einstein (São Paulo). 23/Oct/2025;23:eCE1982.
Hemostasis, myocardial protection, and advanced monitoring in cardiovascular anesthesia: evidence-based practical insights
DOI: 10.31744/einstein_journal/2025CE1982
RATIONAL USE OF TRANEXAMIC ACID
There is strong evidence supporting the use of tranexamic acid (TXA) to reduce bleeding and transfusion needs in cardiac surgery, even among patients receiving dual antiplatelet therapy.(,) The OPTIMAL trial (2022), involving over 3,000 patients, demonstrated that high- and low-dose regimens had comparable efficacy, although high-dose TXA was associated with a higher risk of postoperative seizures.()
In practice, we favor a low-dose regimen of 10-15mg/kg as a bolus, followed by a continuous infusion of 1mg/kg/h. Recent systematic reviews support this safety-first approach, specifically for patients at higher neurological risk.(,)
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Hemostasis, myocardial protection, and advanced monitoring in cardiovascular anesthesia: evidence-based practical insights
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