sing remote ischaemic preconditioning to reduce heart injury following coronary artery stenting

Not Applicable

Conditions: Coronary Artery Disease.
Atherosclerotic heart disease

Registration Number: IRCT138901173646N1

Lead Sponsor: Mazandran University of Medical Sciences, Research Council

Brief Summary: Decreasing blood loss and the need for transfusion after CABG surgery: a double-blind randomized clinical trial of topical tranexamic acid Mahmoud NOURAEI1, Afshin GHOLIPOUR BARADARI2,*, Rahman GHAFARI1, Mohammad Reza HABIBI2, Amir EMAMI ZEYDI3, Narges SHARIFI2 1Department of Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 2Department of Anesthesia and Critical Care, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 3Department of Nursing, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran * Correspondence: research9090@yahoo.com 1. Introduction Today, coronary artery diseases (CADs) are the most common causes of morbidity and mortality (1) and coronary artery bypass graft (CABG) surgery is a common intervention annually performed in more than 800,000 cases worldwide (2). Bleeding is a common complication after CABG. Excessive bleeding and blood transfusion play an important role in post-CABG mortality and morbidity (3–5). Patients undergoing cardiac surgery still receive more blood transfusions than in other surgical procedures, consuming 20% of blood bank reserves (6). Reopening sternotomy to control bleeding has been reported in 2%–7% of cases (7). Blood transfusion can cause infection and immunological reactions and increase hospital length stay and cost, which justifies all efforts to reduce bleeding after CABG (4). Activation of fibrinolytic cascade and platelet dysfunction have proven to have a major role in on-pump CABG mediastinal bleeding (3). Fibrinolysis plays a major role in 25% to 45% of cases (7). Tranexamic acid is an antifibrinolytic agent that is substituted for more expensive drugs like aprotinin in recent years (3,4). It can be used both systemically and topically (5). Tranexamic acid binds to lysine binding sites of plasmin and plasminogen. Saturation of these sites displaces plasminogen from the fibrin surface, thus inhibiting fibrinolysis (7). Intravenous tranexamic acid can increase risk of thromboembolism and early graft occlusion (7). This drug has been used topically in patients with a bleeding tendency and in patients taking anticoagulation medication to reduce bleeding after surgery. Tranexamic acid also has been used topically in bladder, gynecology, and ear, nose, and throat operations successfully (7). Systemic complications and the higher expense of its intravenous use prompted us to investigate the efficacy of topical tranexamic acid to reduce blood loss after CABG surgery. Aim: Reopening sternotomy to control bleeding after coronary artery bypass grafting surgery (CABG) has been reported in 2%–7% of cases. Platelet dysfunction and activation of fibrinolytic cascade are the common causes of bleeding after on-pump CABG. Different antifibrinolytic drugs have been used to reduce bleeding. In this study, we aimed to investigate the efficacy of topical tranexamic acid in reducing postoperative mediastinal bleeding after CABG. Materials and methods: This was a double-blind placebo-controlled randomized clinical trial on 40 patients as the control and another 40 patients as the study group. On completion of CABG before sternotomy wound closure, tranexamic acid (2 g/20 mL) or placebo (20 mL of saline) was diluted in 500 mL of warm saline (37 °C), poured into the pericardial cavity, and left for 5 min. Results: There was no significant difference in baseline demographic data and laboratory results between the 2 groups (P > 0.05). Mediastinal bleeding and packed red cell transfusion requirements were significantly lower in the study group (P = 0.01). There were no complications related to topical tranexamic such as mortality, myocardial infarction, cerebrovascular accident, seizure, or renal failure. Conclusion: Topical tranexamic acid can reduce mediastinal bleeding and packed red cell transfusion requirements after CABG

Detailed Description: Not available

Recruitment & Eligibility

Status: Complete

Sex: All

Target Recruitment: 80

Inclusion Criteria

patients undergoing elective percutaneous coronary intervention (PCI) who receive at least one coronary artery stent. Exclusion criteria: (1) emergency PCI (2) an episode of severe angina within 48 hours of the procedure (3) myocardial infarction within six weeks of the procedure and (4) patients taking Nicorandil or Sulphonylurea medications (5) patients unable to give informed consent.

Exclusion Criteria

Not provided