Tranexamic acid in on-pump coronary artery bypass grafting without clopidogrel and aspirin cessation: randomized trial and 1-year follow-up.

This small, single-center, prospective, randomized, double-blinded controlled trial included patients undergoing primary and isolated on-pump CABG. One hundred and seventeen patients were randomly assigned to receive either tranexamic acid (TA; 15 mg/kg before surgical incision and 15 mg/kg after protamine neutralization) or placebo. Expectedly, given the well documented efficacy of TA in CABG surgery, the primary outcome (allogeneic erythrocyte transfusion) was positive: tranexamic acid was more effective than placebo in those patients who had received their last dose of dual antiplatelet therapy (DAPT; clopidogrel and aspirin) less than 7 days before surgery. Nonetheless, the average time interval between the last ingestion of platelet inhibitors and surgery was 127.0 ± 57.0 hours and 120.0 ± 57.1 hours in the tranexamic acid group and the placebo group, respectively (5 days on average), meaning that, at the time of surgery, an almost total wash-out of the antiplatelet agent had occurred and therefore probably no residual effect of the antiplatelet agents was present. Consequently, the authors cannot conclude that tranexamic acid is effective in CABG patients in the presence of clopidogrel and aspirin.

– Charles-Marc Samama