الفهرس 
ANATOMY OF THE THORAXOnly 14 pages are availabe for public view
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Abstract
SUMMARY
O
ne of the major cardiac surgery problems is post-operative bleeding which may lead to blood transfusion. Blood loss is due to many causes one of them is fibrinolysis. Many antifibrinolytic drugs have been used to decrease the post-operative bleeding for cardiac surgery including ε-aminocaproic acid, aprotinin and tranexamic acid. Tranexamic acids are synthetic derivatives of the amino acid lysine. It binds with the lysine on binding site of plasminogen and plasmin due to that the plasminogen dislodge from the surface of the fibrin so demoralizing the fibrinolysis process.
Moreover, both the route and quantity for administration of tranexamic acid has varied across cardiac surgery studies. Tranexamic acid can be administered orally, topically and intravenously. Topical and intravenous administration are most common in perioperative cardiac surgeries. Intravenous or systemic tranexamic acid carries high risk of thromboembolic complications and also may result in an early graft closure in CABG.
Topical application of tranexamic acid during sternal closure was found to have low systemic absorption and can prevent further incidence of these complications, and several studies shows the benefit of its use topically in significance reduction of postoperative bleeding.
The Aim was to study the effect of application of topical tranexamic acid in reducing the postoperative bleeding in patients undergoing cardiac surgery by median sternotomy.
In our Randomized Controlled Clinical Trial we studied the effect of application of topical TXA in reducing the postoperative mediastinal bleeding in cardiac surgery.
A 50 subjects were programmed for elective open cardiac surgery, enrolled by computer program and divided randomly in two group, group A (n=25) received TXA 2g in 100ml NSS in the pericardial cavity and mediastinum before the sternal closure While group B (n=25) 100ml of NSS alone.
The result of the study revealed statistically significant difference between TXA group and the placebo group regarding the postoperative blood loss and the need for packed RBC transfusion. This means the topical application of TXA decreased the postoperative bleeding, blood transfusion and the need for reopration, but there was no statistically significant difference in plasma and platelet transfusions between the two groups.
The study also showed that there was statistically significant difference between both groups regarding to ICU and hospital stay length which were longer in the placebo group.
The results of our study indicated that the use of topical TXA have a significant effect on the reduction of bleeding after Cardiac Surgery, also was able to decrease the blood transfusions. Moreover, show better results in reducing the return to the operating room due to bleeding.