Tranexamic acid in cardiac surgery. What is a safe dose?

Cardiac surgery with cardiopulmonary bypass (CPB) is associated with increased postoperative bleeding, blood product consumption, and the number of surgical re -explorations. Currently, of the 50% of transfused patients from cardiac surgery, 20% have significant bleeding, and 5% required reoperation for postoperative bleeding. This increased consumption of blood increases morbidity, mortality, hospital stay, and healthcare costs. The causes of coagulopathy after CPB are multifactorial: hemodilution, blood exposure to CPB circuits, destruction of platelets, and thrombin activation. The guidelines of the American and European scientific societies recommend the use of tranexamic acid (TA) to reduce perioperative bleeding in cardiac surgery. TA saves an average of 300 ml of blood, with a relative reduction of 32% receiving transfusion. CS interventions with CPB carried out without using any antifibrinolytic drug is characterized by increased blood loss, increased reoperations for bleeding, and increased transfusion and blood products, when compared to other interventions where antifibrinolytic were used. The main problem with the use of TA lies in the many administration patterns and different doses which vary from one article to another. The aim of this article is to alert on the use of high doses of TA and its consequences according to the latest recommendations in the literature. (C) 2013 Sociedad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U. All rights reserved.