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Tranexamic acid in paediatric cardiac surgery
Sandeep Chauhan1, Akshay Bisoi, Rakesh Modi
1Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences Ansari Nagar, New Delhi, India. sdeep61@yahoo.com
Insights
Tranexamic acid significantly reduced blood loss and blood product usage in pediatric cardiac surgery for cyanotic heart disease. This antifibrinolytic agent is effective in improving outcomes for these young patients.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Research
- Pharmacology
Background:
- Antifibrinolytic agents are standard in adult cardiac surgery to minimize blood loss.
- Limited research exists on newer agents like tranexamic acid in pediatric cardiac surgery.
- Cyanotic heart disease presents unique challenges in pediatric cardiac surgery.
Purpose of the Study:
- To evaluate the efficacy of tranexamic acid in reducing postoperative blood loss.
- To assess the impact of tranexamic acid on blood product usage in children with cyanotic heart disease.
- To investigate the effect of tranexamic acid on coagulation parameters post-cardiac surgery.
Main Methods:
- A randomized controlled trial involving 120 children with cyanotic heart disease.
- Two groups: control (no drug) and study (tranexamic acid 10 mg/kg at specific intervals).
- Measured mediastinal drainage, blood product use, and coagulation tests (ACT, fibrinogen, FDPs, platelets).
Main Results:
- Tranexamic acid group showed significantly lower blood loss and blood product requirements.
- Reduced rates of re-exploration were observed in the tranexamic acid group.
- Preserved fibrinogen levels and lower fibrin degradation products in the tranexamic acid group.
Conclusions:
- Tranexamic acid is highly effective in pediatric cardiac surgery for cyanotic heart disease.
- It significantly reduces postoperative bleeding and the need for transfusions.
- The study supports tranexamic acid use to improve surgical outcomes in this pediatric population.
Background & Objectives:
Antifibrinolytic agents are used commonly in adult cardiac surgery to reduce postoperative blood loss. Paucity of literature on the use of a newer antifibrinolytic agent tranexamic acid (TA) in children undergoing cardiac surgery promoted us to conduct this study in children with cyanotic heart disease.
Methods:
One hundred and twenty consecutive children with cyanotic heart disease were randomised into two groups. Control (group A) (n=24) given no drug while the study (group B, n=96) group was given tranexamic acid 10 mg/kg each after anaesthetic induction, on bypass and after protamine at the end of bypass. Postoperatively, total mediastinal chest tube drainage and blood and blood product usage at 24 h were recorded. Tests of coagulation including activated clotting time, fibrinogen, fibrin degradation products and platelet count were performed at 6 h postoperatively.
Results:
The two groups were comparable in terms of demographic characteristics such as age, sex, weight, operations performed, and preoperative haematocrit. Postoperatively, group B, had a significantly (P<0.05) lower blood loss, blood and blood product usage, re-exploration rate compared to the control group. There was preservation of fibrinogen and lower levels of fibrin degradation products in group B.
Interpretation & Conclusion:
Tranexamine acid was highly effective in reducing post-operative blood loss, blood and blood product usage in children with congenital cyanotic heart disease undergoing corrective surgery.
