Comparison of efficacy of two different doses of tranexamic acid in prevention of post operative blood loss in patients with congenital cyanotic heart disease undergoing cardiac surgery
Thushara Madathil, Rakhi Balachandran, Brijesh P Kottayil, K R Sundaram, Suresh G Nair, Thushara Madathil, Rakhi Balachandran, Brijesh P Kottayil, K R Sundaram, Suresh G Nair
Abstract
Background: The optimal dose of tranexamic acid in minimizing perioperative bleeding is uncertain. We compared efficacy of two different doses of tranexamic acid in reducing post-operative blood loss and its side effects in patients with congenital cyanotic heart disease undergoing cardiac surgery.
Settings and design: Prospective observational study at a pediatric cardiac center in South India.
Methods: Consecutive cyanotic patients undergoing cardiac surgery were divided into groups I and II to receive either 10 mg/kg or 25 mg/kg of tranexamic acid administered as triple dose regime after induction, during cardiopulmonary bypass, and after protamine. Post-operative blood loss at 24 hours, blood component utilization, incidence of renal dysfunction and seizures were compared.
Results: Totally, 124 patients were recruited, 62 in each group. The pre-operative variables and cardiopulmonary bypass time were comparable. Patients receiving 25 mg/kg had lower post-operative blood loss compared to patients in lower dose group (8.04 ± 8.89 vs 12.41 ± 19.23 ml/kg/24 hours, P = 0.03). There was no difference in the transfused volume of packed red cells (9.21 ± 7.13 ml/kg vs 12.41 ± 9.23 ml/kg, P = 0.712), fresh frozen plasma (13.91 ± 13.38 ml/kg vs 11.02 ± 8.04 ml/kg, P = 0.19), platelets (9.03 ± 6.76 ml/kg vs 10.90 ± 6.9 ml/kg, P = 0.14) or cryoprecipitate (0.66 ± 0.59 ml/kg vs 0.53 ± 0.54 ml/kg, P = 0.5) in group II and I, respectively. Two patients developed renal dysfunction secondary to low cardiac output in lower dose group. There were no seizures.
Conclusions: Tranexamic acid administered at a dose of 25 mg/kg as triple dose regime is associated with lower post-operative blood loss compared to a lower dose of 10 mg/kg in cyanotic patients undergoing cardiac surgery without causing major adverse effects.
Keywords: Blood loss; cardiac surgery; cyanotic; pediatric; tranexamic acid.
Conflict of interest statement
None
References
- Henriksson P, Värendh G, Lundström NR. Haemostatic defects in cyanotic congenital heart disease. Br Heart J. 1979;41:23–7.
- Tempe D, Virmani S. Coagulation abnormalities in patients with congenital cyanotic heart disease. J Cardiothorac Vasc Anaesth. 2002;16:752–65.
- Astedt B. Clinical pharmacology of tranexamic acid. Scand J Gastroenterol Suppl. 1987;137:22–5.
- Cholette JM, Faraoni D, Goobie SM, Ferraris V, Hassan N. Patient blood management in pediatric cardiac surgery: A review. Anaesth Analg. 2018;127:1002–16.
- Chauhan S, Bisoi A, Kumar N, Mittal D, Kale S, Kiran U, et al. Dose comparison of tranexamic acid in pediatric cardiac surgery. Asian Cardiovasc Thorac Ann. 2004;12:121–4.
- Wesley MC, Pereira LM, Scharp LA, Emani SM, McGowan FX, Dinardo JA. Pharmacokinetics of tranexamic acid in neonates, infants and children undergoing cardiac surgery with cardiopulmonary bypass. Anesthesiology. 2015;122:746–58.
- Guo J, Gao X, Ma Y, Lv W, Hu W, Zhang S, et al. Different dose regimes and administration methods of tranexamic acid in cardiac surgery: A meta-analysis of randomized trials. BMC Anesthesiol. 2019;19:129.
- Zonis Z, Seear M, Reichert C, Sett S, Allen C. The effect of preoperative Tranexamic acid on blood loss after cardiac operations in children. J Thorac Cardiovasc Surg. 1996;111:982–7.
- Reid RW, Zimmerman AA, Laussen PC, Mayer JE, Gorlin JB, Burrows FA. The efficacy of tranexamic acid versus placebo in decreasing blood loss in pediatric patients undergoing repeat cardiac surgery. Anesth Analg. 1997;84:990–6.
- Giordano R, Palma G, Poli V, Palumbo S, Russolillo V, Cioffi S, et al. Tranexamic acid in pediatric cardiac surgery- A single centre study. Ann Thorac Surg. 2012;94:1302–6.
- Fiechtner BK, Nuttall GA, Johnson ME, Dong Y, Sujirattanawimol N, Oliver WC, Jr, et al. Plasma tranexamic acid concentrations during cardiopulmonary bypass. Anesth Analg. 2001;92:1131–6.
- Soslau G, Horrow J, Brodsky I. Effect of tranexamic acid on platelet ADP during extracorporeal circulation. Am J Hematol. 1991;38:113–9.
- Zhang Y, Zhang X, Wang Y, Shi J, Yuan S, Gong J, et al. Efficacy and safety of tranexamic acid in pediatric patients undergoing cardiac surgery: A single-centre experience. Frontr Paediatr. 2019;7:181.
- Faraoni D, Willems A, Melot C, De Hert S, Van der Linden P. Efficacy of tranexamic acid in paediatric cardiac surgery: A systematic review and meta-analysis. Eur J Cardiothorac Surg. 2012;42:781–6.
- Schindler E, Photiadis J, Sinzobahamvya N, Döres A, Asfour B, Hraska V. Tranexamic acid: An alternative to aprotinin as antifibrinolytic therapy in pediatric congenital heart surgery. Eur J Cardiothorac Surg. 2011;39:495–9.
- Pasquali SK, Li JS, He X, Jacobs ML, O’Brien SM, Hall M, et al. Comparative analysis of antifibrinolytic medications in pediatric heart surgery. J Thorac Cardiovasc Surg. 2012;143:550–7.
- Martin K, Breuer T, Gertler R, Hapfelmeier A, Schreiber C, Lange R, et al. Tranexamic acid versus ε-aminocaproic acid: Efficacy and safety in paediatric cardiac surgery. Eur J Cardiothorac Surg. 2011;39:892–7.
- Maeda T, Sasabuchi Y, Matsui H, Ohnishi Y, Miyata S, Yasunaga H, et al. Safety of tranexamic acid in pediatric cardiac surgery: A nationwide database study. J Cardiothorac Vasc Anesth. 2017;31:549–53.
Source: PubMed