Year 2020 Vol. 28 No 2

SCIENTIFIC PUBLICATIONS
GENERAL & SPECIAL SURGE

D.V. OSIPENKO 1, S.P. SALIVONCHIK 1, A.A. SKARAKHODAU 1, A.A. SILANAU 1, A.V. MAROCHKOV 2

EFFICIENCY ESTIMATION OF VARIOUS DOSES OF TRANEXAMIC ACID IN CARDIOPULMONARY BYPASS SURGERY

Gomel Regional Clinical Cardiological Center 1, Gomel,
Mogilev Regional Hospital 2, Mogilev,
The Republic of Belarus

Objective. To determine the effectiveness of various doses of tranexamic acid (TA) in the cardiopulmonary bypass surgery (CPB).
Methods. The study included 128 patients who underwent the heart surgery with CPB. Three groups were formed: group 1 (n=30) a loading dose of TA 10 mg/kg was administered intravenously with titration 1 mg/kg/h during CPB; the 2nd group (n=32) a loading dose of TA was administered intravenously 12.5 mg/kg with titration 6.5 mg/kg/h during CPB and 1 mg/kg/h in the first 6 hours after surgery; 3rd group (n=66) the control one.
Results. The blood loss volume during the period from the operation onset to 42 48 hours after it, in the 1st, 2nd and 3rd group of patients was: 20.9 (18.1; 26.7) ml/kg, 19.3 (13.9; 22.5) ml/kg and 22.8 (18.4; 27.6) ml/kg; statistically significant differences were only between the 2nd and 3rd group of patients. The total volume of the chest tube drainage in the first 42-48 hours after the operation was significantly less in the 1st group (475.0 (350.0; 650.0) ml) and the 2nd group (500.0 (350.0; 550.0) ml), compared with the 3rd group (600.0 (500.0; 750.0) ml). The use of TA in the 2nd group of patients, compared with the 3rd group, led to the decrease in the frequency of blood transfusions in the first 42-48 hours after surgery. In the 1st group of patients, statistically significant differences in the frequency of blood transfusions were not found.
Conclusions. Maintenance of TA according to the method the bolus of 12.5 mg/kg, titration of 6.5 mg/kg/ h during CPB and 1 mg/kg/h in the first 6 hours after surgery (total dose of 2.5 (2.1; 3.0) g) is optimal in the cardiopulmonary bypass heart surgery.

Keywords: tranexamic acid, cardiac surgery, cardiopulmonary bypass, blood loss, blood preparations
p. 133-140 of the original issue
References
  1. Miller R. Millers Anesthesia: ruk v 4 t: per. s angl: Izdatelstvo: Chelovek. Rossiia; 2015. 3472 p. https://www.ozon.ru/context/detail/id/143579136/. (In Russ.)
  2. Pagano D, Milojevic M, Meesters MI, Benedetto U, Bolliger D, von Heymann C, Jeppsson A, Koster A, Osnabrugge RL, Ranucci M, Ravn HB, Vonk ABA, Wahba A, Boer C. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg. 2018 Jan 1;53(1):79-111. doi: 10.1093/ejcts/ezx325
  3. Greilich PE, Jessen ME, Satyanarayana N, Whitten CW, Nuttall GA, Beckham JM, Wall MH, Butterworth JF. The effect of epsilon-aminocaproic acid and aprotinin on fibrinolysis and blood loss in patients undergoing primary, isolated coronary artery bypass surgery: a randomized, double-blind, placebo-controlled, noninferiority trial. Anesth Analg. 2009 Jul;109(1):15-24. doi: 10.1213/ane.0b013e3181a40b5d
  4. Henry DA, Carless PA, Moxey AJ, OConnell D, Stokes BJ, Fergusson DA, Ker K. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD001886. doi: 10.1002/14651858.CD001886.pub3
  5. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999 Mar 16;130(6):461-70. doi: 10.7326/0003-4819-130-6-199903160-00002
  6. Gao F-Q, Li Z-J, Zhang K, Sun W, Zhang H. Four methods for calculating blood-loss after total knee arthroplasty. Chin Med J (Engl). 2015 Nov 5;128(21): 2856-60. doi: 10.4103/0366-6999.168041
  7. Jimenez JJ, Iribarren JL, Lorente L, Rodriguez JM, Hernandez D, Nassar I, Perez R, Brouard M, Milena A, Martinez R, Mora ML. Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial. Crit Care. 2007;11(6):R117. doi: 10.1186/cc6173
  8. Dowd NP, Karski JM, Cheng DC, Carroll JA, Lin Y, James RL, Butterworth J. Pharmacokinetics of tranexamic acid during cardiopulmonary bypass. Anesthesiology. 2002 Aug;97(2):390-99. doi: 10.1097/00000542-200208000-00016
Address for correspondence:
246046, Republic of Belarus,
Gomel, Meditsinskaya Str., 4,
Gomel Regional Clinical Cardiological Center,
Department of Anesthesiology and Intensive Care
With the Intensive Care Wards.
Tel.: +375 29 614 65 98,
e-mail: osipenko081081@mail.ru
Dzmitry V. Osipenko
Information about the authors:
Osipenko Dzmitry V., PhD, Anesthesiologist-Resuscitator, the Department of Anesthesiology and Intensive Care with the Intensive Care Wards, Gomel Regional Clinical Cardiological Center, Gomel, Republic of Belarus.
http://orcid.org/0000-0003-4838-1140
Salivonchik Sergey A., PhD, Cardiac Surgeon, Deputy Chief Physician for Surgical Care, Gomel Regional Clinical Cardiological Center, Gomel, Republic of Belarus.
https://orcid.org/0000-0001-6011-9351
Silanau Aliaksandr A., Anesthesiologist-Resuscitator, the Department of Anesthesiology and Intensive Care with the Intensive Care Wards, Gomel Regional Clinical Cardiological Center, Gomel, Republic of Belarus.
http://orcid.org/0000-0002-1849-071X
Skarakhodau Aliaksandr A., Cardiac Surgeon, the Cardiac Surgery Unit, Gomel Regional Clinical Cardiological Center, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-2618-8692
Marochkov Alexey V., MD, Anesthesiologist-Resuscitator, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-5092-8315
Contacts | ©Vitebsk State Medical University, 2007-2023