Fibrinolysis and the Influence of Tranexamic Acid Dosing in Cardiac Surgery.

Abstract Objective Whether underlying disease, performed surgery and dose of tranexamic acid influence fibrinolysis measured by D-dimers. Design Retrospective analysis. Setting Single-institutional at the Department of Cardiovascular Surgery at the Dusseldorf University Hospital. Participants 3152 adult patients undergoing elective cardiac surgery between February 2013 and October 2016. Interventions Two doses of tranexamic acid during surgery were applied. Measurements and Main Results D-dimer levels were analyzed at the start of surgery and before protamine. D-dimers at start were compared according to disease. Intraoperative D-dimer development was analyzed according to the type of surgery as well as within two cohorts with different tranexamic acid doses. Interindividual variability was pronounced for D-dimer levels at the start of surgery, with significant differences between patients with coronary artery disease, valve disease, aortic disease, and patients receiving heart transplants, compared to patients receiving an LVAD (p Conclusions D-dimer testing allows for the assessment of individual fibrinolytic activity in cardiac surgery, which is influenced by disease-type and surgery-type and dose of tranexamic acid. The assessment of the fibrinolytic status may have the potential of facilitating dose adjusted antifibrinolytic therapy in the future.