Tranexamic acid as a means of reducing the need for blood and blood component therapy in children undergoing open heart surgery for congenital cyanotic heart disease

Abstract

Children undergoing cardiac operations using cardiopulmonary bypass (CPB) are at risk of significant postoperative bleeding and the need for transfusion. The antifibrinolytic drug, tranexamic acid, decreases blood loss in adult patients undergoing cardiac surgery. However, its efficacy has not been extensively studied in patients with cyanotic congenital heart defects (CHD). Using a prospective, randomized, double-blind study design, we examined 67 children undergoing repair of cyanotic CHD. After induction of anesthesia and prior to skin incision, patients received 15 mg/kg of tranexamic acid intravenously. At the end of CPB, a second bolus of tranexamic acid (15 mg/kg) or saline placebo was administered. Postoperative blood loss and transfusion requirements from the period after protamine administration until 24 hours after admission to the intensive care unit were recorded. In addition, the hematocrit, platelet count and other indices of coagulation were recorded every 6 hours. There was no significant difference in postoperative blood loss between the treated and the placebo group (12.51 +/- 13.20 ml/kg per 24 hours, in the tranexamic acid group, vs 10.68 + 6.38 ml/kg per 24 hours, in the placebo group). Also there was no significant difference in the amounts of blood and blood products administered between the two groups. No adverse effects of tranexamic acid were found in this study. In conclusion, there was no significant difference in postoperative blood loss or blood and blood product requirement between those children with cyanotic CHD undergoing open heart surgery who received a single dose of tranexamic acid compared with those who received two doses.