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Comparative analysis of antifibrinolytic medications in pediatric heart surgery

Sara K Pasquali1, Jennifer S Li, Xia He

  • 1Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA. sara.pasquali@duke.edu

The Journal of Thoracic and Cardiovascular Surgery
|January 24, 2012
PubMed

Insights

Aprotinin reduced bleeding and mortality in pediatric heart surgery, with similar efficacy to aminocaproic acid (ACA). Tranexamic acid (TXA) showed improved outcomes compared to aprotinin.

Area of Science:

  • Pediatric Cardiac Surgery
  • Pharmacology
  • Critical Care Medicine

Background:

  • Limited contemporary data exist comparing aprotinin with aminocaproic acid (ACA) and tranexamic acid (TXA) in pediatric heart surgery.
  • Aprotinin's safety profile in children requires further investigation, as adult data may not directly translate.

Purpose of the Study:

  • To compare the efficacy and safety of aprotinin, ACA, and TXA in pediatric patients undergoing heart surgery.
  • To guide current clinical practice and inform future clinical trial design for antifibrinolytic use in this population.

Main Methods:

  • Retrospective analysis of a large multicenter cohort using linked databases (Society of Thoracic Surgeons Congenital Heart Surgery Database and Pediatric Health Information Systems Database).
  • Multivariable analysis adjusted for patient and center factors to evaluate efficacy and safety outcomes.
  • Subgroup analyses were performed for neonates and patients undergoing redo sternotomy.

Main Results:

  • Aprotinin use was associated with reduced hospital mortality/bleeding requiring surgical intervention overall and in the redo sternotomy subgroup.
  • No significant benefit of aprotinin was observed in neonates, and there was no difference in renal failure requiring dialysis across groups.
  • Comparative analysis showed no difference between aprotinin and ACA, but TXA was associated with significantly reduced mortality/bleeding compared to aprotinin, particularly in neonates.

Conclusions:

  • Aprotinin appears safe and effective in reducing bleeding and mortality in children undergoing heart surgery, without increasing the need for dialysis.
  • Aminocaproic acid (ACA) demonstrates similar efficacy to aprotinin.
  • Tranexamic acid (TXA) offers superior outcomes in terms of reduced mortality and bleeding compared to aprotinin in this pediatric cohort.
Abstract

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