[Home ] [Archive]    
:: Main About journal Editorial Board Current Issue Archive Submit an article Site Map Contact ::
:: Volume 10, Issue 4 (12-2021) ::
Int J Med Invest 2021, 10(4): 1-13 Back to browse issues page
Tranexamic Acid Use In Cardiac Surgery: A Review On Indications, Dosage, And Complications
Sohrab Negargar *
Professor of Anesthesiology and critical care, cardiovascular Research centre of Tabriz university of Medical sciences, Tabriz, Iran
Abstract:   (1524 Views)
It has been demonstrated that cardiovascular diseases are one of the most common causes of death in humans; therefore, various prevention and treatment measures are being taken by the medical community in this regard. For a long time, various treatments have been recommended, including surgeries, but these methods may have a number of complications that the most important of which is bleeding after surgery. Therefore, preserving patient's blood during heart surgery is very important. Due to the high number of patients undergoing heart surgery and the high probability of using blood products, regardless of the costs to be paid, there is a wide range of known and unknown and at the same time unwanted complications and conditions that can be caused by blood transfusions. Therefore, researchers have conducted several studies to find ways to preserve the blood of patients undergoing heart surgery, including the use of drugs such as tranexamic acid (TXA). TXA is a synthetic analogue of the amino acid lysine and an anti-fibrinolytic compound that competitively inhibits plasminogen-to-plasmin activation. This compound non-competitively blocks plasmin at high concentrations, thus TXA prevents the dissolution and destruction of fibrin clots by plasmin. Extensive review of literature has shown that TXA has prevented bleeding in multiple trials without increasing the risk of thrombosis and has a wide range of clinical uses. Despite the role of tranexamic acid in reducing postoperative bleeding, however, the use of this drug will have several side effects. Due to the contradictory results of different literature related to the use of this drug in reducing bleeding and also reducing the need for blood transfusion in patients undergoing surgery, the present review study was conducted to investigate the literature on this subject.
Keywords: Tranexamic Acid, Cardiac Surgery, Antifibrinolytic Agents, Blood Conservation.
Full-Text [PDF 196 kb]   (354 Downloads)    
Type of Study: Review | Subject: General
1. 1.‎ Stoelting RK, Dierdorf SF. Anesthesia and co-existing disease. 2002.‎ ‎2.‎ Rosamond, W., Flegal, K., Furie, K., Go, A., Greenlund, K., Haase, N., Hailpern, S. M., ‎Ho, M., Howard, V., Kissela, B., Kittner, S., Lloyd-Jones, D., McDermott, M., Meigs, J., ‎Moy, C., Nichol, G., O'Donnell, C., Roger, V., Sorlie, P., Steinberger, J., … American ‎Heart Association Statistics Committee and Stroke Statistics Subcommittee (2008). ‎Heart disease and stroke statistics--2008 update: a report from the American Heart ‎Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, ‎‎117(4), e25–e146. https://doi.org/10.1161/CIRCULATIONAHA.107.187998‎ ‎3.‎ Shafiei Z, Babaee S, Nazari A. Relationship between Mood State and Quality of Life in ‎Patients Undergoing Coronary Artery Bypass Graft Surgery. IJN. 2013; 26 (83) :57-67. ‎URL: http://ijn.iums.ac.ir/article-1-1611-en.html ‎4.