The effect of preoperative tranexamic acid on blood loss after cardiac operations in children

Abstract

Children undergoing cardiac operations in which cardiopulmonary bypass is used are at risk of significant postoperative blood loss. The acquired coagulopathy is complex but is thought to be due, in part, to excessive fibrinolysis. We examined the possibility of reducing postoperative blood loss in children by using the antifibrinolytic drug tranexamic acid. Using a prospective, randomized, double-blind study design, we administered a single dose of tranexamic acid (50 mg/kg intravenously) or saline placebo, before skin incision, in 88 children undergoing cardiac operations. Post-operative blood loss and fluid replacement were recorded for the next 24 hours. In addition, hemoglobin, platelet counts, and coagulation measures were recorded every 6 hours. When all patients were examined, there was no significant difference in postoperative blood loss between the treated and placebo groups (21.2 +/- 12 ml/kg per 24 hours, tranexamic acid, vs 27.2 +/- 20.3 mls/kg per 24 hours, placebo). However, when the children with cyanosis were analyzed separately, there was a highly significant difference in blood loss between the groups during the first 6 hours (11.2 +/- 3.7 ml/kg per 6 hours, tranexamic acid, vs 27.2 +/- 11.4 mls/kg per 6 hours, placebo; p < 0.002), as well as the overall 24 hour study period (23.7 +/- 7.5 mls/kg per 24 hours, tranexamic acid, vs 48.9 +/- 27.6 mls/kg per 24 hours, placebo; p < 0.02). Also significantly less blood and blood products were administered to the treated cyanosed group. Tranexamic acid produced a significant reduction in postoperative blood loss and blood product requirements in children with cyanosis undergoing heart operations. The drug had no effect in children without cyanosis or those requiring a second thoracotomy.

Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*

“…Of these 142 trials, 95 were apparently randomized, controlled studies. Nine studies were excluded because no clinical outcome other than blood loss was available, [7][8][9][10][11][12][13][14][15] eight studies were found not to be randomized after more thorough analysis, [16][17][18][19][20][21][22][23] five studies concerned cardiac surgery in child- ren, [24][25][26][27][28] and there was one double report. 29,36 66,75,[86][87][88][89][90][91][92][93][94][95][96][97][98][99] In addition, 12 studies compared treatment with the conventional dose of aprotinin with lower doses of aprotinin.…”

A Practical Tranexamic Acid Dosing Scheme Based on Population Pharmacokinetics in Children Undergoing Cardiac Surgery

“…4 The use of antifibrinolytic drugs is one of the strategies for reducing blood loss, and tranexamic acid (TA) is among the most commonly administered, especially because the conclusions of the Blood Conservation Using Antifibrinolytics in a Randomized Trial study raised concerns about aprotinin. 5 The efficacy of TA in pediatric cardiac surgery has been demonstrated in several trials [6][7][8][9][10][11] and analyses, 12,13 but the determination of its dosage regimen …”

Réduire les pertes sanguines et les besoins transfusionnels en chirurgie pédiatrique

“…54 Blood conservation strategies studied for open heart surgery are summarized in Table III. 28,29,[55][56][57][58][59][60][61][62][63] The population studied should be taken into account to interpret published results: age, complexity of surgery, cyanotic/acyanotic disease and reoperations. 1,61 When available, whole blood of less than 48 hr is helpful …”