Clinical study on the blood conservation effect of different time application of tranexamic acid in patients with cardiac valve surgery undergoing cardiopulmonary bypass

doi:10.12092/j.issn.1009-2501.2019.12.014

Abstract

Abstract:

AIM: To investigate the effect of different time of tranexamic acid on blood protection in patients undergoing cardiac valve replacement under the condition of cardiopulmonary bypass (CPB). METHODS: Forty patients undergoing cardiac valve replacement were randomly divided into two groups: group A (n=20) and group B (n=20). Group A received 15mg/kg tranexamic acid via central vein 5 minutes after heparinize. Group B received 15 mg/kg tranexamic acid intravenously 10 minutes after protamine injection at the end of cardiopulmonary bypass (CPB), and then 10 mg·kg-1·h-1 tranexamic acid was continuous intravenous infused until the end of the operation in the both groups. The venous blood samples were taken before operation T1, at the end of operation T2, and at the morning of after operation T3, 24 hours after operation T4. Then the coagulation indexes and the blood routine of the two groups were analyzed. The volume of pericardial mediastinal drainage, allogeneic erythrocyte red suspension and plasma input were recorded at T3 and T4. RESULTS:Compared with group B, group A could reduce pericardial mediastinal drainage and plasma infusion. But in terms of coagulation function, the APTT in group B at T3 time point was significantly longer than that in group A, the DD in group B at T2-4 time point and the FDP in group B at T2 time point was significantly higher than that in group A as well. No significant differences were found in all the other coagulation indexes (PT,APTT,INR,FIB,FDP) and blood routine (HB,HCT,PLT) between the two groups during perioperative period. There were no significant differences in the volume of allogeneic red suspension infusion between the two groups, but the volume of pericardial mediastinal drainage and the demand of allogeneic plasma in group B were significantly more than those in group A at T3-4. CONCLUSION:When tranexamic acid is intravenous medicated before CPB in patients undergoing cardiac valve replacement, tranexamic acid can reduce postoperative pericardial mediastinal drainage and allogeneic plasma infusion, and better inhibit hyperfibrinolysis.

Key words: tranexamic acid, blood protection, cardiopulmonary byass, cardiac valve replacement

CLC Number:

R614

YU Jun，JIN Xiaoju，GUO Jianrong，CAO Ya, LU Meijing, CHANG Yan, ZHOU Yumei, ZHOU Wei1. Clinical study on the blood conservation effect of different time application of tranexamic acid in patients with cardiac valve surgery undergoing cardiopulmonary bypass[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(12): 1415-1420.

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