does tranexamic acid reduce blood loss in off-pump coronary artery bypass?

tranexamic acid is now used on a routine basis for on-pump coronary artery bypass grafting (cabg). we assessed the hemostatic effects of tranexamic acid to decrease bleeding tendency and transfusion requirements in patients undergoing off-pump coronary artery bypass surgery (opcab). a total of 66 patients were enrolled to elective opcab in a double-blind, prospective randomized study. of these, 33 patients received tranexamic acid (15 mg/kg before the infusion of heparin and 15 mg/kg after protamin infusion), and 33 patients received only saline. preoperative hematologic variables, postoperative bleeding and allogeneic transfusions were considered. d-dimer plasma levels were also evaluated to monitor the activation of fibrinolysis. postoperative bleeding was significantly lower in the tranexamic acid group compared with the control group (320 ± 38 ml vs. 480 ± 75 ml at 12 hour, p < 0.001). the tranexamic acid group had significantly lesser need for allogeneic blood products (0.46 units/patients vs. 0.94 units/patients, p < 0.001). they had also lower post-operative d-dimer plasma levels. no postoperative thrombotic complications were observed in either group. the defective hemostasis occurs even in the opcabg. tranexamic acid effectively reduces postoperative blood loss and the need for allogeneic blood products after opcab is decreased.