Comparison Between Intravenous Boluses Versus Infusion of Tranexamic Acid (TXA) To Reduce Bleeding In Paediatric Cyanotic Congenital Heart Disease (CHD) Surgeries

Junejo, Faisal; Akhtar, Murtaza; Hamid, Mohammad; Ahmed, Syed Ijlal; Minai, Fauzia; Amanullah, Muneer

doi:10.29271/jcpsp.2018.03.180

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…The initial literature search resulted in 1,008 studies, of which 221 were used for full-text review. Sixty-eight articles, with a total of 28,735 patients, met inclusion criteria and were used in the analysis (3, 6, 7, 18–82). The PRISMA diagram describing the screening of studies is presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Prophylactic Use of Antifibrinolytics During Pediatric Cardiac Surgery With Cardiopulmonary Bypass on Postoperative Bleeding and Transfusion: A Systematic Review and Meta-Analysis

Schertz

Karam

Demetres

et al. 2022

Pediatric Critical Care Medicine

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Section: Resultsmentioning

confidence: 99%

Prophylactic Use of Antifibrinolytics During Pediatric Cardiac Surgery With Cardiopulmonary Bypass on Postoperative Bleeding and Transfusion: A Systematic Review and Meta-Analysis

Schertz

Karam

Demetres

et al. 2022

Pediatric Critical Care Medicine

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“…Some studies had >1 intervention group; hence, the total number of included studies was n = 26 (Table). 16,30-54 Three studies compared 2 different antifibrinolytic drugs or different dosing regimens without a control group and were only included for the analysis of safety outcomes (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Antifibrinolytic Drugs for the Prevention of Bleeding in Pediatric Cardiac Surgery on Cardiopulmonary Bypass: A Systematic Review and Meta-analysis

Siemens

Sangaran

Hunt

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Bleeding is one of the commonest complications affecting children undergoing cardiac surgery on cardiopulmonary bypass. Antifibrinolytic drugs are part of a multifaceted approach aimed at reducing bleeding, though sufficiently sized pediatric studies are sparse, and dosing algorithms are heterogeneous. Our objective was to evaluate the efficacy and safety of antifibrinolytic agents as well as the effectiveness of different dosing regimens in pediatric cardiac surgery using cardiopulmonary bypass. METHODS: We performed a systematic review and meta-analysis evaluating randomized controlled trials published between 1980 and 2019, identified by searching the databases MEDLINE, EMBASE, PubMed, and CENTRAL. All studies investigating patients <18 years of age without underlying hematological disorders were included. The primary outcome was postoperative bleeding; secondary end points included blood product transfusion, mortality, and safety (thromboses, anaphylaxis, renal or neurological dysfunction, and seizures). Different dosing regimens were compared. Studies were dual appraised, outcomes were reported descriptively and, if appropriate, quantitatively using the Review Manager 5 (REVMAN 5) software (The Cochrane Collaboration). RESULTS: Thirty of 209 articles were included, evaluating the following drugs versus control: aprotinin n = 14, tranexamic acid (TXA) n = 12, and epsilon-aminocaproic acid (EACA) n = 4. The number of participants per intervention group ranged from 11 to 100 (median, 25; interquartile range [IQR], 20.5) with a wide age span (mean, 13 days to 5.8 years) and weight range (mean, 3.1–26.3 kg). Methodological quality was low to moderate. All agents reduced mean 24-hour blood loss compared to control: aprotinin by 6.0 mL/kg (95% confidence interval [CI], −9.1 to −3.0; P = .0001), TXA by 9.0 mL/kg (95% CI, −11.3 to −6.8; P < .00001), and EACA by 10.5 mL/kg (95% CI, −21.1 to 0.0; P = .05). Heterogeneity was low for TXA (I2 = 29%; P = .19), moderate for aprotinin (I2 = 41%; P = .11), and high for EACA (I2 = 95%; P < .00001). All agents also reduced 24-hour blood product transfusion. There was no clear dose-response effect for TXA nor aprotinin. Studies were underpowered to detect significant differences in mortality, thromboses, anaphylaxis, and renal or neurological dysfunction. CONCLUSIONS: The available data demonstrate efficacy for all 3 antifibrinolytic drugs. Therefore, the agent with the most favorable safety profile should be used. As sufficient data are lacking, large comparative trials are warranted to assess the relative safety and appropriate dosing regimens in pediatrics.

