SPECIFICITY OF USING TRANEXAMIC ACID IN PATIENTS WITH CARDIAC SURGERY

Abstract

Objective. To evaluate the efficacy of tranexamic acid (TA) in cardiac surgery patients undergoing the open-heart surgery under conditions of artificial blood circulation (ABC) by determining the volume of perioperative blood loss using the hemoglobin balance method. Methods. A pilot non-randomized prospective clinical trial was conducted. To determine the effectiveness of TA use, 2 groups of patients were formed: the 1st group, without TA application (n=40), the 2nd group - with TA application intraoperatively (n=40). In group 2, prior to sternotomy, intravenous bolus injection of TA (1000 mg (20 ml of 5% solution)) was performed and further titration of TA through a syringe dispenser was continued at a rate of 4 ml/hour (200 mg/hour) until the end of the operation.The volume of intraoperative blood-loss was assessed by the hemoglobin balance method. A special protocol was developed to control the volume of postoperative blood loss. Results. The volume of circulating blood (VCB) calculated by Nadler’s formula for the first group was 5433.2 (5008.5; 5768.2) ml, for the second - 5214.0 (4944.1; 5546.8) ml. In the first group of patients who did not receive TA during open- heart surgery, the volume of blood loss was 1460.6 (1196.8; 1725.8) ml or 26.9 % of the average circulating blood volume (CBV), and in the second group of patients who received TA intraoperatively - 1090.7 (882.3; 1468.6) ml or 20.9% of the CBV (p<0,001). Conclusion. The application of TA in cardiac surgery patients during open-heart surgery with ABC according to the developed algorithm (1000 mg/bolus, titration during surgery-200 mg/h) for the purpose of blood saving the volume of blood-loss was reduced by 25.3% compared to the control group. What this paper adds Algorithm for the use of tranexamic acid to reduce perioperative blood loss in cardiac surgery using cardiopulmonary bypass (CPB) during open-heart surgery has been developed. This algorithm included intravenous tranexamic acid injection (1,000 mg.) followed by titration during the operation - 200 mg/h). The use of this algorithm in cardiac surgical procedures allows reducing the volume of blood loss by 25.3%.