1. Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial
- Author
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Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John McNeil, Jean S. Bussières, Shay McGuinness, Kelly Byrne, Matthew T.V. Chan, Giovanni Landoni, Sophie Wallace, Andrew Forbes, Paul Myles, Julian Smith, Donald Esmore, Henry Krum, A. Tonkin, B. Buxton, S. Heritier, A. Merry, D. Liew, J. McNeil, A. Forbes, D.J. Cooper, S. Wallace, A. Meehan, P. Myles, W. Galagher, C. Farrington, A. Ditoro, L. Wutzlhofer, D. Story, P. Peyton, S. Baulch, S. Sidiropoulos, D. Potgieter, R.A. Baker, B. Pesudovs, E. O'Loughlin J Wells, P. Coutts, S. Bolsin, C. Osborne, K. Ives, J. Smith, A. Hulley, G. Christie-Taylor, T. Painter, S. Lang, H. Mackay, C. Cokis, S. March, P.G. Bannon, C. Wong, L. Turner, D. Scott, B. Silbert, S. Said, P. Corcoran, L. de Prinse, J.S. Bussières, N. Gagné, A. Lamy, L. Semelhago, M.T.V. Chan, M. Underwood, G.S.Y. Choi, B. Fung, G. Landoni, R. Lembo, F. Monaco, F. Simeone, D. Marianello, G. Alvaro, G. De Vuono, D. van Dijk, J. Dieleman, S. Numan, S. McGuinness, R. Parke, P. Raudkivi, E. Gilder, K. Byrne, J. Dunning, J. Termaat, G. Mans, M. Jayarajah, J. Alderton, D. Waugh, M.J. Platt, A. Pai, A. Sevillano, A. Lal, C. Sinclair, G. Kunst, A. Knighton, G.M. Cubas, P. Saravanan, R. Millner, V. Vasudevan, M. Patteril, E. Lopez, R. Basu, J. Lu, Myles, P, Smith, Ja, Kasza, J, Silbert, B, Jayarajah, M, Painter, T, Cooper, Dj, Marasco, S, Mcneil, J, Bussières, J, Mcguinness, S, Byrne, K, Chan, Mtv, Landoni, G, Wallace, S, Forbes, A, and ATACAS investigators and the ANZCA Clinical Trials, Network
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Antifibrinolytic ,medicine.drug_class ,Myocardial Infarction ,disability-free survival ,Hemorrhage ,Coronary Artery Disease ,anesthesia ,030204 cardiovascular system & hematology ,antiplatelet ,Coronary artery disease ,Disability Evaluation ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Fibrinolytic Agents ,Coronary thrombosis ,Risk Factors ,Activities of Daily Living ,medicine ,Humans ,Myocardial infarction ,Coronary Artery Bypass ,antifibrinolytic ,Stroke ,Aged ,Aspirin ,business.industry ,Coronary Thrombosis ,Middle Aged ,medicine.disease ,Antifibrinolytic Agents ,Progression-Free Survival ,Cardiac surgery ,Tranexamic Acid ,030228 respiratory system ,major adverse cardiac event ,Anesthesia ,outcome ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Tranexamic acid ,medicine.drug - Abstract
Background Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes. Methods Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery. Results The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053). Conclusions In this trial of patients having coronary artery surgery, tranexamic acid did not affect death or severe disability through to 1 year after surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.
- Published
- 2019
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