Comparing Vancomycin-Tranexamic Acid Paste to Vancomycin- Normal Saline Paste in Reducing Post Coronary Artery Bypass Graft Surgery Bleeding

AUTHORS

Amir Mirmohammadsadeghi ORCID 1 , * , Hafez Asadollahi ORCID 1

1 Cardiovascular Surgery Department, Isfahan University of Medical Sciences (IUMS), Isfahan, IR Iran

How to Cite: Mirmohammadsadeghi A, Asadollahi H. Comparing Vancomycin-Tranexamic Acid Paste to Vancomycin- Normal Saline Paste in Reducing Post Coronary Artery Bypass Graft Surgery Bleeding, Int Cardio Res J. 2020 ; 14(4):e103103.

ARTICLE INFORMATION

International Cardiovascular Research Journal: 14 (4); e103103
Published Online: December 15, 2020
Article Type: Research Article
Received: March 27, 2020
Accepted: September 19, 2020
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Abstract

Background: Postoperative bleeding is a common problem, specially in cardiac surgery.
The bone edges at the sternotomy site are one of the major sites of bleeding. Previously,
some materials, such as vancomycin paste, have been applied to the sternum prior to the
closure of sternum in order to reduce postoperative hemorrhage. In addition, fibrinolytic
drugs, such as tranexamic acid, have been used locally to reduce postoperative bleeding.
Objectives: This study aimed to assess the effect of vancomycin paste made with
tranexamic acid on reducing postoperative mediastinal bleeding.
Methods: In this double-blind clinical trial, all patients undergoing on-pump coronary
artery bypass graft surgery were included and divided into two groups by simple
randomization method. In the control group, two grams of vancomycin paste were
made with two mls of normal saline solution. In the intervention group, two grams of
vancomycin paste were made with two mls (containing 200 mgs) of tranexamic acid. The
paste in each group was applied to the sternal bone edges just prior to sternal closure.
Both groups were compared in terms of demographic data, operation data, packed red
blood cell transfusion, hemoglobin change, and amount of postoperative bleeding 12, 24,
and 48 hours post-surgery. Postoperative sternal wound infection and dehiscence were
also evaluated two months after the surgery. Comparisons were done using independent
t-test, Fisher’s exact test, and Mann-Whitney test using the SPSS software, version 22.
Results: Fifty patients completed the trial. Both groups were similar regarding the
demographic data and operation data, such as pump time and operation duration. The
amount of postoperative bleeding was respectively 268, 624, and 844 mls in the control
group and 174, 362, and 485 mls in the invention group 12, 24, and 48 hours after the
operation (P < 0.001). The results revealed no significant difference between the two
groups concerning postoperative transfusion and hemoglobin changes. Postoperative
sternal wound complications, including infection and dehiscence, were not seen in any
of the study groups.
Conclusions: In comparison to vancomycin paste alone, vancomycin-tranexamic acid
paste had a significantly superior effect on the reduction of post-coronary artery bypass
graft surgery bleeding.

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