A Comparative Study of the Efficacy and Safety Profile of Topical Application of Tranexamic Acid in the Form of Mist to Reduce Postoperative Bleeding in on-Pump CABG Procedures.

Abstract

Background: Postoperative bleeding is a major concern in cardiovascular surgery, leading to an increased need for blood transfusions and a longer hospital stay. Between 30% and 70% of open-heart surgery patients will require blood product transfusion. The use of the cardiopulmonary bypass machine (CPB) often leads to bleeding due to complement activation, platelet activation, and hyperfibrinolysis. Antifibrinolytic drugs, like ε-aminocaproic acid, aprotinin, and tranexamic acid (TXA) are used to decrease postoperative bleeding in cardiac surgery. According to the Society of Thoracic Surgeons guidelines, TXA is class I recommendation to reduce the risk of bleeding.

Aims: Compare the efficacy and safety of TXA in the mist form to reduce postoperative bleeding.

Settings and design: Prospective, Randomized, Single-Centre, Interventional Study.

Material and methods: The study included sixty participants undergoing on-pump CABG randomized into two groups. Group T and Group C received topical TXA and 20 mL NS in mist form, respectively. The mist was blown over the pericardium, LIMA bed, and sternotomy sites before chest closure. The primary objectives were to compare the 48th hour drain collection and need for blood transfusion.

Statistical analysis used: Simple t-test, Chi-square test and Mann-Whitney U test.

Results: The experimental group had significantly less 48-hour drain (P value 0.001), reduced need of blood and blood products (P value 0.001) and less duration of postoperative ventilation (P value 0.001).

Conclusion: The topical application of TXA in mist form significantly reduced postoperative bleeding, the necessity for blood transfusion, and the duration of mechanical ventilation in on-pump CABG procedures.