1- Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery (Paul S. Myles, M.P.H,...,Sophie Wallace, M.P.H., ANZCA Clinical Trials, N Engl J Med January 12, 2017)

Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects.

METHODS; We randomly assigned patients who were scheduled to undergo coronary-artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. 4631 patients underwent surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group.

CONCLUSIONS; Among patients undergoing coronary-artery surgery, tranexamic acid was associated with a lower risk of bleeding than was placebo, without a higher risk of death or thrombotic complications within 30 days after surgery. Tranexamic acid was associated with a higher risk of postoperative seizures.