‎ Shafiei Z, Babaee S, Nazari A. Relationship between Mood State and Quality of Life in ‎Patients Undergoing Coronary Artery Bypass Graft Surgery. IJN. 2013; 26 (83) :57-67. ‎URL: http://ijn.iums.ac.ir/article-1-1611-en.html ‎5.‎ Mojahed A, Bazi M, Azadi Ahmadabadi C, Abbasi Mendi A, Shahraki N. Comparisons ‎of patients’ quality of life before and after coronary artery bypass graft surgery in Ali ‎Ibn Abi Talib Hospital in Zahedan in 2016. RJMS. 2018; 25 (3) :1-9. URL: ‎http://rjms.iums.ac.ir/article-1-4932-en.html ‎6.‎ Babaee G, Keshavarz M, Shayegan AH. Effect of a health education program on quality ‎of life in patients undergoing coronary artery bypass surgery. Acta Medica Iranica. ‎‎2007:69-75.‎ ‎7.‎ MontazerGhaem S, Asar O, Safaei N. Assessing patientś quality of life after open hart ‎surgery in Bandar Abbass, Iran. Hormozgan Med J 2012;15(4):254-9.‎ ‎8.‎ Newcomb AE, Dignan R, McElduff P, Pearse EJ, Bannon P. Bleeding after cardiac ‎surgery is associated with an increase in the total cost of the hospital stay. The Annals ‎of thoracic surgery. 2020 Apr 1; 109(4):1069-78. DOI: 10.1016/j.athoracsur.2019.11.019‎ ‎9.‎ Fassin W, Himpe D, Alexander JP, Borms S, Theunissen W, Muylaert P, Van ‎Cauwelaert P. Predictive value of coagulation testing in cardiopulmonary bypass ‎surgery. Acta Anaesthesiologica Belgica. 1991 Jan 1; 42(4):191-8.‎ ‎10.‎ Casati V, Guzzon D, Oppizzi M, Cossolini M, Torri G, Calori G, Alfieri O. Hemostatic ‎effects of aprotinin, tranexamic acid and ϵ-aminocaproic acid in primary cardiac ‎surgery. The Annals of thoracic surgery. 1999 Dec 1; 68(6):2252-6. DOI: ‎‎10.1016/s0003-4975(99)00866-8‎ ‎11.‎ Hekmat K, Zimmermann T, Kampe S, Kasper SM, Weber SM, Geissler HJ, Mehlhorn ‎U. Impact of tranexamic acid vs. aprotinin on blood loss and transfusion requirements ‎after cardiopulmonary bypass: a prospective, randomised, double-blind trial. Current ‎medical research and opinion. 2004 Jan 1;20(1):121-6. DOI: ‎‎10.1185/030079903125002658.‎ ‎12.‎ Casati V, Della Valle P, Benussi S, et al. Effects of tranexamic acid on postoperative ‎bleeding and related hematochemical variables in coronary surgery: Comparison ‎between on-pump and off-pump techniques. J Thorac Cardiovasc Surg. 2004;128(1):83-‎‎91. doi:10.1016/j.jtcvs.2003.10.034‎ ‎13.‎ Cai J, Ribkoff J, Olson S, et al. The many roles of tranexamic acid: An overview of the ‎clinical indications for TXA in medical and surgical patients. Eur J Haematol. ‎‎2020;104(2):79-87. doi:10.1111/ejh.13348‎ ‎14.‎ Herbertson M. Recombinant activated factor VII in cardiac surgery. Blood Coagul ‎Fibrinolysis. 2004;15 Suppl 1:S31-S32. doi:10.1097/00001721-200405001-00007‎ ‎15.‎ Karkouti K, Wijeysundera DN, Yau TM, et al. The independent association of massive ‎blood loss with mortality in cardiac surgery. Transfusion. 2004;44(10):1453-1462. ‎doi:10.1111/j.1537-2995.2004.04144.x‎ ‎16.‎ Karkouti K, Beattie WS, Dattilo KM, et al. A propensity score case-control comparison ‎of aprotinin and tranexamic acid in high-transfusion-risk cardiac surgery. Transfusion. ‎‎2006;46(3):327-338. doi:10.1111/j.1537-2995.2006.00724.x‎ ‎17.‎ Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, ‎Mohr FW, Serruys PW, Colombo A. Comparison of coronary bypass surgery with drug-‎eluting stenting for the treatment of left main and/or three-vessel disease: 3-year ‎follow-up of the SYNTAX trial. Eur Heart J. 2011 Sep;32(17):2125-34. doi: ‎‎10.1093/eurheartj/ehr213.