The effects of tranexamic acid in patients treated with extracorporeal membrane oxygenation after cardiac surgery

Background The lysine analog tranexamic acid (TXA) is used as a blood protective drug in cardiac surgery, but efficacy and safety outcomes in patients treated with extracorporeal membrane oxygenation (ECMO) after surgery remain poorly understood. Methods From January 1, 2017 to December 31, 2022, we retrospectively analyzed patients assisted by ECMO after cardiac surgery and divided them into TXA and control groups depending on whether TXA was used or not. The primary study outcome was red blood cell (RBC) transfusion during ECMO. Results In total, 321 patients treated with ECMO after cardiac surgery were assessed; 185 patients were eligible for inclusion into to the TXA-intervention group and 136 into to the control group. RBC transfusion during ECMO was 8.0 IU (4.0 IU–14.0 IU) in the TXA group versus 10.0 IU (6.0 IU–16.0 IU) in the control group ( p = .034). Median total chest drainage volume after surgery was 1460.0 mL (650.0–2910.0 mL) and 1680.0 mL (900.0–3340.0 mL) in TXA and control groups, respectively ( p = .021). Postoperative serum D-dimer levels were significantly lower in the TXA group when compared with the control group; 1.125 µg/mL (0.515–2.176 µg/mL) versus 3.000 µg/mL (1.269–5.862 µg/mL), p < .001. Serious adverse events, including vascular occlusive events, did not differ meaningfully between groups. Conclusions In patients treated with ECMO after cardiac surgery, TXA infusion modestly but significantly reduced RBC transfusions and chest tube output when compared with the control group.