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“…The incidence of coronary heart disease is increasing year by year worldwide. For patients with myocardial infarction, timely myocardial reperfusion therapy has become the main strategy for myocardial salvage [1] . However, reperfusion can further exacerbate myocardial ischemia/reperfusion (I/R) injury, which can cause reperfusion arrhythmia [2] .…”

Section: Introductionmentioning

confidence: 99%

“…For patients with myocardial infarction, timely myocardial reperfusion therapy has become the main strategy for myocardial salvage. [ 1 ] However, reperfusion can further exacerbate myocardial ischemia/reperfusion (I/R) injury, which can cause reperfusion arrhythmia. [ 2 ] Therefore, intensive research has focused on the pathophysiological mechanisms related to reperfusion arrhythmia and the development of potential therapeutic strategies.…”

Section: Introductionmentioning

confidence: 99%

Downregulation of cardiac PIASy inhibits Cx43 SUMOylation and ameliorates ventricular arrhythmias in a rat model of myocardial ischemia/reperfusion injury

Wang

Liu

et al. 2023

Chinese Medical Journal

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Background:Dysfunction of the gap junction channel protein connexin 43 (Cx43) contributes to myocardial ischemia/reperfusion (I/R)-induced ventricular arrhythmias. Cx43 can be regulated by small ubiquitin-like modifier (SUMO) modification. Protein inhibitor of activated STAT Y (PIASy) is an E3 SUMO ligase for its target proteins. However, whether Cx43 is a target protein of PIASy and whether Cx43 SUMOylation plays a role in I/R-induced arrhythmias are largely unknown.Methods:Male Sprague–Dawley rats were infected with PIASy short hairpin ribonucleic acid (shRNA) using recombinant adeno-associated virus subtype 9 (rAAV9). Two weeks later, the rats were subjected to 45 min of left coronary artery occlusion followed by 2 h reperfusion. Electrocardiogram was recorded to assess arrhythmias. Rat ventricular tissues were collected for molecular biological measurements.Results:Following 45 min of ischemia, QRS duration and QTc intervals statistically significantly increased, but these values decreased after transfecting PIASy shRNA. PIASy downregulation ameliorated ventricular arrhythmias induced by myocardial I/R, as evidenced by the decreased incidence of ventricular tachycardia and ventricular fibrillation, and reduced arrythmia score. In addition, myocardial I/R statistically significantly induced PIASy expression and Cx43 SUMOylation, accompanied by reduced Cx43 phosphorylation and plakophilin 2 (PKP2) expression. Moreover, PIASy downregulation remarkably reduced Cx43 SUMOylation, accompanied by increased Cx43 phosphorylation and PKP2 expression after I/R.Conclusion:PIASy downregulation inhibited Cx43 SUMOylation and increased PKP2 expression, thereby improving ventricular arrhythmias in ischemic/reperfused rats heart.

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Comparison Between Intravenous Boluses Versus Infusion of Tranexamic Acid (TXA) To Reduce Bleeding In Paediatric Cyanotic Congenital Heart Disease (CHD) Surgeries

Abstract: These infusion and bolus groups had comparable postoperative bleeding and chest closure time.

Cited by 3 publications

References 22 publications

Prophylactic Use of Antifibrinolytics During Pediatric Cardiac Surgery With Cardiopulmonary Bypass on Postoperative Bleeding and Transfusion: A Systematic Review and Meta-Analysis

Prophylactic Use of Antifibrinolytics During Pediatric Cardiac Surgery With Cardiopulmonary Bypass on Postoperative Bleeding and Transfusion: A Systematic Review and Meta-Analysis

Antifibrinolytic Drugs for the Prevention of Bleeding in Pediatric Cardiac Surgery on Cardiopulmonary Bypass: A Systematic Review and Meta-analysis

Downregulation of cardiac PIASy inhibits Cx43 SUMOylation and ameliorates ventricular arrhythmias in a rat model of myocardial ischemia/reperfusion injury

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