Emergency coronary bypass surgery in patients under the influence of dual antiplatelet therapy: effects of tranexamic acid and desmopressin acetate

Background/aim: Bleeding in patients undergoing coronary artery bypass grafting (CABG) while using dual antiplatelet therapy (DAPT) is a cause of significant morbidity and mortality. The aim of this study is to examine the perioperative hemostatic effects of tranexamic acid (TnX-A) and desmopressin acetate (Des) in these patients. Materials and methods: This clinical study was planned in a prospective and randomized manner. Fifty-four patients were enrolled and classified into 4 different groups. They were compared in terms of various bleeding and transfusion parameters. Results: No significant differences were observed between the groups in pre/intraoperative data apart from closure times. Plasmin/alpha-2 antiplasmin complex values in the TnX-A and control groups were significantly higher than those in the Des and TnX-A+Des groups at the end of postoperative drug infusion. Mean duration of closure times, first 3-h and total postoperative amounts of drainage, administered volumes of erythrocyte suspension/fresh frozen plasma, cost of blood products, length of intubation, length of stay in the intensive care unit, and time to discharge were also significantly higher in the Des and control groups. Conclusion: Des had no significant effect on bleeding control and even delayed the hemostatic efficacy of TnX-A. Use of TnX-A infusion alone in these patient groups had a positive effect on hemostasis-related data.