Comparing Vancomycin-Tranexamic Acid Paste to Vancomycin-Normal Saline Paste in Reducing Post Coronary Artery Bypass Graft Surgery Bleeding

Abstract

Background: Postoperative bleeding is a common problem, specially in cardiac surgery. The bone edges at the sternotomy site are one of the major sites of bleeding. Previously, some materials, such as vancomycin paste, have been applied to the sternum prior to the closure of sternum in order to reduce postoperative hemorrhage. In addition, fibrinolytic drugs, such as tranexamic acid, have been used locally to reduce postoperative bleeding. Objectives: This study aimed to assess the effect of vancomycin paste made with tranexamic acid on reducing postoperative mediastinal bleeding. Methods: In this double-blind clinical trial, all patients undergoing on-pump coronary artery bypass graft surgery were included and divided into two groups by simple randomization method. In the control group, two grams of vancomycin paste were made with two mls of normal saline solution. In the intervention group, two grams of vancomycin paste were made with two mls (containing 200 mgs) of tranexamic acid. The paste in each group was applied to the sternal bone edges just prior to sternal closure. Both groups were compared in terms of demographic data, operation data, packed red blood cell transfusion, hemoglobin change, and amount of postoperative bleeding 12, 24, and 48 hours post-surgery. Postoperative sternal wound infection and dehiscence were also evaluated two months after the surgery. Comparisons were done using independent t-test, Fisher's exact test, and Mann-Whitney test using the SPSS software, version 22. Results: Fifty patients completed the trial. Both groups were similar regarding the demographic data and operation data, such as pump time and operation duration. The amount of postoperative bleeding was respectively 268, 624, and 844 mls in the control group and 174, 362, and 485 mls in the invention group 12, 24, and 48 hours after the operation (P < 0.001). The results revealed no significant difference between the two groups concerning postoperative transfusion and hemoglobin changes. Postoperative sternal wound complications, including infection and dehiscence, were not seen in any of the study groups. Conclusions: In comparison to vancomycin paste alone, vancomycin-tranexamic acid paste had a significantly superior effect on the reduction of post-coronary artery bypass graft surgery bleeding.