B54-32 Fewer Transfusions, Better Control: The Role of Tranexamic Acid in Cardiothoracic Surgical Bleeding

Abstract Rationale Tranexamic acid (TXA) is widely used to mitigate perioperative bleeding in cardiac surgery, yet its influence on broader postoperative outcomes remains uncertain. Although antifibrinolytic therapy effectively reduces blood loss and transfusion requirements, the clinical relevance regarding recovery and intensive care utilization has not been fully established. This study aimed to evaluate whether intraoperative TXA administration was associated with reduced transfusion needs and shorter intensive care unit (ICU) stay among patients undergoing major cardiothoracic procedures at a high-altitude tertiary center. Methods We conducted a retrospective cohort study including 196 adult patients who underwent major cardiothoracic surgery between 2022 and 2024. Demographic and clinical data were retrieved from electronic records. TXA use (binary variable) and intraoperative transfusion volume (mL) were analyzed as primary variables. The secondary outcome was prolonged ICU stay, defined as 10 days. Group comparisons were performed using Chi-square and Mann-Whitney U tests, with significance set at p 0.05. All procedures were performed under standardized anesthesia and hemostasis protocols. Results The median age was 65.2 years (SD ± 12.1), and 68.4% of patients were male. Intraoperative TXA was administered in 53.6% of cases. Patients receiving TXA exhibited a significantly lower median transfusion volume (1600 mL, IQR 900-2400) compared to those without TXA (1840 mL, IQR 1050-2600; p = 0.0419). However, no significant association was found between TXA administration and prolonged ICU stay (10 days; p = 0.5601). No differences were observed in baseline demographic or clinical characteristics between groups, indicating comparable surgical risk profiles. Conclusion Intraoperative administration of tranexamic acid significantly reduced transfusion requirements in patients undergoing major cardiothoracic surgery but did not translate into shorter ICU stays. These findings suggest that while TXA improves intraoperative hemostatic efficiency, its effect on recovery trajectories and intensive care outcomes appears limited. Further prospective studies are warranted to determine whether combining TXA with multimodal blood conservation strategies can yield measurable improvements in postoperative morbidity and resource utilization. References 1. Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, et al. Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. N Engl J Med. 2017;376(2):136-148. doi:10.1056/NEJMoa1606424. This abstract is funded by: None