFP transfusion.