@article{3d5774a355eb4f66aff6c2f4d02c172e,
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 = "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} and Esmore, {Donald Steven} and Henry Krum and Andrew Tonkin and Buxton, {Brian F.} and Heritier, {Stephane R.} and Merry, {Alan F.} and Danny Liew and Meehan, {Aislin C.} and Wendy Galagher and Catherine Farrington and Alessandro Ditoro and Wutzlhofer, {Lisa M.} and Story, {David Andrew} and Peyton, {Philip John} and Sarah Baulch and Sofia Sidiropoulos and D. Potgieter and Baker, {Robert A.} and B. Pesudovs and {O'Loughlin J Wells}, E. and Pauline Coutts and Bolsin, {Stephen N.C.} and Cameron Osborne and K. Ives and A. Hulley and Christie-Taylor, {G. A.} and Lang, {Samuel J.} and H. Mackay and Cokis, {Chris J.} and S. March and Bannon, {Paul Gerard} and Wong, {Chee Siong} and Lisa Turner and Scott, {David A.} and Said, {Simone A.} and Corcoran, {Philip C.} and {de Prinse}, L. and Gagn{\'e}, {Nathalie L.} and Andre Lamy and Semelhago, {Lloyd C.} and M. Underwood and Choi, {G. S.Y.} and B. Fung and Rosalba Lembo and Fabrizio Monaco and Felicetta Simeone and Daniele Marianello and Gabriele Alvaro and {De Vuono}, Giovanni and {van Dijk}, Diederik and Dieleman, {Jan M.} and Numan, {Sandra C.} and Parke, {Rachael L.} and Raudkivi, {Peter J.} and Eileen Gilder and Dunning, {Joel D.} and Jonathan Termaat and Gay Mans and J. Alderton and Darren Waugh and Platt, {M. J.} and A. Pai and A. Sevillano and Lal, {Anil P.} and C. Sinclair and Gudrun Kunst and A. Knighton and Cubas, {G. M.} and Palanikumar Saravanan and R. Millner and V. Vasudevan and Patteril, {Mathew V.} and E. Lopez and R. Basu and J. Lu",
year = "2019",
month = feb,
doi = "10.1016/j.jtcvs.2018.09.113",
language = "English",
volume = "157",
pages = "644--652.e9",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Elsevier",
number = "2",
}