Effect of high dose intra-operative tranexamic acid infusion to reduce postoperative bleeding in cardiac surgery

Background: Tranexamic acid (TXA) have been used to reduce blood loss and transfusion in patients undergoing cardiac surgery. The effect to reduce blood loss and transfusion among different doses remains unclear. In addition, higher dose of TXA is associated with increased risk of stroke and postoperative seizure. Objective: The aim of this retrospective study was to investigate safety and efficacy of high dose TXA infusion in patients undergoing adult cardiac surgery. Materials and Methods: From November 2016 to January 2018, 127 adult patients were included (41 in TXA group and 86 in control group) and retrospectively reviewed. Results: Patient characteristics were similar between groups. Chest tube output 680 (360, 1,140) mL vs. 635 (420, 1,020) mL (p = 0.604), re-operation for bleeding 4.88% vs. 3.49% (p = 0.658), and blood transfusion 240 (0, 518) mL vs. 250 (0, 579) mL (p = 0.498) were not significantly different between groups. Subgroup analysis for chest tube output and transfusion in each type of operation was also not different. No hospital death, seizure, and thrombotic complications occurred. Overall postoperative complications were not statistically different between groups. Conclusion: High dose TXA infusion does not reduce blood loss and transfusion requirement in cardiac surgery; however, incidence of seizure, thrombotic complications, postoperative complications, and mortality are not increased with TXA.