High-dose tranexamic acid infusion results in reduced blood transfusion in cardiac surgery cases: JAMA

China: High-dose tranexamic acid infusion resulted in a moderate outcome of requiring allogeneic red blood cell transfusion among patients having heart surgery with cardiopulmonary bypass, says an article published in the Journal of American Medical Association (JAMA). 

Tranexamic acid is indicated in heart surgery to reduce blood loss and transfusion. However, it is uncertain if a large dosage of tranexamic acid saves more blood than a modest dose without raising the risk of thrombotic problems or seizures during heart surgery. As a result, Jia Shi and colleagues carried out this study to assess the effectiveness and side effects of high-dose tranexamic acid vs low-dose tranexamic acid in patients having heart surgery with cardiopulmonary bypass.

This was a randomized, double-blind clinical trial of adult patients having heart surgery with cardiopulmonary bypass. From December 26, 2018, to April 21, 2021, 3079 participants were recruited in the trial at four hospitals in China; the final follow-up was on May 21, 2021. Participants were randomly assigned to either a high-dose regimen of 30-mg/kg bolus, 16-mg/kg/h maintenance dose, and 2-mg/kg prime (n = 1525) or a low-dose regimen of 10-mg/kg bolus, 2-mg/kg/h maintenance dose, and 1-mg/kg prime (n = 1506).

The key findings of this study were as follow:

1. The experiment was completed by 3031 (98.4%) of the 3079 participants who were randomly assigned to treatment groups.

2. Transfusion of allogeneic red blood cells occurred in 333 of 1525 patients (21.8%) in the high-dose group and 391 of 1506 patients (26.0%) in the low-dose group.

3. Postoperative seizures, thrombotic events, renal failure, and mortality occurred in 265 patients (17.6%) in the high-dose group and 249 patients in the low-dose group (16.8%).

4. Seizures occurred in 15 patients (1.0%) in the high-dose group and 6 patients (0.4%) in the low-dose group.

In conclusion, with regard to a composite primary safety endpoint composed of 30-day mortality, kidney dysfunction, seizure, and thrombotic events, high-dose tranexamic acid infusion as compared to low-dose tranexamic acid infusion led to a modest statistically significant decrease in the percentage of patients who required an allogeneic red blood cell transfusion.

Reference:

Shi, J., Zhou, C., Pan, W., Sun, H., Liu, S., Feng, W., Wang, W., Cheng, Z., Wang, Y., Zheng, Z., Fan, H., Yang, Y., Xu, F., … Gao, G. (2022). Effect of High- vs Low-Dose Tranexamic Acid Infusion on Need for Red Blood Cell Transfusion and Adverse Events in Patients Undergoing Cardiac Surgery. In JAMA (Vol. 328, Issue 4, p. 336). American Medical Association (AMA). https://doi.org/10.1001/jama.2022.10725