Treatment Of Tranexamic Acid Combined With Autotransfusion In Off-pump Coronary Artery Bypass Patients

Objective : To observe the influence on the blood loss and allogeneic blood transfusion and coagulation function after off-pump coronary artery bypass(OPCAB) with injection of tranexamic acid and autotransfusion.Methods: One hundred and forty-six patients with ASA III-Ⅳ, including 112 males and 34 females who were elective off-pump coronary artery bypass(OPCAB) surgery from 2011 February to 2014 March in General Hospital of Ningxia Medical University were divided into the control group(group A, n=51), the tranexamic acid group(group B, n=30) and tranexamic acid in combination with autologous blood transfusion group(group C, n=65). Patients of group A neither application of tranexamic acid nor the autologous blood transfusion; the patients in group B were given 1 g(100 ml) tranexamic acid by intravenous drip after anesthesia induction before cutting skin and 1g(100ml) was given after protamine neutralization; the patients in group C were autologous blood recovery of the operative field hemorrhage and pleural hematocele during the operation, and use the same way in the same timepoint with group B to give tranexamic acid, total 2g. Collected the values of hemoglobin(Hb), hematocrit(Hct), platelet(Plt) before and 24 h after the operation. Preoperative and postoperative blood coagulation four indices of PT, APTT, INR, FIB were recorded; The input amount of liquid, Urine output, types of blood transfusion and transfusion volume, pericardium and mediastinum blood loss postoperative 24 hours were also recorded.Results: Before the surgery, the three groups had no significant difference in Hb, Hct and Plt. After the surgery, although the Hb, Hct and Plt in the three groups were both significantly decreased compared with the relative baseline(P < 0.05), both were remained in the normal range. Compared with group A, patients in group B and group C postoperative pericardial mediastinal drainage was significantly reduced, and the difference was statistically significant(P < 0.05). The difference of allogeneic transfusion incidence(%) between groups was statistically significant(P < 0.0125). Compared with group A, patients in group B and group C were significantly reduced allogeneic blood input in patients(P < 0.05), and allogeneic blood transfusion of patients in group C were less than group B, and the difference was statistically significant(P < 0.05). The coagulation function(PT/APTT/INR/FIB) of patients in three groups before the surgery showed no statistically significant difference, and comparison of pre-operative and post-operative, there was also no significant difference in coagulation function(P > 0.05).Conclusion: The treatment of tranexamic acid combined with autotransfusion can reduce the blood loss and the allogeneic blood transfusion after OPCAB surgery safely and effectively.