Du et al. report on a randomised trial evaluating low-dose versus high-dose tranexamic acid during cardiac surgery, which showed no difference in bleeding at 24 hours. The high dose tested here is in alignment with the dose used in the BART trial. Du and colleagues are part a very productive group in Beijing, People’s Republic of China, which has published several important trials in cardiac surgery with special interest in tranexamic acid.
In this trial of 175 patients, bleeding as measured by drainage at 24 hours was not significantly different, however bleeding at 6 hours was significantly lower in the high-dose group. This study is limited by the relatively small sample size that was only powered to detect a 24-hour bleeding reduction of 15%, making it very difficult to evaluate the findings on transfusions, complications and morbidity.
Tranexamic acid safely reduces bleeding and transfusion in cardiac as well as non-cardiac surgery and should be considered as part of standard of care in most surgical procedures associated with high blood loss. The optimal dose warrants further evaluation in cardiac surgery and possibly also in other settings.
– Jakob Stensballe
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