Routine Extended Use of Fibrinolysis Inhibitors During and After Cardiac Surgery A Multicenter Randomized Study to Reduce Bleeding and Blood Transfusions

What this Trial Is About

Researchers are evaluating whether routinely extending the use of fibrinolysis inhibitors during and after cardiac surgery can reduce the need for blood transfusions compared to using these inhibitors only during surgery. This study focuses on patients undergoing open heart surgery and addresses the current uncertainty about the optimal dosing and timing of fibrinolysis inhibitors. Previous research has shown that fibrinolytic activity remains elevated for hours after surgery, suggesting potential benefits from prolonged inhibitor use, but evidence so far is limited and inconclusive. The study compares two hospital policies: one where fibrinolysis inhibitors such as tranexamic acid or epsilon-aminocaproic acid are given only during surgery following routine practice, and another where about 70% of the routine dose is given during surgery, with the remaining 30% infused continuously over the first 4 hours after surgery. This extended administration is evaluated against no routine postoperative use to determine effects on bleeding and transfusion needs. Participants are monitored from hospital admission until discharge or death, with the main outcome being the need for red blood cell transfusions during this period. The study involves multiple centers and uses a cluster crossover design to compare hospital policies. Researchers will assess safety and effectiveness through clinical data collected during hospitalization. Total participation time corresponds to the hospital stay, with no additional long-term follow-up described.

Extended Perioperative Administration of Fibrinolysis Inhibitors After Cardiac Surgery