Efficiency of Preoperative Tranexamic Acid in Coronary Bypass Surgery: An Analysis Correlated with Preoperative Clopidogrel Use


  • Sahin Senay
  • Fevzi Toraman
  • Hasan Karabulut
  • Cem Alhan




Objective: This study evaluates the efficiency of prophylactic tranexamic acid in coronary bypass surgery with respect to preoperative clopidogrel use.

Methods: We analyzed data for 3754 consecutive patients who underwent isolated coronary bypass surgery with cardiopulmonary bypass between January 1999 and August 2008. The patients were placed into 4 groups according to the perioperative use of clopidogrel and tranexamic acid. Group 1 included patients administered neither of these medications (n = 3160, 84.2%); group 2 included patients who received tranexamic acid only (n = 444, 11.8%); group 3 included patients who received clopidogrel only (n = 113, 3.0%); and group 4 included patients who received both medications (n = 37, 1.0%).

Results: In patients who received tranexamic acid, we noted significant decreases in postoperative drainage (615 ± 336 mL versus 458 ± 289 mL, group 1 versus group 2 [P = .0001]; 740 ± 399 mL versus 570 ± 408 mL, group 3 versus group 4 [P = .03]) and the use of fresh frozen plasma (1.4 ± 1.4 units/patient versus 0.2 ± 0.7 units/patient, group 1 versus group 2 [P = .0001]; 2.2 ± 1.7 units/patient versus 0.5 ± 1.3 units/patient, group 3 versus group 4 [P = .0001]), irrespective of the use of clopidogrel. We found significant decreases in postoperative blood transfusion (0.59 ± 1.1 units/patient versus 0.39 ± 1.1 units/patient, group 1 versus group 2 [P = .0001]; 1.2 ± 1.8 units/patient versus 0.7 ± 1.1 units/patient, group 3 versus group 4 [P > .05]) and in the percentage of patients who received transfusions (31.3% versus 19.3%, group 1 versus group 2 [P = .0001]; 54.5% versus 37.8%, group 3 versus group 4 [P > .05]) only in the patients who did not receive clopidogrel.

Conclusion: Prophylactic tranexamic acid reduces bleeding and the need for transfusion. This effect exists in patients using clopidogrel but is less prominent. Preoperative use may be beneficial in patients using clopidogrel without any need for delaying the surgical procedure.


Andreasen JJ, Nielsen C. 2004. Prophylactic tranexamic acid in elective, primary coronary artery bypass surgery using cardiopulmonary bypass. Eur J Cardiothorac Surg 26:311-7.nBrown JR, Birkmeyer NJ, O'Connor GT. 2007. Meta-analysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery. Circulation 115:2801-13.nCasati V, Della Valle P, Benussi S, et al. 2004. Effects of tranexamic acid on postoperative bleeding and related hematochemical variables in coronary surgery: comparison between on-pump and off-pump techniques. J Thorac Cardiovasc Surg 128:83-91.nDiprose P, Herbertson MJ, O'Shaughnessy D, Deakin CD, Gill RS. 2005. Reducing allogeneic transfusion in cardiac surgery: a randomized double-blind placebo-controlled trial of antifibrinolytic therapies used in addition to intra-operative cell salvage. Br J Anaesth 94:271-8.nEagle KA, Guyton RA, Davidoff R, et al, for the American College of Cardiology and American Heart Association. 2004. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 110:e340-437.nFergusson DA, Hébert PC, Mazer CD, et al, for the BART Investigators. 2008. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 358:2319-31.nFox KAA, Mehta SR, Peters R, et al. 2004. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome. The Clopidogrel in Unstable Angina to Prevent Recurrent Ischemic Events (CURE) Trial. Circulation 110:1202-8.nHartmann M, Sucker C, Boehm O, Koch A, Loer S, Zacharowski K. 2006. Effects of cardiac surgery on hemostasis. Transfus Med Rev 20:230-41.nHenry DA, Carless PA, Moxey AJ, et al. 2007. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion (Cochrane Review). Cochrane Database Syst Rev 2007:CD001886.nKing SB 3rd, Smith SC Jr, Hirshfeld JW Jr, et al. 2008. 2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. J Am Coll Cardiol 51:172-209.nMannucci PM. 1998. Hemostatic drugs. N Engl J Med 339:245-53.nPaparella D, Brister SJ, Buchanan MR. 2004. Coagulation disorders of cardiopulmonary bypass: a review. Intensive Care Med 30:1873-81.nParr KG, Patel MA, Dekker R, et al. 2003. Multivariate predictors of blood product use in cardiac surgery. J Cardiothorac Vasc Anesth 17:176-81.nPollack CV Jr, Braunwald E. 2008. 2007 update to the ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: implications for emergency department practice. Ann Emerg Med 51:591-606.nSantos AT, Kalil RA, Bauemann C, Pereira JB, Nesralla IA. 2006. A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting. Braz J Med Biol Res 39:63-9.nSellman M, Intonti MA, Ivert T. 1997. Reoperations for bleeding after coronary artery bypass procedures during 25 years. Eur J Cardiothorac Surg 11:521-7.nSkubas NJ, Despotis GJ. 2001. Optimal management of bleeding complications after cardiac surgery. Semin Cardiothorac Vasc Anesth 5:217-28.nUmscheid CA, Kohl BA, Williams K. 2007. Antifibrinolytic use in adult cardiac surgery. Curr Opin Hematol 14:455-67.nVanek T, Jares M, Fajt R, et al. 2005. Fibrinolytic inhibitors in offpump coronary surgery: a prospective, randomized, double-blind TAP study (tranexamic acid, aprotinin, placebo). Eur J Cardiothorac Surg 28:563-8.nVanek T, Jares M, Snircova J, Maly M. 2007. Fibrinolysis in coronary artery surgery: detection by thromboelastography. Interact Cardiovasc Thorac Surg 6:700-4.nVedin J, Antovic A, Ericsson A, Vaage J. 2005. Hemostasis in off-pump compared to on-pump coronary artery bypass grafting: a prospective, randomized study. Ann Thorac Surg 80:586-93.nWoodman RC, Harker LA. 1990. Bleeding complications associated with cardiopulmonary bypass. Blood 76:1680-97.nYusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, for the Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. 2001. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 345:494-502.nZabeeda D, Medalion B, Sverdlov M, et al. 2002. Tranexamic acid reduces bleeding and the need for blood transfusion in primary myocardial revascularization. Ann Thorac Surg 74:733-8.n



How to Cite

Senay, S., Toraman, F., Karabulut, H., & Alhan, C. (2010). Efficiency of Preoperative Tranexamic Acid in Coronary Bypass Surgery: An Analysis Correlated with Preoperative Clopidogrel Use. The Heart Surgery Forum, 13(3), E149-E154. https://doi.org/10.1532/HSF98.20091176