Effect Of Blood Conservation Of Tranexamic Acid In Cardiac Valve Replacement With Cardiopulmonary Bypass

Objective: To investigate the effect of tranexamic acid (TA) on platelets, coagulation system function,and volume of postoperative bleeding and blood transfusions in cardiac patients undergoing valvereplacement with cardiopulmonary bypass(CPB), giving some basic theories on using tranexamic acid forthe blood protection in reasonable on the clinic.Methods:60patients undergoing cardiac valve replacement in General Hospital of Ningxia MedicalUniversity from December in2010to October in2011， were randomly assigned to2groups with30caseseach, tranexamic acid group (group A) and placebo group (group B). During CPB, A group was injectedwith tranexamic acid (20mg/kg), and B group with normal saline. Two groups，blood samples were takenfrom vein to analyze: Platelet count(PLT)， Prothrombin time(PT)，Activated partial thromboplastintime(APTT)，Thrombin time(TT)，Fibrinogen(FIB) of change before operation，3h after operation, and12hafter operation, and Activated Prothrombin time(ACT) of change pre-CPB, during of process of CPB, andpost-CPB. To observe and record the time of sternal closure and the amount of postoperative12hmediastinal chest tube drainage and transfusion of blood products.RESULTS: PLT, PT, APTT, TT and FIB measured values before operation were not statisticallysignificant between the two group (P>0.05); Compared with group B， they were higher at3h afteroperation in group A (P <0.05); PLT, PT, APTT and TT measured values at12h after operation were notstatistically significant between the two group (P>0.05), compared with group B FIB was higher in groupA (P <0.05). PLT changes: A group: postoperative3h,12h was lower preoperative (P <0.05), there was nosignificant differences between postoperative12h and postoperative3h (P>0.05); B group: postoperative 3h,12h was lower preoperative (P <0.05), postoperative12h was lower postoperative3h (P <0.05). PT,APTT and TT change in A and B groups: postoperative3h was lower preoperative (P<0.05), there was nosignificant differences between postoperative12h and preoperative (P>0.05), postoperative3h was higherpostoperative12h (P <0.05). FIB changes: A group: postoperative3h was lower preoperative (P<0.05),there was no significant differences between postoperative12h and preoperative (P>0.05), postoperative12h was higher postoperative3h (P <0.05); B group: postoperative3h,12h was lower preoperative(P<0.05), postoperative12h was higher postoperative3h (P <0.05). ACT measured values at pre-CPB,during of process of CPB, and post-CPB was not statistically significant between the two group (P>0.05),it was similar in the pre-CPB and post-CPB (P>0.05). The amount of postoperative12h mediastinal chesttube drainage and transfusion of blood products in group A than group B were significantly reduced(P<0.05), sternal closure time with two groups of patients was not statistically significant (P>0.05).Conclusion: Tranexamic acid does not affect the ACT measured values, has the effect in bloodconservation of Cardiac Valve surgery with cardiopulmonary bypass, has a good effect on anti-fibrinolytic,platelet protective and reduce postoperative bleeding and blood transfusion.