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Association between CK-MB Area Under the Curve and Tranexamic Acid Utilization in Patients Undergoing Coronary Artery Bypass Surgery.

Publication ,  Journal Article
van Diepen, S; Merrill, PD; Carrier, M; Tardif, J-C; Podgoreanu, M; Alexander, JH; Lopes, RD
Published in: J Thromb Thrombolysis
May 2017

Myonecrosis after coronary artery bypass graft (CABG) surgery is associated with excess mortality. Tranexamic acid (TA), an anti-fibrinolytic agent, has been shown to reduce peri-operative blood loss without increasing the risk of myocardial infarction (MI); however, no large study has examined the association between TA treatment and post-CABG myonecrosis. In the MC-1 to Eliminate Necrosis and Damage in Coronary Artery Bypass Graft Surgery II trial, inverse probability weighting of the propensity to receive TA was used to test for differences among the 656 patients receiving and 770 patients not receiving TA. The primary outcome was creatine kinase MB (CK-MB) area under the curve (AUC) through 24 h. The secondary outcome was 30-day cardiovascular death or MI. Patients who received TA were more frequently female, had a previous MI, heart failure, low molecular weight heparin therapy, on-pump CABG, valvular surgery, and saphenous vein or radial grafts. The median 24-h CK-MB AUC was higher in TA-treated patients [301.9 (IQR 196.7-495.6) vs 253.5 (153.4-432.5) ng h/mL, p < 0.001]. No differences in the 30-day incidence of cardiovascular death or MI were observed (8.7 vs 8.3%, adjusted OR 0.99; 95% CI 0.67-1.45, p = 0.948). In patients undergoing CABG, TA use was associated with a higher risk of myonecrosis; however, no differences were observed in death or MI. Future larger studies should be directed at examining the pathophysiology of TA myonecrosis, and its association with subsequent clinical outcomes.

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Published In

J Thromb Thrombolysis

DOI

EISSN

1573-742X

Publication Date

May 2017

Volume

43

Issue

4

Start / End Page

446 / 453

Location

Netherlands

Related Subject Headings

  • Tranexamic Acid
  • Necrosis
  • Myocardial Infarction
  • Muscles
  • Middle Aged
  • Male
  • Humans
  • Female
  • Death
  • Creatine Kinase, MB Form
 

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van Diepen, S., Merrill, P. D., Carrier, M., Tardif, J.-C., Podgoreanu, M., Alexander, J. H., & Lopes, R. D. (2017). Association between CK-MB Area Under the Curve and Tranexamic Acid Utilization in Patients Undergoing Coronary Artery Bypass Surgery. J Thromb Thrombolysis, 43(4), 446–453. https://doi.org/10.1007/s11239-017-1480-6
Diepen, Sean van, Peter D. Merrill, Michel Carrier, Jean-Claude Tardif, Mihai Podgoreanu, John H. Alexander, and Renato D. Lopes. “Association between CK-MB Area Under the Curve and Tranexamic Acid Utilization in Patients Undergoing Coronary Artery Bypass Surgery.J Thromb Thrombolysis 43, no. 4 (May 2017): 446–53. https://doi.org/10.1007/s11239-017-1480-6.
van Diepen S, Merrill PD, Carrier M, Tardif J-C, Podgoreanu M, Alexander JH, et al. Association between CK-MB Area Under the Curve and Tranexamic Acid Utilization in Patients Undergoing Coronary Artery Bypass Surgery. J Thromb Thrombolysis. 2017 May;43(4):446–53.
van Diepen, Sean, et al. “Association between CK-MB Area Under the Curve and Tranexamic Acid Utilization in Patients Undergoing Coronary Artery Bypass Surgery.J Thromb Thrombolysis, vol. 43, no. 4, May 2017, pp. 446–53. Pubmed, doi:10.1007/s11239-017-1480-6.
van Diepen S, Merrill PD, Carrier M, Tardif J-C, Podgoreanu M, Alexander JH, Lopes RD. Association between CK-MB Area Under the Curve and Tranexamic Acid Utilization in Patients Undergoing Coronary Artery Bypass Surgery. J Thromb Thrombolysis. 2017 May;43(4):446–453.
Journal cover image

Published In

J Thromb Thrombolysis

DOI

EISSN

1573-742X

Publication Date

May 2017

Volume

43

Issue

4

Start / End Page

446 / 453

Location

Netherlands

Related Subject Headings

  • Tranexamic Acid
  • Necrosis
  • Myocardial Infarction
  • Muscles
  • Middle Aged
  • Male
  • Humans
  • Female
  • Death
  • Creatine Kinase, MB Form