‎ ‎18.‎ Flegel WA, Natanson C, Klein HG. Does prolonged storage of red blood cells cause ‎harm?. Br J Haematol. 2014;165(1):3-16. doi:10.1111/bjh.12747‎ ‎19.‎ Bennett-Guerrero E, Zhao Y, O'Brien SM, et al. Variation in use of blood transfusion in ‎coronary artery bypass graft surgery. JAMA. 2010;304(14):1568-1575. ‎doi:10.1001/jama.2010.1406‎ ‎20.‎ Fitzgerald DC, Simpson AN, Baker RA, et al. Determinants of hospital variability in ‎perioperative red blood cell transfusions during coronary artery bypass graft surgery ‎‎[published online ahead of print, 2020 May 13]. J Thorac Cardiovasc Surg. 2020;S0022-‎‎5223(20)31128-4. doi:10.1016/j.jtcvs.2020.04.141‎ ‎21.‎ Khuri SF, Wolfe JA, Josa M, Axford TC, Szymanski I, Assousa S, Ragno G, Patel M, ‎Silverman A, Park M, Valeri CR. Hematologic changes during and after ‎cardiopulmonary bypass and their relationship to the bleeding time and nonsurgical ‎blood loss. The journal of Thoracic and cardiovascular surgery. 1992 Jul 1;104(1):94-‎‎107.‎ ‎22.‎ Cramer EM, Lu H, Caen JP, Soria C, Berndt MC, Tenza D. Differential redistribution of ‎platelet glycoproteins Ib and IIb-IIIa after plasmin stimulation [published erratum ‎appears in Blood 1991 Jul 15; 78 (2): 545].‎ ‎23.‎ Fullerton D, Grover F. Surgery of the chest. 6 th Ed. Toronto. Saunders Company. 1996; ‎pp: 1884-1897.‎ ‎24.‎ Branchereau A. Glenn's Thoracic and Cardiovascular Surgery. 6th Edn.‎ ‎25.‎ Henry DA, Carless PA, Moxey AJ, et al. Anti-fibrinolytic use for minimising ‎perioperative allogeneic blood transfusion. The Cochrane Database of Systematic ‎Reviews. 2011 Jan(1):CD001886. DOI: 10.1002/14651858.cd001886.‎ ‎26.‎ Ortmann E, Besser MW, Klein AA. Antifibrinolytic agents in current anaesthetic ‎practice. British journal of anaesthesia. 2013 Oct 1;111(4):549-63. ‎https://doi.org/10.1093/bja/aet154‎ ‎27.‎ Santos AT, Kalil RA, Bauemann C, Pereira JB, Nesralla IA. A randomized, double-‎blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic ‎activity after primary coronary artery bypass grafting. Brazilian journal of medical and ‎biological research. 2006 Jan;39(1):63-9.‎ ‎28.‎ Kohno K, Kimura S, Kashima T, Kume M, Hirata I, Amano H, Iwasa S, Meguro T, ‎Fukaya T. Hemostatic effect of tranexamic acid (transamin) during coronary artery ‎bypass grafting. Journal of Artificial Organs. 2001 Sep;4(3):241-4.‎ ‎29.‎ Brown JR, Birkmeyer NJ, O’Connor GT. Meta-analysis comparing the effectiveness and ‎adverse outcomes of antifibrinolytic agents in cardiac surgery. Circulation. 2007 Jun ‎‎5;115(22):2801-13.‎ ‎30.‎ Andreasen JJ, Nielsen C. Prophylactic tranexamic acid in elective, primary coronary ‎artery bypass surgery using cardiopulmonary bypass. Eur J Cardiothorac Surg. ‎‎2004;26(2):311-317. doi:10.1016/j.ejcts.2004.03.012‎ ‎31.‎ Ghavidel AA, Jalilifar N, Sharifi M, Ghasemzadeh B, Alinejad Z, Ghafarinejad MH, ‎Khamushi A, Bakhshande H, Hosseini S, Farsad F, Yousefnia MA. Role of Epsilon ‎Aminocaproic acid & Tranexamic Acid, vs Placebo in Reduction of mediastinal ‎Bleeding following Open Heart Surgery.‎ ‎32.‎ Myles PS, Smith JA, Forbes A, et al. Tranexamic Acid in Patients Undergoing ‎Coronary-Artery Surgery [published correction appears in N Engl J Med. 2018 Feb ‎‎22;378(8):782]. N Engl J Med. 2017;376(2):136-148. doi:10.1056/NEJMoa1606424‎ ‎33.