Comparative Analysis of the Effect of Intravenous, Topical, and Oral Tranexamic Acid on Reducing Bleeding After Coronary Artery Bypass Surgery

Background: Bleeding is a significant complication of cardiac surgeries, leading to increased blood product utilization, higher rates of reoperation, and mortality. Tranexamic acid is one of the main medications used to control postoperative bleeding in these patients. Therefore, the aim of this study was to compare the effects of intravenous, topical, and oral tranexamic acid in reducing postoperative bleeding after coronary artery bypass grafting (CABG) surgery. Materials and methods: This clinical trial was conducted on 96 patients scheduled for CABG surgery. The patients were divided into three groups of 32, receiving oral, intravenous, and topical tranexamic acid. After the surgery and administration of the respective medication, the amount of bleeding within 72 hours postoperatively, as well as the amount of packed red blood cells, platelets, and fresh frozen plasma received within 24 hours postoperatively were assessed. Results: The mean age of the participating patients was 64±5.4 years, and the three groups did not significantly differ in terms of age, gender distribution, number of grafts (P=0.421), and duration of surgery (P=0.624). There was no significant difference in the bleeding score among the three groups, with scores of 3.9±0.88 in the intravenous group, 4.1±1.1 in the oral group, and 4.4±0.98 in the topical group (P=0.221). The average amount of packed red blood cells, platelets, and fresh frozen plasma received during and after surgery was similar in all three groups, with values of 2 (P=0.422), 3.5 (P=0.402), and 2.4 (P=0.412), respectively. Conclusion: In general, the results of this study indicate that the use of tranexamic acid in all three available forms (oral, intravenous, and topical) leads to a reduction in postoperative bleeding with similar outcomes. Therefore, concerning the fewer side effects of the topical and oral forms and their sufficient effectiveness, physicians can utilize these methods for prescribing tranexamic acid.