Dose Comparison of Tranexamic Acid in Pediatric Cardiac Surgery

Abstract

To compare different doses of tranexamic acid, 150 consecutive children with congenital cyanotic heart disease were randomly assigned to one of 5 groups of 30 each. Group A served as a control. Group B received 50 mg.kg(-1) of tranexamic acid at induction of anesthesia. Group C received 10 mg.kg(-1) at induction followed by an infusion of 1 mg.kg(-1).h(-1). Group D had 10 mg.kg(-1) at induction, 10 mg.kg(-1) on bypass, and 10 mg.kg(-1) after protamine. Group E had 20 mg.kg(-1) at induction and again after protamine. The control group had the longest sternal closure time, the greatest blood loss in the first 24 hours, and the highest requirements for blood and blood products. Among the 4 groups given tranexamic acid, group D (triple dose) had the best results, followed by group E (double dose). Group B (single dose) had the worst results among the groups receiving tranexamic acid.

Intraoperative Tranexamic Acid Reduces Blood Transfusion in Children Undergoing Craniosynostosis Surgery

“…For pediatric cardiac surgery, Schouten et al 25 reported that TXA reduced PRBC transfusion by 7 ml/kg (95% CI, 10 -5 ml/kg) compared with the placebo group. These results are similar to those of others studies 18 for the same type of surgery. In young children, we report that TXA reduced the mean PRBC transfusion volume by 9.4 ml/kg during the study compared with a placebo group receiving saline.…”

“…They stated a nonsignificant trend of blood transfusion requirement decrease in the treated group compared with the placebo group during surgery and the postoperative period. 23 A few studies 13,16,17,20,23 have shown that intraoperative TXA administration led to less blood loss compared with a placebo group for different types of surgery. Nevertheless, some researchers 19,22 did not report a significant difference in blood loss using TXA or aprotinin, despite a significant decrease in total blood transfusion in the treated patients.…”

“…This dose of TXA was within the dose range previously found effective. [17][18][19][20]23 A continuous infusion of 1 ml/kg TXA (10 mg/kg per hour) or saline was then initiated until skin closure. All solutions were prepared in identical 50-ml syringes by a nurse anesthetist not involved in clinical management and were presented to the operating team in a blind manner.…”

“…TXA suppresses fibrinolysis by inhibiting plasminogen and the binding of plasmin to fibrin. 12 TXA has decreased intraoperative blood loss during cardiac surgery [13][14][15][16][17][18] and surgical correction of scoliosis in children.…”

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…There have been 11 comparative studies of lysine analogs in pediatric patients totaling >1000 patients. 147,[445][446][447][448][449][450][451][452][453][454][455] These are well described in a recent review and meta-analysis, and Table 7 summarizes the results of these studies. 445,456 These studies are of varying quality, and more than half of the patients have come from a single institution, the All-India Institute of Medical Sciences.…”