‎ Yao YT, He LX, Tan JC. The effect of tranexamic acid on the values of activated ‎clotting time in patients undergoing cardiac surgery: A PRISMA-compliant systematic ‎review and meta-analysis. J Clin Anesth. 2020;67:110020. ‎doi:10.1016/j.jclinane.2020.110020‎ ‎34.‎ Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomised controlled trial ‎and economic evaluation of the effects of tranexamic acid on death, vascular occlusive ‎events and transfusion requirement in bleeding trauma patients. Health Technol Assess. ‎‎2013;17(10):1-79. doi:10.3310/hta17100‎ ‎35.‎ Callender ST, Warner GT, Cope E. Treatment of menorrhagia with tranexamic acid. A ‎double-blind trial. Br Med J. 1970;4(5729):214-216. doi:10.1136/bmj.4.5729.214‎ ‎36.‎ Ozier Y, Schlumberger S. Pharmacological approaches to reducing blood loss and ‎transfusions in the surgical patient. Can J Anaesth. 2006;53(6 Suppl):S21-S29. ‎doi:10.1007/BF03022249‎ ‎37.‎ Shakur H, Beaumont D, Pavord S, Gayet-Ageron A, Ker K, Mousa HA. Antifibrinolytic ‎drugs for treating primary postpartum haemorrhage. Cochrane Database Syst Rev. ‎‎2018;2(2):CD012964. Published 2018 Feb 20. doi:10.1002/14651858.CD012964‎ ‎38.‎ Sentilhes L, Winer N, Azria E, et al. Tranexamic Acid for the Prevention of Blood Loss ‎after Vaginal Delivery. N Engl J Med. 2018;379(8):731-742. ‎doi:10.1056/NEJMoa1800942‎ ‎39.‎ McCormack PL. Tranexamic acid: a review of its use in the treatment of ‎hyperfibrinolysis. Drugs. 2012;72(5):585-617. doi:10.2165/11209070-000000000-00000‎ ‎40.‎ Khuri SF, Valeri CR, Loscalzo J, et al. Heparin causes platelet dysfunction and induces ‎fibrinolysis before cardiopulmonary bypass. Ann Thorac Surg. 1995;60(4):1008-1014. ‎doi:10.1016/0003-4975(95)00668-b ‎41.‎ Ng W, Jerath A, Wąsowicz M. Tranexamic acid: a clinical review. Anaesthesiol ‎Intensive Ther. 2015;47(4):339-350. doi:10.5603/AIT.a2015.0011‎ ‎42.‎ Soslau G, Horrow J, Brodsky I. Effect of tranexamic acid on platelet ADP during ‎extracorporeal circulation. American journal of hematology. 1991 Oct;38(2):113-9.‎ ‎43.‎ Jimenez JJ, Iribarren JL, Lorente L, et al. Tranexamic acid attenuates inflammatory ‎response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case ‎control study followed by a randomized double-blind controlled trial. Crit Care. ‎‎2007;11(6):R117. doi:10.1186/cc6173‎ ‎44.‎ Schöchl H, Frietsch T, Pavelka M, Jámbor C. Hyperfibrinolysis after major trauma: ‎differential diagnosis of lysis patterns and prognostic value of thrombelastometry. J ‎Trauma. 2009;67(1):125-131. doi:10.1097/TA.0b013e31818b2483‎ ‎45.‎ Ozal E, Kuralay E, Bingöl H, Cingöz F, Ceylan S, Tatar H. Does tranexamic acid reduce ‎desmopressin-induced hyperfibrinolysis?. J Thorac Cardiovasc Surg. 2002;123(3):539-‎‎543. doi:10.1067/mtc.2002.117281‎ ‎46.‎ Freeman EW, Lukes A, VanDrie D, Mabey RG, Gersten J, Adomako TL. A dose-‎response study of a novel, oral tranexamic formulation for heavy menstrual bleeding. ‎Am J Obstet Gynecol. 2011;205(4):319.e1-319.e3197. doi:10.1016/j.ajog.2011.05.015‎ ‎47.‎ Mangano DT, Tudor IC, Dietzel C; Multicenter Study of Perioperative Ischemia ‎Research Group; Ischemia Research and Education Foundation. The risk associated with ‎aprotinin in cardiac surgery. N Engl J Med. 2006;354(4):353-365. ‎doi:10.1056/NEJMoa051379‎ ‎48.