Goal-directed vs. Empirical Tranexamic Acid Administrationin Cardiovascular Surgery

This study compares two ways of using tranexamic acid (TXA) — a medication that reduces bleeding — during cardiovascular surgery requiring cardiopulmonary bypass. The first approach is empirical (giving a standard dose based on body weight to everyone), and the second is goal-directed (using real-time blood clotting tests to personalize the dose for each individual patient). Excessive bleeding during heart surgery remains a major cause of complications and blood transfusions, and tailoring TXA dosing may improve both safety and effectiveness. Adults aged 19 and over scheduled for elective cardiovascular surgery using a heart-lung bypass machine, who provide written consent, are eligible. Those who are pregnant, refuse blood transfusions, have a history of blood clots or coagulation disorders, recent heart attack or stroke, allergy to TXA, or are on dialysis are excluded. Blood loss is a major challenge in cardiac surgery — it contributes to complications including organ failure, prolonged ICU stays, and the need for blood transfusions, which carry their own risks. Personalized dosing of antifibrinolytic drugs like TXA has the potential to optimize bleeding control while minimizing side effects like clot formation. This study aims to determine whether tailoring the dose in real time — guided by point-of-care testing — produces better outcomes than the standard one-size-fits-all approach.