Effect of two doses of tranexamic acid on fibrinolysis evaluated by thromboelastography during cardiac surgery: a randomised, controlled study.

This study, although it has a small sample size, is informative about the dosing of tranexamic acid (TA) in cardiac surgery. High-dose TA has been associated with neurological events. The comparison between high dose and low dose showed little difference in effect and notably there was complete suppression of D-dimer production (a good marker of fibrinolysis) with the low dose.

Yes, more research is required to confirm these finding BUT this data, alongside in vitro data and the meta-analysis by Ker et al. (Br J Surg 2013;100:1271-9), does strongly suggest that higher doses of TA are not associated with an increased benefit in efficacy.

– Beverley J. Hunt

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