‎ Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical ‎bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054. ‎Published 2012 May 17. doi:10.1136/bmj.e3054‎ ‎49.‎ Giordano R, Palma G, Poli V, et al. Tranexamic acid therapy in pediatric cardiac ‎surgery: a single-center study. Ann Thorac Surg. 2012;94(4):1302-1306. ‎doi:10.1016/j.athoracsur.2012.04.078‎ ‎50.‎ Giordano R, Palma G, Poli V, et al. Tranexamic acid therapy in pediatric cardiac ‎surgery: a single-center study. Ann Thorac Surg. 2012;94(4):1302-1306. ‎doi:10.1016/j.athoracsur.2012.04.078‎ ‎51.‎ Basta MN, Stricker PA, Taylor JA. A systematic review of the use of antifibrinolytic ‎agents in pediatric surgery and implications for craniofacial use. Pediatr Surg Int. ‎‎2012;28(11):1059-1069. doi:10.1007/s00383-012-3167-6‎ ‎52.‎ Kagoma YK, Crowther MA, Douketis J, Bhandari M, Eikelboom J, Lim W. Use of ‎antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: ‎a systematic review of randomized trials. Thromb Res. 2009;123(5):687-696. ‎doi:10.1016/j.thromres.2008.09.015‎ ‎53.‎ Poeran J, Rasul R, Suzuki S, et al. Tranexamic acid use and postoperative outcomes in ‎patients undergoing total hip or knee arthroplasty in the United States: retrospective ‎analysis of effectiveness and safety. BMJ. 2014;349:g4829. Published 2014 Aug 12. ‎doi:10.1136/bmj.g4829‎ ‎54.‎ Zhang Y, Fu X, Liu WX, Li YM, Ma XL, Li ZJ. Safety and efficacy of intra-articular ‎injection of tranexamic acid in total knee arthroplasty. Orthopedics. 2014;37(9):e775-‎e782. doi:10.3928/01477447-20140825-53‎ ‎55.‎ CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on ‎death, vascular occlusive events, and blood transfusion in trauma patients with ‎significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. ‎‎2010;376(9734):23-32. doi:10.1016/S0140-6736(10)60835-5‎ ‎56.‎ CRASH-2 collaborators, Roberts I, Shakur H, et al. The importance of early treatment ‎with tranexamic acid in bleeding trauma patients: an exploratory analysis of the ‎CRASH-2 randomised controlled trial. Lancet. 2011;377(9771):1096-1101.e11012. ‎doi:10.1016/S0140-6736(11)60278-X ‎57.‎ Armellin G, Vinciguerra A, Bonato R, Pittarello D, Giron GP. Tranexamic acid in ‎primary CABG surgery: high vs low dose. Minerva Anestesiol. 2004;70(3):97-107. ‎ ‎58.‎ Lukes AS, Moore KA, Muse KN, et al. Tranexamic acid treatment for heavy menstrual ‎bleeding: a randomized controlled trial. Obstet Gynecol. 2010;116(4):865-875. ‎doi:10.1097/AOG.0b013e3181f20177‎ ‎59.‎ Weeks A. The prevention and treatment of postpartum haemorrhage: what do we know, ‎and where do we go to next?. BJOG. 2015;122(2):202-210. doi:10.1111/1471-‎‎0528.13098‎ ‎60.‎ Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum ‎haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. ‎‎2008;22(6):999-1012. doi:10.1016/j.bpobgyn.2008.08.004‎ ‎61.‎ Perel P, Ker K, Morales Uribe CH, Roberts I. Tranexamic acid for reducing mortality in ‎emergency and ‎62.‎ urgent surgery. Cochrane Database of Systematic Reviews 2012 , Issue 11 . Art. No.: ‎CD010245. DOI:10.1002/14651858.CD010245 .‎ ‎63.‎ Chornenki NLJ, Um KJ, Mendoza PA, et al. Risk of venous and arterial thrombosis in ‎non-surgical patients receiving systemic tranexamic acid: A systematic review and ‎meta-analysis. Thromb Res. 2019;179:81-86. doi:10.1016/j.thromres.2019.05.003‎ ‎64.