INFLUENCE OF DIFFERENT DOSES OF TRANEXAMIC ACID ON EARLY AND TOTAL POSTOPERATIVE BLEEDING IN NON - ANAEMIC PATIENTS UNDERGOING ON - PUMP CARDIAC SURGERY

Abstract

Introduction: Postoperative bleeding is a frequent and clinically significant complication after cardiac surgery due to its invasive nature, cardiopulmonary bypass, and perioperative anticoagulation. Excessive bleeding is associated with re-exploration, prolonged intensive care unit stay, increased morbidity, and increased mortality. Antifibrinolytic therapy, particularly tranexamic acid (TXA), is strongly recommended to reduce bleeding and transfusion requirements, yet the optimal dosing strategy remains uncertain. 

Aim: To assess the influence of three different doses of TXA on early and total postoperative bleeding in non-anaemic patients undergoing on-pump cardiac surgery.

Material and Methods: Prospective, randomized, single-center study of 180 non-anaemic patients, randomized in three TXA dosing groups: low-dose 20mg/kg, medium-dose 35mg/kg, and high-dose 50mg/kg. The following outcomes were monitored: postoperative bleeding at 4, 12, and 24 hours, total postoperative bleeding, and surgical revision due to bleeding or cardiac tamponade. 

Results: Bleeding volumes did not differ significantly between TXA dosing groups at any predefined postoperative interval (0–4 hours, p = 0.470; 4–12 hours, p = 0.853; 12–24 hours, p = 0.199), nor did the cumulative bleeding volumes differ within 24 hours (p = 0.647) or the total postoperative bleeding volumes (p = 0.758). In multivariable models, the TXA dose was not an independent predictor of early postoperative bleeding, neither there are significant differences for low-dose (B = 0.136, p = 0.214) nor for medium-dose TXA (B = 0.182, p = 0.087) compared with the high-dose group. Similarly, the TXA dose was not associated with total postoperative bleeding (low-dose: B = 0.019, p = 0.785; medium-dose: B = −0.011, p = 0.870). Aortic valve surgery was associated with significantly lower total postoperative bleeding compared with combined procedures (B = −0.393, 95% CI −0.592 to −0.194; p < 0.001).

Conclusion: These findings do not support routine escalation of tranexamic acid dosing.