Impact of tranexamic acid on bleeding during coronary artery bypass for patients under treatment of low molecular weight heparin




Coronary bypass surgery, Low molecular weight heparin, Tranexamic acid, Bleeding, Blood products


Aim: Tranexamic acid (TA) is an antifibrinolytic agent that prevents the dissolution of fibrin clot. We investigated the impact of the use of tranexamic acid (TA) on bleeding for patients under treatment of low molecular weight heparin during coronary artery bypass graft (CABG) operations.
Methods: Among 82 patients, 60 patients undergoing CABG with cardiopulmonary bypass (CPB) were enrolled into a case-control study within a six month-period. On the first postoperative day, patients were divided into two groups depending on the intraoperative use of TA. TA was not administered to control group patients (n=30) while those in the study group (n=30) received TA intravenously at a dose of 10 mg/kg. Coagulation variables including complete blood cell count, D-Dimer, fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalized ratio (INR) values were collected preoperatively and 24 hours after surgery. Estimated blood loss, loss by drainage, total amounts of packed red blood cell and fresh frozen plasma transfusions were recorded. P-value <0.05 was considered statistically significant.
Results: Among 60 patients included in the study, there were 39 and 21 males and females, respectively. The mean age of all patients was 61.6 years. The two groups were similar in terms of use of fresh frozen plasma, age, height, and weight (P=0.268, P=0.586, P=0.787, P=0.641, respectively). The amount of postoperatively transfused packed red blood cells in units were lower in the study group (P=0.04). Total mediastinal drainage amounts in the 4th, 8th, 12th hours and overall were lower in the study group (P=0.016, P=0.006, P=0.013, P=0.04, respectively).
Conclusions: TA is a safe drug that reduces postoperative bleeding without side effects in patients using DMAH undergoing CABG operations.


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Ekim H, Kutay V, Başel H, Turan E, Hazar A, Karadağ M. Bleeding After Open Heart Surgery. Van Medical Journal. 2004:11(4):119-23.

Ateş M, Kayacıoğlu İ, Şaşkın H, Şensöz Y, Yangel M, Ekinci A, et. al. Revision surgeries due to bleeding after open heart surgery (2-year follow-up) Turkish Thoracic and Cardiovascular Surgery. 2003:11:207-10.

Ozatik MA,Göl K, Budak B, Küçüker Ş, Sarıtaş A, Mavitaş B, et al. Reexploration for bleeding and tamponade in the intensive care unit following open heart surgery. Anadolu Kardiyol Journal. 2004;4:19-22.

Mehta RH, Sheng S, O'Brien SM, Grover FL, Gammie JS, Ferguson TB, et al. Society of Thoracic Surgeons National Cardiac Surgery Database Reoperation for bleeding in patients undergoing coronary artery bypass surgery: incidence, risk factors, time trends, and outcomes. Circ Cardiovasc Qual Outcomes. 2009 Nov;2(6):583-90.

Biancari F, Mikkola R, Heikkinen J, Lahtinen J, Airaksinen KE, Juvonen T. Estimating the risk of complications related to re-exploration for bleeding after adult cardiac surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2012;41(1):50-5.

Kristensen KL, Rauer LJ, Mortensen PE, Kjeldsen BJ. Reoperation for bleeding in cardiac surgery. Interact Cardiovasc Thorac Surg. 2012;14(6):709-13.

Hirsh J, Bauer KA, Donati MB, Gould M, Samama MM, Weitz JI. Parenteral anticoagulants: American College of Chest Physicians Evidence‐Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133:141S-159S

Crowther MA, Warkentin TE. Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood. 2008;111(10):4871-9.

Gray E, Mulloy B, Barrowcliffe TW. Heparin and low‐molecular‐weight heparin. Thrombosis and Haemostasis.2008;99:807–18.

Mahdy AM, Webster NR. Perioperative systemic haemostatic agents. Br J Anaesth. 2004;93:842-58.

Brown RS, Thwaites BK, Mongan PD. Tranexamic acid is effective in decreasing postoperative bleeding and transfusions in primary coronary artery bypass operations: a double-blind, randomized, placebo-controlled trial. Anesth Analg. 1997;85:963-70.

Longstaff C. Studies on the mechanisms of action of aprotinin and tranexamic acid as plasmin inhibitors and antifibrinolytic agents. Blood Coagul Fibrinolysis.1994;5:537-42.