‎ Goobie SM, Meier PM, Sethna NF, et al. Population pharmacokinetics of tranexamic ‎acid in paediatric patients undergoing craniosynostosis surgery. Clin Pharmacokinet. ‎‎2013;52(4):267-276. doi:10.1007/s40262-013-0033-1‎ ‎65.‎ Yee BE, Wissler RN, Zanghi CN, Feng C, Eaton MP. The effective concentration of ‎tranexamic acid for inhibition of fibrinolysis in neonatal plasma in vitro. Anesth Analg. ‎‎2013;117(4):767-772. doi:10.1213/ANE.0b013e3182a22258‎ ‎66.‎ Panteli M, Papakostidis C, Dahabreh Z, Giannoudis PV. Topical tranexamic acid in total ‎knee replacement: a systematic review and meta-analysis. Knee. 2013;20(5):300-309. ‎doi:10.1016/j.knee.2013.05.014‎ ‎67.‎ Kaabachi O, Eddhif M, Rais K, Zaabar MA. Inadvertent intrathecal injection of ‎tranexamic acid. Saudi J Anaesth. 2011;5(1):90-92. doi:10.4103/1658-354X.76504‎ ‎68.‎ Manji RA, Grocott HP, Leake J, et al. Seizures following cardiac surgery: the impact of ‎tranexamic acid and other risk factors. Can J Anaesth. 2012;59(1):6-13. ‎doi:10.1007/s12630-011-9618-z ‎69.‎ Sharma V, Katznelson R, Jerath A, et al. The association between tranexamic acid and ‎convulsive seizures after cardiac surgery: a multivariate analysis in 11 529 patients. ‎Anaesthesia. 2014;69(2):124-130. doi:10.1111/anae.12516‎ ‎70.‎ Fiechtner BK, Nuttall GA, Johnson ME, et al. Plasma tranexamic acid concentrations ‎during cardiopulmonary bypass. Anesth Analg. 2001;92(5):1131-1136. ‎doi:10.1097/00000539-200105000-00010‎ ‎71.‎ Dowd NP, Karski JM, Cheng DC, et al. Pharmacokinetics of tranexamic acid during ‎cardiopulmonary bypass. Anesthesiology. 2002;97(2):390-399. doi:10.1097/00000542-‎‎200208000-00016‎ ‎72.‎ Negargar S, Naghipour B, Anvari S, Enamzadeh E, Shiriza-Deh M. EFFECTS OF PRE ‎AND POST-PUMP TRANEXAMIC ACID ON BLEEDING AFTER CORONARY ‎ARTERY BYPASS GRAFT SURGERY. ACTA MEDICA MEDITERRANEA. 2016 Jan ‎‎1;32:1231-5.‎ ‎73.‎ Gerstein NS, Deriy L, Patel PA. Tranexamic Acid Use in Cardiac Surgery: Hemostasis, ‎Seizures, or a Little of Both. J Cardiothorac Vasc Anesth. 2018;32(4):1635-1637. ‎doi:10.1053/j.jvca.2017.12.001‎ ‎74.‎ Besser V, Albert A, Sixt SU, et al. Fibrinolysis and the Influence of Tranexamic Acid ‎Dosing in Cardiac Surgery. J Cardiothorac Vasc Anesth. 2020;34(10):2664-2673. ‎doi:10.1053/j.jvca.2020.03.040‎ ‎75.‎ Beverly A, Ong G, Wilkinson KL, Doree C, Welton NJ, Estcourt LJ. Drugs to reduce ‎bleeding and transfusion in adults undergoing cardiac surgery: a systematic review and ‎network meta‐analysis. The Cochrane Database of Systematic Reviews. 2019 ‎Sep;2019(9). doi: 10.1002/14651858.CD013649‎ ‎76.‎ Yang JM, Zhang C, Li CB, Huang GW, Yu DF. Tranexamic acid application in open ‎heart valve replacement surgery. Chin J Mod Ope Sur 2017;21(02):117–20.‎
Add your comments about this article
Your username or Email:


XML     Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Negargar S. Tranexamic Acid Use In Cardiac Surgery: A Review On Indications, Dosage, And Complications. Int J Med Invest 2021; 10 (4) :1-13
URL: http://intjmi.com/article-1-708-en.html

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Volume 10, Issue 4 (12-2021) Back to browse issues page
International Journal of Medical Investigation
Persian site map - English site map - Created in 0.04 seconds with 30 queries by YEKTAWEB 4570