High-Dose Tranexamic Acid May Reduce Need for RBC Transfusion During Cardiac Surgery

Administering a high dose of tranexamic acid, rather than a low dose of tranexamic acid, during cardiac surgery resulted in a modest reduction in the percentage of patients who required a red blood cell transfusion, according to recent findings published in JAMA.

Investigators in the OPTIMAL trial enrolled 3,079 patients undergoing cardiac surgery with cardiopulmonary bypass to receive either high-dose (30-mg/kg bolus and a 16-mg/kg/h maintenance dose) or low-dose (10-mg/kg bolus and a 2-mg/kg/h maintenance dose) tranexamic acid. The primary efficacy end point was the rate of allogeneic red blood cell transfusion after start of operation, and the primary safety end point was a composite of the 30-day postoperative rate of mortality and adverse events.

Of the 3,031 patients that completed the trial, 1,525 patients received high-dose tranexamic acid and 1,506 received low-dose tranexamic acid. RBC transfusion occurred in 333 (21.8%) patients in the high-dose group and 391 (26%) of patients in the low-dose group. An adverse event or mortality occurred in 265 patients in the high-dose group (17.6%) and 249 patients in the low-dose group (16.8%), but 14 of the 15 prespecified secondary end points were not significantly different between groups.