Tranexamic acid therapy in pediatric cardiac surgery: a single-center study

We conducted a retrospective study of cyanotic and acyanotic patients undergoing cardiopulmonary bypass to determine the effect of tranexamic acid on blood loss and blood products administered during the operation in pediatric cardiac surgery.

From January 2008 to December 2011, during 2 different periods, a total of 231 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (123 cyanotic, 108 acyanotic) were included in this study. A total of 104 patients were in the antifibrinolytic group and exclusively treated with tranexamic acid that was given as a bolus of 20 mg/kg(-1) after anesthetic induction and 20 mg/kg(-1) after protamine. The other 127 patients were in the control group. We analyzed intraoperative and postoperative outcomes of tranexamic acid administration.

There were no differences in mortality or operative time, but blood loss in 48 hours was greater in the control group (p=0.0012). A significant difference was found in the amount of intraoperative erythrocyte concentrate transfused (140±55 vs 170±78 mL, p=0.0011) but not in number. The number and amount of erythrocyte concentrate transfused in the first 48 postoperative hours were also greater in the control group (45 vs 77 patients, p=0.012; 100±40 vs 120±55 mL, p=0.0022). There were not many differences in the effect of tranexamic acid between the cyanotic and acyanotic subgroup.

This retrospective study provides evidence that tranexamic acid may be used in the field of congenital cardiac surgery effectively.