Wang Enshi, Wang Yang, Li Yuan, Hu Shengshou, Yuan Su
Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China.
Front Surg. 2023 Feb 21;10:1117974. doi: 10.3389/fsurg.2023.1117974. eCollection 2023.
More elderly patients undergo coronary artery bypass surgery (CABG) than younger patients. Whether tranexamic acid (TA) is still effective and safe in elderly patients undergoing CABG surgeries is still unclear.
In this study, a cohort of 7,224 patients ≥70 years undergoing CABG surgery were included. Patients were categorized into the no TA group, TA group, high-dose group, and low-dose group according whether TA was administered and the dose administered. The primary endpoint was blood loss and blood transfusion after CABG. The secondary endpoints were thromboembolic events and in-hospital death.
The blood loss at 24 and 48 h and the total blood loss after surgery in patients in the TA group were 90, 90, and 190 ml less than those in the no-TA group, respectively ( < 0.0001). The total blood transfusion was reduced 0.38-fold with TA administration compared to that without TA (OR = 0.62, 95% CI 0.56-0.68, < 0.0001). Blood component transfusion was also reduced. High-dose TA administration reduced the blood loss by 20 ml 24 h after surgery ( = 0.032) but had no relationship with the blood transfusion. TA increased the risk of perioperative myocardial infarction (PMI) by 1.62-fold [ = 0.003, OR = 1.62, 95% CI (1.18-2.22)] but reduced the hospital stay time in patients who were administered TA compared to that of patients who did not receive TA ( = 0.026).
We revealed that elderly patients undergoing CABG surgeries had better hemostasis after TA administration but increased the risk of PMI. High-dose TA was effective and safe compared with low-dose TA administration in elderly patients undergoing CABG surgery.
接受冠状动脉搭桥手术（CABG）的老年患者比年轻患者更多。氨甲环酸（TA）在接受CABG手术的老年患者中是否仍然有效和安全尚不清楚。
本研究纳入了7224例年龄≥70岁接受CABG手术的患者。根据是否使用TA以及使用的剂量，将患者分为未使用TA组、TA组、高剂量组和低剂量组。主要终点是CABG术后的失血量和输血情况。次要终点是血栓栓塞事件和住院死亡。
TA组患者术后24小时和48小时的失血量以及术后总失血量分别比未使用TA组少90、90和190毫升（<0.0001）。与未使用TA相比，使用TA可使总输血量减少0.38倍（OR = 0.62，95%CI 0.56 - 0.68，<0.0001）。血液成分输血也有所减少。高剂量TA给药可使术后24小时失血量减少20毫升（P = 0.032），但与输血无关。TA使围手术期心肌梗死（PMI）风险增加1.62倍[P = 0.003，OR = 1.62，95%CI（1.18 - 2.22）]，但与未接受TA的患者相比，接受TA的患者住院时间缩短（P = 0.026）。
我们发现接受CABG手术的老年患者使用TA后止血效果更好，但增加了PMI风险。在接受CABG手术的老年患者中，高剂量TA与低剂量TA给药相比有效且安全。
