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

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.