Autologous Platelet-Rich Plasma Combined With Tranexamic Acid In Cardiac Surgery For Blood Protection:A Randomized Controlled Study

Objective: To explore the clinical value of Autologous platelet-rich plasmapheresis(APP)combined with Tranexamic acid(TXA)in Tranexamic acid blood protection during cardiac surgery.Methods: This is a prospective,single blind,randomized controlled study.Twenty aortic dissection patients undergoing cardiopulmonary bypass and 40 patients undergoing valve replacement under CPB were included.The patients were randomly divided into two groups: autologous platelet-rich Plasma Group(APP group,n= 30)and routine treatment group(NAPP group,n=30).Patients in App Group were treated with autologous plateletrich plasma separation combined with tranexamic acid,while patients in NAPP group were treated with tranexamic acid only.The value of hemoglobin,platelet,PT,APTT,Thromboelastogram(R,K,Angle,MA,CI)were recorded before anesthesia induction(T1),after platelet collection(T2),1 h after operation(T3),24 h after operation(T4).Preoperative patient’s general condition,perioperative allogeneic blood transfusion,postoperative complications,postoperative mechanical ventilation time,ICU treatment time,were also recorded.Results: there was no significant difference in general condition between the two groups(P > 0.05).There was no significant difference in the time of extracorporeal bypass,aortic cross-clamp and operation between the two groups(P > 0.05).Compared with the NAPP group,Plt in the APP group was significantly lower at T2(p < 0.05),and significantly higher at T3 and T4(p < 0.05).MA decreased significantly at T2(p < 0.05),and MA increased significantly at T3 and T4(p < 0.05).Compared with the NAPP group,the amount of thoracic drainage at T4 and T5 was significantly decreased in the experimental group(p < 0.05),and the amount and rate of red blood cell transfusion,platelet transfusion and rate of transfusion were significantly decreased in the experimental group,the transfusion volume and transfusion rate of fresh frozen plasma were significantly decreased(p < 0.05).Compared with the NAPP group,there was no significant difference in the incidence of postoperative complications in the experimental group.The duration of mechanical ventilation and ICU stay were significantly reduced in the experimental group(P < 0.05).Conclusions: the technique of autologous platelet separation can reduce the postoperative bleeding and the incidence of allogeneic blood transfusion in patients undergoing cardiac surgery,and does not increase the incidence of adverse events.