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Brazilian Journal of Cardiovascular Surgery

Print version ISSN 0102-7638

Rev Bras Cir Cardiovasc vol.7 no.4 São José do Rio Preto Oct./Dec. 1992

 

ARTIGOS ORIGINAIS

 

Acido tranexâmico e hemostasia em cirurgia de revascularização do miocárdio com circulação extracorpórea

 

Tranexamic acid and hemostasis in myocardial revascularization with extracorporeal circulation

 

 

Guilherme F. Vargas; João Nelson R. Branco; Ana Hercília S. Guimarães; Cecília Kobata; Espedito T. V. F. Silva; Carlos Alberto Teles; Carlos Arnulfo A. La Rotta; M. L. A. Batista Filho; José Carlos S. Andrade; Ênio Buffolo

Do Serviço de Cirurgia Cardiovascular da Escola Paulista de Medicina

Endereço para separatas

 

 


RESUMO

O antífibrinolítico sintético ácido tranexâmico (Transamin ®) foi avaliado em seus efeitos hemostáticos e poupadores de transfusões homólogas, em pacientes submetidos a revascularização do miocárdio com circulação extracorpórea (CEC). Quarenta pacientes receberam placebo e 55 pacientes foram operados sob o efeito do ácido tranexâmico na dose de 10 g endovenosa no trans-operatório (2 g administrados na indução anestésica e os restantes 8 g nas 4 horas seguintes de cirurgia, de modo contínuo). O ácido tranexâmico, na dosagem utilizada, demonstrou possuir efeito hemostático impressionante, promovendo uma redução no débito pelos drenos torácicos da ordem de 47% nas 12 horas de P.O., 42,5% nas 24 horas de P. O. e 40,5% até a retirada dos drenos, em relação ao grupo-controle (p<0,05). O ácido tranexâmico promoveu uma menor utilização de concentrado de glóbulos homólogos por paciente, porém, diferença estatisticamente significante foi demonstrada apenas nas 24 horas de P.O. com 1,025 unidades/paciente no grupo controle e 0,333 unidades/paciente no grupo-estudo. Com relação às complicações pós-operatórias, houve maior número de alterações neurológicas sem seqüelas (2,5% contra 12,7%) e alterações de creatinina (5% contra 10,9%) no grupo com o ácido tranexâmico. Tais alterações foram atribuídas à alta dosagem da droga. Como conclusão, não se recomenda o uso rotineiro do ácido tranexâmico em pacientes submetidos a revascularização do miocárdio na dosagem de 10 g endovenoso no trans-operatório, mas, devido ao evidente efeito hemostático da droga, aconselha-se maiores investigações a respeito da dosagem e modo de administração ideais.

Descritores: ácido tranexâmico, cirurgia cardíaca; hemostasia cirúrgica; miocárdio, revascularização, cirurgia; circulação extracorpórea.


ABSTRACT

The synthetic antif ibrinolytic drug tranexamic acid was evaluated in its hemostatic and blood saving effects, in patients submitted to myocardial revascularization with extracorporeal circulation. To 40 patients were administered placebo and to 55 tranexamic acid I.V. in a dosage of 10 g in the operative period (2 g in the anesthetic induction and the remaining 8 g in a continuous way during the operative procedure). Tranexamic acid, in this dosage, has proved to have a very impressive hemostatic effect, leadir g to a reduction in post operative bleeding of 47% in 12 h, 42,5% in 24 h and 40,5% when drains were taken off, related to the control group (p < 0.05). Tranexamic acid have led to less utilization for homologous paked red cells per patient, but statistical significance was found only in the 24 h of post operative period, with 1,025 units/patient in control group and 0,333 units/ patient in treated group. Concerning post operative complications, there have been more neurological alterations without sequelae (2.5% against 12.7%) and creatinin alterations (5% against 10.9%) in the tranexamic acid group. Such alterations were attributed to the high dosage used. As a conclusion, we do not recommend routine use of tranexamic acid to patients submitted to myocardial revascularization in the dosage of 10 g I.V., but, owing to the evident hemostatic effect of the drug, we recommend more investigations concerning the ideal dosage and way of administration.

Descriptors: tranexamic acid; surgical hemostasis; myocardial revascularization, surgery; extracorporeal circulation.


 

 

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Endereço para separatas:
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Trabalho realizado no Serviço de Cirurgia Cardiovascular da Escola Paulista de Medicina. São Paulo, SP, Brasil.
Apresentado ao 19º Congresso Nacional de Cirurgia Cardíaca. Sâo Paulo. SP, 7 a 9 de maio de 1992.

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