INTRODUCTION :
Cardiac surgery has grown up with regard to technical
advances..and major cardiac anomalies are repaired ,majorly aided and
eased with the advent of cardio pulmonary by pass…
Extra corporeal circulation has made it extremely safe, in providing
perfusion to the heart, rendering the heart more accessible and amenable
for complicated procedures.
But the use of cardio pulmonary by pass has not been free from
adverse effects …there is a hoard of changes that happen at the bio
molecular lever which triggers off, a whole body inflammatory
response…
The commonest function to be hampered is easily the physiology
of circulation. There is significant amount of disruption in the normal
coagulation system ,leading to trivial to significant blood loss..
The reason for this altercation would be in multitude, and to name
a few…
• Fall in the quantity of platelets.
• Decrease in the factors that aid in clotting.
AIM OF THE STUDY :
The study was designed with the primary AIM of evaluating the
effect of tranexamic acid in reducing the bleeding tendency in immediate
post operative period for patients who have undergone cardiac sugery .
To evaluate whether tranexamic acid reduces the need for red cell
transfusions. To understand the occurrence of post operative thrombo
embolic events.
MATERIAL AND METHODS ;
This study, designed to be prospective and randomized was
undertaken as an observational evaluation on the topic of usefulness of
tranexamic acid in reducing post operative bleed in patients undergoing
cardiac surgery.
This study was conducted in the department of cardio thoracic
surgery at Rajiv Gandhi government general hospital, Chennai.
This study design was for a year , 2013, and we used a descriptive
analytical method.
Inclusion Criteria :
All patients undergoing open cardiac surgery procedures involving
cardiopulmonary by pass.
Exclusion Criteria :
• Patients with pre existing evidence of of coagulopathy.
• Patients with hepatic dysfunction.
• Patients with renal dysfunction.
• Off pump cardiac sugery cases.
METHODOLOGY : Relevant information were documented in a specially designed
proforma. Meticulous clinical examination preceded by detailed history,
using pre framed questions.
Sixty patients undergoing cardiac surgeries were randomized into
a group of two, thirty each. One group of thirty patients would receive
tranexamic acid , loading dose of 15 milligram per kilogram of body
weight , five minutes before skin incision and one more similar dose after
weaning from CPB. The other group would not receive tranexamic acid.
Assessment of efficacy obtained by evaluating post operative data.
Patients were received in post operative room and monitored.
Routine blood investigations sent on arrival..chest drains were
documented one hourly.clinical evidence for generalized medical bleed
looked out for.red cell transfusion decided on appropriate indications
only.all this data was recorded and analysis drawn and conclusions made.
The patients were followed up during their hospital stay to record
any events of thrombo embolism.
Ethical committee clearance was obtained and all procedures were
performed without any ethical breach. The patient and their relatives
were kept well informed about the procedure.
RESULTS
The observation and the analytical data from this prospective
,randomized study yielded the following results.
• In this study, either groups had a preponderance of young adult
population. The age group of 25 to 36 were about 50% and 45% in
tranexamic and neutral group.
• Mitral valve replacement was among the highest in both groups with
close to 50 and 42% in tranexamic and neutral group.
• The mean post operative drain at six hours were 120 ml and 250 ml in
tranexamic acid and neutral group, higher drain tendencies were
reported in the neutral group.th p value was 0.27 not very significant,
yet the trend reflects in favour of tranexamic acid.
• The need for red cell transfusion or packed cells were, only 45%
required one unit of packed cell, in tranexamic acid group.
• The need for packed cell transfusion in neutral group was like, 40%
required one unit, 35% required two units, and 20% required three and
more, with 5% not requiring transfusion..
• The clotting time tests were almost similar with not much of disparity,
but a smaller trend of benefit in tranexamic acid group, which had
20% of prolonged clotting time, six percent lesser than the
tranexamic acid group.
• The platelet counts too, showed a benefit trend towards tranexamic
acid group.th p value was not significant though, with 0.587
• There were three mortality in each group, totaling six..and all the
mortality were not related to the drug..the cause of death was low
cardiac out put syndrome.
• There were no incidence of re operation due to bleeding in either
groups.
CONCLUSION :
In this study , we come to the conclusion that using tranexamic acid
reduces immediate post operative bleeding and significantly reduces
the morbitity of the patient. However there is not much benefit in post
operative period beyond twenty four hours.
The need for packed cell transfusion also is significantly lesser with
the tranexamic acid group.
The abnormalities in clotting time and and platelets were almost
similar with no statistical significance in either group,but showing
marginal beneficial trend in tranexamic acid group.
Tranexamic acid has been an efficient , cost effective and simple way
in controlling post operative bleed in patients undergoing cardiac
surgery
