Comparison of epsilon aminocaproic acid and tranexamic acid in pediatric cardiac surgery
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Published on: August 24, 2018
Sandeep Chauhan1, Sambhu N Das, Akshay Bisoi
1Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India. sdeep61@yahoo.com
Insights
Aminocaproic acid and tranexamic acid effectively reduce blood loss in pediatric cardiac surgery. Both antifibrinolytic drugs demonstrated equal efficacy in minimizing postoperative bleeding and the need for transfusions in children with cyanotic heart disease.
Area of Science:
- Cardiology
- Pediatric Surgery
- Pharmacology
Background:
- Cyanotic congenital heart disease (CCHD) often necessitates complex surgical interventions.
- Postoperative blood loss and transfusion requirements are significant concerns in pediatric cardiac surgery, particularly in CCHD patients undergoing cardiopulmonary bypass (CPB).
- Antifibrinolytic agents like aminocaproic acid and tranexamic acid are used to mitigate bleeding, but their comparative efficacy in this specific population requires further elucidation.
Purpose of the Study:
- To compare the efficacy of aminocaproic acid and tranexamic acid in reducing postoperative blood loss.
- To evaluate the impact of these antifibrinolytics on blood and blood product requirements in children with CCHD undergoing corrective surgery.
- To assess the rates of reexploration due to bleeding in the treatment groups versus a control group.
Main Methods:
- A prospective randomized study was conducted involving 150 children (2 months to 14.5 years) with CCHD undergoing corrective surgery on CPB.
- Participants were randomized into three groups: aminocaproic acid, tranexamic acid, or a control group.
- Specific dosing regimens for aminocaproic acid (100 mg/kg) and tranexamic acid (10 mg/kg) were administered at key surgical time points.
Main Results:
- The control group exhibited the longest sternal closure time, highest 24-hour blood loss, and greatest need for blood products.
- No statistically significant difference was observed between the aminocaproic acid and tranexamic acid groups regarding postoperative blood loss, blood product requirements, or reexploration rates.
- Both antifibrinolytic agents significantly reduced blood loss and transfusion needs compared to the control group.
Conclusions:
- Aminocaproic acid and tranexamic acid are equally effective in managing postoperative blood loss in pediatric CCHD surgery.
- Both agents significantly decrease the requirement for blood and blood products compared to no antifibrinolytic therapy.
- These findings support the use of either aminocaproic acid or tranexamic acid to improve outcomes in children undergoing corrective cardiac surgery for CCHD.
Objective:
This study compared the efficacy of aminocaproic acid and tranexamic acid in reducing postoperative blood loss, as well as blood and blood product requirements in children with cyanotic congenital heart disease.
Design:
A prospective randomized study.
Setting:
Cardiac center of a tertiary care, referral hospital.
Participants:
One hundred fifty children in the age group of 2 months to 14.5 years with cyanotic congenital heart disease undergoing corrective surgery on cardiopulmonary bypass (CPB).
Interventions:
Patients were randomized into 3 groups. Group A was given aminocaproic acid in a dose of 100 mg/kg after anesthetic induction, 100 mg/kg on CPB and 100 mg/kg after protamine. Group T was given tranexamic acid, 10 mg/kg, after anesthetic induction, 10 mg/kg on CPB, and 10 mg/kg after protamine. Group C was the control group.
Main Result:
Control group had the longest sternal closure time, maximum blood loss at 24 hours, and maximum requirements of blood and blood products. Among the 2 groups given antifibrinolytics, there was no significant difference in postoperative blood loss, blood and product requirement, and reexploration rates.
Conclusion:
Aminocaproic acid and tranexamic acid are equally effective in reducing postoperative blood loss, as well as blood and blood product requirements in children with cyanotic heart disease undergoing corrective surgery as compared with the control group.
