Optimal Tranexamic Acid Dosing Regimen in Cardiac Surgery: What Are the Missing Pieces?

Multiple randomized clinical trials evaluating prophylactic tranexamic acid administration consistently demonstrate a reduction of bleeding and allogeneic blood product transfusion requirements.^1,2  International guidelines recommend prophylactic administration of antifibrinolytic agents in patients undergoing high-risk cardiac surgical procedures.^3,4  In the most recent large trial, patients scheduled to undergo coronary artery bypass surgery and at risk for perioperative complications were randomized to receive either tranexamic acid (50 to 100 mg/kg of actual body weight) or placebo.⁵  Tranexamic acid was associated with a lower risk of bleeding than placebo without increase in mortality or thrombotic complications within 30 days of surgery. However, tranexamic acid was also associated with a higher risk of postoperative seizures (0.1% vs. 0.7%, P = 0.002). In a 1-yr follow-up study, there was no difference in death or severe...