1.
Comparison of two tranexamic acid dose regimens in patients undergoing cardiac valve surgery
Du Y, Xu J, Wang G, Shi J, Yang L, Shi S, Lu H, Wang Y, Ji B, Zheng Z
Journal of Cardiothoracic & Vascular Anesthesia. 2014;28((5):):1233-7.
Abstract
OBJECTIVE Tranexamic acid (TA), a synthetic antifibrinolytic drug, has been shown to reduce postoperative bleeding and the need for allogeneic blood transfusion in cardiac surgery. However, the optimal dose regimen of TA is still under debate. The aim of this study was to evaluate whether a lower-dose TA regimen produced equivalent efficacy to its higher-dose counterpart in reducing postoperative bleeding and transfusion needs. DESIGN A prospective, randomized, double-blind trial. SETTING National Center for Cardiovascular Diseases & University Hospital, Beijing, People's Republic of China. PARTICIPANTS One hundred seventy-five patients undergoing cardiac valve surgery were enrolled in the study. INTERVENTIONS All patients were divided randomly into 2 groups. The lower-dose TA group received a loading dose of 10 mg/kg, maintenance dose of 2 mg/kg/h, and a cardiopulmonary bypass pump prime dose of 40 mg; the higher-dose TA group received a loading dose of 30 mg/kg, maintenance dose of 16 mg/kg/h, and a pump prime dose of 2 mg/kg. MEASUREMENTS AND MAIN RESULTS The amount of postoperative bleeding, the amount and frequency of allogeneic transfusion, mortality, and morbidities were recorded. There was no significant difference in the volume of 24-hour postoperative bleeding between the lower-dose group and the higher-dose group. Other measurements also showed no statistical difference between the 2 groups, including the amount and frequency of allogeneic transfusion, mortality, and morbidities. CONCLUSION Lower-dose TA regimen was as effective as the higher-dose regimen in reducing postoperative bleeding and transfusion needs in patients undergoing cardiac valve surgery. 2014 Elsevier Inc. All rights reserved.
2.
Autotransfusion of shed mediastinal blood after open heart surgery
Zhao K, Xu J, Hu S, Wu Q, Wei Y, Liu Y
Chinese Medical Journal. 2003;116((8):):1179-82.
Abstract
OBJECTIVE To determine the safety and effectiveness of autotransfusion of shed mediastinal blood after open heart surgery. METHODS Sixty patients undergoing coronary artery bypass grafting (CABG) were selected randomly to receive either nonwashed shed mediastinal blood (Group 1, n = 30) or banked blood (Group 2, n = 30). Drainage and transfusion volume were determined after the operation. Hb, RBC, HCT and PLT were detected immediately before and after the operation, as well as 24 hours and 7 days after the operation. Data were analyzed using Fisher's exact test. A P < 0. 05 was considered significant. RESULTS There were no significant differences in Hb, HCT, PLT or length of cardiopulmonary bypass (CPB) (P > 0. 05). In the two groups, no significant difference in the mean blood loss was observed during 24 hours after the operation (660 +/- 300 ml in Group 1 and 655 +/- 280 ml in Group 2, P > 0. 05). In Group 1, the mean volume autotransfused was 280 +/- 160 ml, and the patients required 360 +/- 80 ml banked blood compared with 660 +/- 120 ml in Group 2. In other words, the banked blood requirement in Group 1 was 40% lower. CONCLUSIONS Autotransfusion of shed mediastinal blood after an open heart operation is safe and effective.