DEPOSITION
Trial question
What is the role of topical tranexamic acid in patients undergoing cardiac surgery?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
22.0% female
78.0% male
N = 3242
3242 patients (713 female, 2529 male).
Inclusion criteria: adult patients undergoing cardiac surgery with cardiopulmonary bypass.
Key exclusion criteria: allergy to tranexamic acid; minimally invasive surgery; emergency surgery; bleeding disorder; infective endocarditis; previous cardiac surgery; eGFR < 30 mL/min.
Interventions
N=1624 topical tranexamic acid (at a dose of 5-10 g).
N=1618 IV tranexamic acid (at a dose of 1-10 g).
Primary outcome
Rate of in-hospital seizures
0.2%
0.7%
0.7 %
0.5 %
0.3 %
0.2 %
0.0 %
Topical tranexamic
acid
IV tranexamic
acid
No significant
difference ↔
No significant difference in rate of in-hospital seizures (0.2% vs. 0.7%; ARD -0.5, 95% CI -0.9 to 0.03).
Secondary outcomes
Significant increase in RBC transfusion (35.1% vs. 26.8%; AD 8.3%, 95% CI 5.2 to 11.5).
Significant increase in transfusion of any blood product (46.6% vs. 36%; AD 10.6%, 95% CI 7.2 to 13.9).
No significant difference in major CV events (2.5% vs. 1.9%; AD 0.6%, 95% CI -0.5 to 1.6).
Conclusion
In adult patients undergoing cardiac surgery with cardiopulmonary bypass, topical tranexamic acid was not superior to IV tranexamic acid with respect to the rate of in-hospital seizures.
Reference
André Lamy, Dmitry A Sirota, Frederic Jacques et al. Topical Versus Intravenous Tranexamic Acid in Patients Undergoing Cardiac Surgery: The DEPOSITION Randomized Controlled Trial. Circulation. 2024 Oct 22;150(17):1315-1323.
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