Abstract
Objectives: In the endovascular treatment of aortic aneurysm, type 2 endoleaks remain an issue. We created a hypothesis that type 2 endoleaks are associated with postoperative blood coagulation abnormalities. Intravascular coagulation and fibrinolysis are accelerated by the rapid progression of coagulation in the postoperative state after aortic aneurysm. We treated the patient via the chronic administration of oral tranexamic acid and assessed the efficacy of tranexamic acid in the suppression of fibrinolysis and type 2 endoleaks. Methods: Eighty-nine patients were included (51 EVAR and 38 TEVAR). Forty-eight patients were treated with tranexamic acid (Group T), and 41 patients were treated as controls (Group N). Patients took 750 mg oral tranexamic acid thrice daily as soon as possible after their operations. Plasma fibrinogen and Fibrinogen Degenerative Products (FDP) were measured during the perioperative period (POD 1, 2, 3, 5, 7 and 9), and type 2 endoleaks were assessed by using computed tomography at one week and six months after the operation. Results: During the perioperative period, the plasma fibrinogen levels of group T were significantly higher than those of group N (559.5±172.7 vs. 444.2±151.9 mg/dl: p = 0.013). FDP levels in group T were significantly lower than those in group N (18.3±17.1 vs. 43.8±36.6 μg/ml: p = 0.004). One week after the operation, type 2 endoleaks were significantly less prevalent in group T than in group N (6.3 vs. 22.0%: p = 0.031), and the number of type 2 endoleak patients in group T was significantly reduced by postoperative month 6 (0.0 vs. 27.2%: p = 0.005). There were only two patients in group N who experienced Major Adverse Cardiovascular and Cerebrovascular Events (MACCE), which included one death and one unstable angina. Conclusions: This study showed that tranexamic acid may suppress the acceleration of fibrinolysis after endovascular treatment for aortic aneurysm and that this effect may contribute to the prevention and reduction of type 2 endoleaks.
