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

Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John McNeil, Jean S. Bussières, Shay McGuinness, Kelly Byrne, Matthew T.V. Chan, Giovanni Landoni, Sophie Wallace, Andrew Forbes, ATACAS investigators and the ANZCA Clinical Trials Network

Research output: Contribution to journalArticleResearchpeer-review

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 languageEnglish
Pages (from-to)644-652
Number of pages18
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number2
DOIs
Publication statusPublished - 1 Feb 2019

Keywords

  • anesthesia
  • antifibrinolytic
  • antiplatelet
  • disability-free survival
  • major adverse cardiac events
  • outcomes

Cite this

Myles, Paul S. ; Smith, Julian A. ; Kasza, Jessica ; Silbert, Brendan ; Jayarajah, Mohandas ; Painter, Thomas ; Cooper, D. James ; Marasco, Silvana ; McNeil, John ; Bussières, Jean S. ; McGuinness, Shay ; Byrne, Kelly ; Chan, Matthew T.V. ; Landoni, Giovanni ; Wallace, Sophie ; Forbes, Andrew ; ATACAS investigators and the ANZCA Clinical Trials Network. / Tranexamic acid in coronary artery surgery : One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial. In: Journal of Thoracic and Cardiovascular Surgery. 2019 ; Vol. 157, No. 2. pp. 644-652.
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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 = "anesthesia, antifibrinolytic, antiplatelet, disability-free survival, major adverse cardiac events, outcomes",
author = "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 {ATACAS investigators and the ANZCA Clinical Trials Network}",
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Tranexamic acid in coronary artery surgery : One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial. / Myles, Paul S.; Smith, Julian A.; Kasza, Jessica; Silbert, Brendan; Jayarajah, Mohandas; Painter, Thomas; Cooper, D. James; Marasco, Silvana; McNeil, John; Bussières, Jean S.; McGuinness, Shay; Byrne, Kelly; Chan, Matthew T.V.; Landoni, Giovanni; Wallace, Sophie; Forbes, Andrew; ATACAS investigators and the ANZCA Clinical Trials Network.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 157, No. 2, 01.02.2019, p. 644-652.

Research output: Contribution to journalArticleResearchpeer-review

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 - 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 - ATACAS investigators and the ANZCA Clinical Trials Network

PY - 2019/2/1

Y1 - 2019/2/1

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 - anesthesia

KW - antifibrinolytic

KW - antiplatelet

KW - disability-free survival

KW - major adverse cardiac events

KW - outcomes

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U2 - 10.1016/j.jtcvs.2018.09.113

DO - 10.1016/j.jtcvs.2018.09.113

M3 - Article

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SP - 644

EP - 652

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

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ER -