Jones HU, Muhlestein JB, Jones KW, Bair TL, Lavasani F, Sohrevardi M, et al. Preoperative use of enoxaparin compared with unfractionated heparin increases the incidence of re-exploration for postoperative bleeding after open-heart surgery in patients who present with an acute coronary syndrome: clinical investigation and reports. Circulation. 2002;106(12 Suppl 1):I19-22.

Parr KG, Patel MA, Dekker R, Levin R, Glynn R, Avorn J, Morse SE. Multivariate predictors of blood product use in cardiac surgery. J Cardiothorac Vasc Anesth. 2003;17:176–81.

Ranucci M, Bozzetti G, Ditta A, Cotza M, Carboni G, Ballotta A. Surgical reexploration after cardiac operations: why a worse outcome? Ann Thorac Surg. 2008;86:1557–62.

Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Re-exploration for bleeding is a risk factor for adverse outcome after cardiac operations. J Thorac Cardiovasc Surg. 1996;11(1):1037–46.

Nuttall GA, Gutierrez MC, Dewey JD, Johnson ME, Oyen LJ, Hanson AC, et al. A preliminary study of a new tranexamic acid dosing Schedule for cardiac surgery. J Cardio Vasc Anesth. 2008;22:230-5.

Karski JM, Dowd NP, Joiner R, Carroll J, Peniston C, Bailey K, et al. The effect of three different doses of tranexamic acid on blood loss after cardiac surgery with mild systemic hypothermia (32 ºC). J Cardio Vasc Anesth. 1998;12:642-46.

Gürbüz HA, Durukan AB, Tavlaşoğlu M, Salman N, Durukan E, Tanzer Serter F, et al. Evaluation of routine tranexamic acid use in cardiac surgery. Gülhane Medical Journal. 2013;55:111-6.

Pleym H, Stenseth R, Wahba A, Bjella L, Tromsdal A, Karevold A, Dale O. Prophylactic treatment with desmopressin does not reduce postoperative bleeding after coronary surgery in patients treated with aspirin before surgery. Anesth Analg. 2004;98(3):578-84.

Pleym H, Stenseth R, Wahba A, Bjella L, Karevold A, Dale O. Single-dose tranexamic acid reduces postoperative bleeding after coronary surgery in patients treated with aspirin untilsurgery. Anesth Analg. 2003;96(4):923-8.

Jiménez JJ, Iribarren JL, Brouard M, Hernández D, Palmero S, Jiménez A, et al. Safetyan deffecti veness of two treatment regimens with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomize double-blind, dose-dependent, phase IV clinical trial. J Cardiothorac Surg. 2011;14;6:138.

Krivokuca I, Lammers JW. Recurrent pulmonary embolism associated with a hemostatic drug: tranexamic acid. Clin Appl Thromb Hemost. 2011;17:106-7.

Sander M, Spies CD, Martiny V, Rosenthal C, Wernecke KD, von Heymann C. Mortality associated with administration of high-dose tranexamic acid and aprotinin in primary open-heart procedures: A retrospective analysis. Critical Care. 2010;14:1-14.

Ege T, Çıkırıkçıoğlu M, Arar C, Acıpayam M, Duran E. The effect of two different heparin neutralization methods on postoperative drainage in open heart surgery. Gulhane Med J. 2002;44:399-404.

Casati V, Sandrelli L, Speziali G, Calori G, Grasso MA, Spagnola S. Hemostatic effects of tranexamic acid in elective thoracic aortic surgery: A prospective, randomize, double–blind, placebo controlled study. J Thorac Cardiovasc Surg. 2002;123:1084-91.

Wong BI, McLean RF, Fremes SE, Deemar KA, Harrington EM, Christakis GT, et al. Aprotinin and tranexamic acid for high transfusion risk cardiac surgery. Ann Thorac Surg. 2000 Mar;69(3):808-16.

Chauhan S, Gharde P, Bisoi A, Kale S, Kiran U. A comparison of amino caproic acid and tranexamic acid in adult cardiac surgery. Ann Card Anaesth. 2004;7(1):40.






Research Article

How to Cite

Doğukan M, Güler F, Baysal A, Güven C, Uludag Öznur. Impact of tranexamic acid on bleeding during coronary artery bypass for patients under treatment of low molecular weight heparin. J Surg Med [Internet]. 2020 Apr. 1 [cited 2022 Jun. 25];4(4):309-13. Available from: