The Efficacy and Safety of a Low-Dose Tranexamic Acid Bolus-Only Protocol Compared with the Moderate-Dose Protocol in Valvular Heart Surgery

In 873 propensity score-matched pairs of patients undergoing valvular heart surgery, we compared a moderate dose of tranexamic acid (TXA) protocol (group 1; median TXA dose: 24mg/kg body weight) with a 1.5-g bolus-only protocol (group 2; median TXA dose: 19 mg/kg body weight). The number of transfused patients was higher in group 2 than in group 1 (74.5 vs 66.0%, p< 0.001), as was the number of transfused red blood cell concentrates (p = 0.001). The risks of re-exploration and convulsive seizures were similar between groups (p > 0.50). Data indicate an impaired efficacy following the bolus-only protocol, without a significant safety improvement.

Automated summary

We compared a moderate dose of tranexamic acid (TXA) protocol with a 1.5-g bolus-only protocol in 873 propensity score-matched pairs of valvular heart surgery patients. The number of transfused patients and transfused red blood cell concentrates was higher in the bolus-only protocol group. The risks of re-exploration and convulsive seizures were similar between the two groups.