Tranexamic acid for routine use in off-pump coronary artery bypass surgery: Evidence base 'fait accompli' or more research needed?

摘要

For both the patient and the surgical team, one of the most feared adverse events related to cardiac surgery is massive blood loss leading to substantial use of blood products. Because excessive fibrinolysis is one of the causes of blood loss in cardiac surgery, administration of antifibrinolytic agents has become a common strategy for blood conservation in patients at high risk for blood loss. Tranexamic acid is a synthetic lysine analog that imparts its antifibrinolytic action by competitively blocking lysine binding sites on plasminogen, thereby preventing plasmin-ogen activation. Although inhibition of fibrinolysis may reduce bleeding, patients might be at greater risk of throm-botic events such as coronary graft occlusion, myocardial infarction, stroke, or death.