Triple-dose bolus versus continuous infusion of tranexamic acid: impacts on clinical outcomes in isolated coronary artery bypass surgery

BACKGROUND: In cardiac surgery, intraoperative tranexamic acid (TXA) is commonly used and highly recommended approach for managing perioperative bleeding. Nevertheless, a standardized dose and administration protocol remains undefined. This study compares the efficacy of intraoperative triple-dose intravenous (IV) bolus TXA versus IV bolus followed by continuous IV infusion in preventing postoperative bleeding in patients undergoing isolated coronary artery bypass grafting (CABG). METHODS: The study included 93 patients who underwent elective isolated CABG between August 14, 2023, and October 14, 2024. Patients received either triple-dose IV bolus TXA (Group 1, n = 53) or IV bolus followed by continuous IV infusion (Group 2, n = 40) during surgery. RESULTS: Postoperative bleeding was lower in Group 1 at all assessed time points (1 h: 116 vs. 146 mL; 6 h: 253 vs. 332 mL; 24 h: 589 vs. 713 mL). However, a statistically significant difference was found only at 6 h (p = 0.03), representing an approximately 24% relative reduction in bleeding volume compared with Group 2. No significant differences were observed in transfusion requirements (packed red blood cells p = 0.85; fresh frozen plasma p = 0.55). Three patients in Group 2 required reoperation due to bleeding (p = 0.07), and one late mortality occurred in Group 2 (p = 0.43). CONCLUSION: This study suggests that triple-dose IV bolus TXA administration may be both an effective and safe strategy for preventing postoperative bleeding in isolated CABG surgery. TRIAL REGISTRATION: The study was registered at the Clinical Trial Registry (NCT05994989, August 8, 2023) on.