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. 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...

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