# Triple-dose bolus versus continuous infusion of tranexamic acid: impacts on clinical outcomes in isolated coronary artery bypass surgery

## TL;DR

This study compares two methods of administering tranexamic acid during heart surgery to see which is better at reducing postoperative bleeding.

## Contribution

The study evaluates the efficacy of triple-dose bolus versus continuous infusion of tranexamic acid in isolated CABG surgery.

## Key findings

- Triple-dose bolus TXA reduced postoperative bleeding at 6 hours compared to continuous infusion.
- No significant differences in transfusion requirements or mortality were observed between the groups.
- Three patients in the continuous infusion group required reoperation due to bleeding.

## Abstract

In cardiac surgery, intraoperative tranexamic acid (TXA) is commonly used and highly recommended approach for managing perioperative bleeding. Nevertheless, a standardized dose and administration protocol remains undefined. This study compares the efficacy of intraoperative triple-dose intravenous (IV) bolus TXA versus IV bolus followed by continuous IV infusion in preventing postoperative bleeding in patients undergoing isolated coronary artery bypass grafting (CABG).

The study included 93 patients who underwent elective isolated CABG between August 14, 2023, and October 14, 2024. Patients received either triple-dose IV bolus TXA (Group 1, n = 53) or IV bolus followed by continuous IV infusion (Group 2, n = 40) during surgery.

Postoperative bleeding was lower in Group 1 at all assessed time points (1 h: 116 vs. 146 mL; 6 h: 253 vs. 332 mL; 24 h: 589 vs. 713 mL). However, a statistically significant difference was found only at 6 h (p = 0.03), representing an approximately 24% relative reduction in bleeding volume compared with Group 2. No significant differences were observed in transfusion requirements (packed red blood cells p = 0.85; fresh frozen plasma p = 0.55). Three patients in Group 2 required reoperation due to bleeding (p = 0.07), and one late mortality occurred in Group 2 (p = 0.43).

This study suggests that triple-dose IV bolus TXA administration may be both an effective and safe strategy for preventing postoperative bleeding in isolated CABG surgery.

The study was registered at the Clinical Trial Registry (NCT05994989, August 8, 2023) on.

The online version contains supplementary material available at 10.1186/s13019-026-03877-5.