Evaluating the Effect on Mortality of a No-Tranexamic acid (TXA) Policy for Cardiovascular Surgery

Objectives: The authors stopped using tranexamic acid (TXA) in April 2013. The present study aimed to examine the impact of a "no-TXA-use" policy by comparing the adverse effects of TXA and clinical outcomes before and after the policy change in patients undergoing cardiovascular surgery. Design: A single center retrospective cohort study. Setting: A single cardiovascular center. Participants: Patients undergoing cardiovascular surgery between January 2008 and July 2015 (n = 3,535). Interventions: Patients' outcomes before and after the policy change were compared to evaluate the effects of the change. Measurements and Main Results: The seizure rate decreased significantly after the policy change (6.9% v 2.7%, p < 0.001). However, transfusion volumes and blood loss volumes increased significantly after the policy change (1,840 mL v 2,030 mL, p = 0.001; 1,250 mL v 1,372 mL, p < 0.001, respectively). Thirty-day mortality was not statistically different (1.6% v 1.4%, p = 0.82), nor were any of the other outcomes. Propensity-matched analysis and segmented regression analysis showed similar results. Conclusions: The mortality rate remained the same even though the seizure rate decreased after the policy change. Blood loss volume and transfusion volume both increased after the policy change. TXA use provides an advantageous benefit by reducing the need for blood transfusion. (C) 2017 Elsevier Inc. All rights reserved.