Tranexamic acid reduces postbypass blood use: a double-blinded, prospective, randomized study of 210 patients

Ann Thorac Surg. 1996 Apr;61(4):1131-5. doi: 10.1016/0003-4975(96)00022-7.


Background: Pharmacologic intervention to minimize postbypass bleeding and blood product transfusions has received increasing attention for both medical and economic reasons.

Methods: Two hundred ten patients were entered into a double-blinded, prospective, randomized study to receive either 10 g of fibrinolytic inhibitor tranexamic acid before incision (n = 104) or 250 mL of placebo saline solution (n = 106). All subjects requiring cardiopulmonary bypass were deemed suitable, including those having first-time coronary bypass grafting, valve replacement, and reoperation.

Results: There were no statistically significant differences between the groups with respect to demographic or operative characteristics. The tranexamic acid group had a 48% reduction in 24-hour blood drainage (p < 0.001) and received 69% fewer total units of packed red blood cells, 83% fewer total units of plasma, and 75% fewer platelet transfusion units than controls. Only 13 of 104 tranexamic acid patients received blood products versus 33 of 106 controls (p < 0.001). The incidences of thrombotic complications, perioperative myocardial infarction, renal failure, and neurologic complications were not significantly different between the two groups. The tranexamic acid group had 0% mortality versus 1.9% for controls (not significant).

Conclusions: Tranexamic acid is safe and effective in reducing blood loss and blood use in a wide variety of cardiac surgical patients.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antifibrinolytic Agents / therapeutic use*
  • Blood Transfusion* / statistics & numerical data
  • Cardiopulmonary Bypass* / mortality
  • Cardiopulmonary Bypass* / statistics & numerical data
  • Double-Blind Method
  • Female
  • Hemorrhage / blood
  • Hemorrhage / mortality
  • Hemorrhage / prevention & control*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / blood
  • Postoperative Complications / mortality
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Time Factors
  • Tranexamic Acid / therapeutic use*


  • Antifibrinolytic Agents
  • Tranexamic Acid