Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial

ATACAS investigators and the ANZCA Clinical Trials Network

doi:10.1016/j.jtcvs.2018.09.113

Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial

ATACAS investigators and the ANZCA Clinical Trials Network

Cardiovascular Sciences

Research output: Contribution to journal › Article › peer-review

21 Citations (Scopus)

Abstract

BACKGROUND: Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes.

METHODS: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery.

RESULTS: The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053).

CONCLUSIONS: In this trial of patients having coronary artery surgery, tranexamic acid did not affect death or severe disability through to 1 year after surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.

Original language	English
Pages (from-to)	644-652.e9
Journal	The Journal of thoracic and cardiovascular surgery
Volume	157
Issue number	2
DOIs	https://doi.org/10.1016/j.jtcvs.2018.09.113
Publication status	Published - Feb 2019

Keywords

Activities of Daily Living
Aged
Antifibrinolytic Agents/administration & dosage
Aspirin/administration & dosage
Coronary Artery Bypass/adverse effects
Coronary Artery Disease/diagnostic imaging
Coronary Thrombosis/etiology
Disability Evaluation
Double-Blind Method
Female
Fibrinolytic Agents/administration & dosage
Hemorrhage/chemically induced
Humans
Male
Middle Aged
Myocardial Infarction/etiology
Progression-Free Survival
Risk Factors
Time Factors
Tranexamic Acid/administration & dosage

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jtcvs.2018.09.113

Cite this

@article{ace499929e174616a4de5202d6eba417,

title = "Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial",

abstract = "BACKGROUND: Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes.METHODS: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery.RESULTS: The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053).CONCLUSIONS: In this trial of patients having coronary artery surgery, tranexamic acid did not affect death or severe disability through to 1 year after surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.",

keywords = "Activities of Daily Living, Aged, Antifibrinolytic Agents/administration & dosage, Aspirin/administration & dosage, Coronary Artery Bypass/adverse effects, Coronary Artery Disease/diagnostic imaging, Coronary Thrombosis/etiology, Disability Evaluation, Double-Blind Method, Female, Fibrinolytic Agents/administration & dosage, Hemorrhage/chemically induced, Humans, Male, Middle Aged, Myocardial Infarction/etiology, Progression-Free Survival, Risk Factors, Time Factors, Tranexamic Acid/administration & dosage",

author = "{ATACAS investigators and the ANZCA Clinical Trials Network} and Myles, {Paul S} and Smith, {Julian A} and Jessica Kasza and Brendan Silbert and Mohandas Jayarajah and Thomas Painter and Cooper, {D James} and Silvana Marasco and John McNeil and Bussi{\`e}res, {Jean S} and Shay McGuinness and Kelly Byrne and Chan, {Matthew T V} and Giovanni Landoni and Sophie Wallace and Andrew Forbes and Gudrun Kunst",

year = "2019",

month = feb,

doi = "10.1016/j.jtcvs.2018.09.113",

language = "English",

volume = "157",

pages = "644--652.e9",

journal = "The Journal of thoracic and cardiovascular surgery",

issn = "1097-685X",

publisher = "Elsevier",

number = "2",

}

TY - JOUR

T1 - Tranexamic acid in coronary artery surgery

T2 - One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial

AU - ATACAS investigators and the ANZCA Clinical Trials Network

AU - Myles, Paul S

AU - Smith, Julian A

AU - Kasza, Jessica

AU - Silbert, Brendan

AU - Jayarajah, Mohandas

AU - Painter, Thomas

AU - Cooper, D James

AU - Marasco, Silvana

AU - McNeil, John

AU - Bussières, Jean S

AU - McGuinness, Shay

AU - Byrne, Kelly

AU - Chan, Matthew T V

AU - Landoni, Giovanni

AU - Wallace, Sophie

AU - Forbes, Andrew

AU - Kunst, Gudrun

PY - 2019/2

Y1 - 2019/2

N2 - BACKGROUND: Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes.METHODS: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery.RESULTS: The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053).CONCLUSIONS: In this trial of patients having coronary artery surgery, tranexamic acid did not affect death or severe disability through to 1 year after surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.

AB - BACKGROUND: Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes.METHODS: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery.RESULTS: The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053).CONCLUSIONS: In this trial of patients having coronary artery surgery, tranexamic acid did not affect death or severe disability through to 1 year after surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.

KW - Activities of Daily Living

KW - Aged

KW - Antifibrinolytic Agents/administration & dosage

KW - Aspirin/administration & dosage

KW - Coronary Artery Bypass/adverse effects

KW - Coronary Artery Disease/diagnostic imaging

KW - Coronary Thrombosis/etiology

KW - Disability Evaluation

KW - Double-Blind Method

KW - Female

KW - Fibrinolytic Agents/administration & dosage

KW - Hemorrhage/chemically induced

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/etiology

KW - Progression-Free Survival

KW - Risk Factors

KW - Time Factors

KW - Tranexamic Acid/administration & dosage

U2 - 10.1016/j.jtcvs.2018.09.113

DO - 10.1016/j.jtcvs.2018.09.113

M3 - Article

C2 - 30459103

SN - 1097-685X

VL - 157

SP - 644-652.e9

JO - The Journal of thoracic and cardiovascular surgery

JF - The Journal of thoracic and cardiovascular surgery

IS - 2

ER -