We enrolled 102 patients scheduled for on-pump (n = 51) or off-pump (n = 51) coronary artery bypass grafting. Patients were separately double-blind randomly assigned to treatment with tranexamic acid (1 g as 20-minute bolus before skin incision, followed by continuous infusion of 400 mg/h, with 500 mg added to priming in patients undergoing on-pump coronary artery bypass grafting) or placebo (saline solution of equivalent volume). Bleeding in the first 24 postoperative hours was the primary outcome. Requirement for allogeneic transfusions, thrombotic complications, outcomes, and monitoring of coagulation, fibrinolysis, and inflammation were also recorded.
Tranexamic acid reduced total postoperative bleeding by 43 % in patients undergoing on-pump coronary artery bypass grafting and by 27 % in those undergoing off-pump coronary artery bypass grafting (P < .0001), with 80 % reduction in bleeding exceeding 600 mL (P < .001), 58 % reduction in the requirement for all allogeneic transfusions (P = .07), and no apparent effect on thrombotic complications or outcome. This was associated with a reduction in plasma D-dimer levels (P < .0001), to a greater degree in patients undergoing on-pump coronary artery bypass grafting (P < .0001), and interleukin 6 levels (P < .0001), to a greater degree in patients undergoing off-pump coronary artery bypass grafting (P < .001).
By affecting fibrinolysis, tranexamic acid significantly reduces bleeding both in off- and on-pump coronary artery bypass grafting and may modulate inflammation in these surgical settings.