Efficacy of tranexamic acid as compared to aprotinin in open heart surgery in children
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Published on: September 28, 2022
Nagarajan Muthialu1, Soundaravalli Balakrishnan, Rajani Sundar
1Department of Cardiothoracic Surgery, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India, .
Insights
Tranexamic acid is as effective as aprotinin in controlling postoperative bleeding in pediatric cardiac surgery patients. This study found no significant increase in complications or mortality with tranexamic acid use.
Area of Science:
- Cardiology
- Pediatric Surgery
- Pharmacology
Background:
- Coagulopathy is a significant concern in pediatric cardiac surgery.
- The safety and efficacy of antifibrinolytics, like tranexamic acid, are debated for routine use in children.
- Tranexamic acid's role in pediatric cardiac surgery requires further investigation.
Purpose of the Study:
- To evaluate the benefits of tranexamic acid in managing postoperative bleeding in pediatric cardiac surgical patients.
- To compare the effectiveness and safety of tranexamic acid versus aprotinin in this population.
Main Methods:
- A prospective randomized study of 50 pediatric cardiac surgery patients.
- Patients received either aprotinin (Group A, n=24) or tranexamic acid (Group B, n=26).
- Primary endpoints included mortality, bleeding, reoperation, and complications.
Main Results:
- Group A had longer cardiopulmonary bypass and aortic cross-clamp times, and higher blood product usage.
- No significant differences were observed in indexed postoperative drainage or coagulation parameters between groups.
- Group A showed higher C-reactive protein levels and renal dysfunction; mortality was higher in Group A (16.66%) versus Group B (7.6%).
Conclusions:
- Antifibrinolytics play a crucial role in high-risk pediatric open-heart surgery.
- Tranexamic acid demonstrates comparable effectiveness to aprotinin.
- Tranexamic acid does not increase morbidity or mortality in this patient group.
Background:
Coagulopathy is a major issue in children undergoing high-risk pediatric cardiac surgery. Use of anti-fibrinolytics is well documented in adults, but recently there are questions raised about safety and effectiveness of their use on routine use. Tranexamic acid is a potent anti-fibrinolytic, but its role is not fully understood in children. This study aims to study the benefits tranexamic acid in controlling postoperative bleeding in pediatric cardiac surgical patients.
Methods And Results:
Fifty consecutive children who underwent cardiac surgery were randomized prospectively to receive either aprotinin (Group A; n = 24) or tranexamic acid (Group B; n = 26) from September 2009 to February 2010 were studied. Primary end points were early mortality, postoperative drainage, reoperation for bleeding and complications. Mean age and body weight was smaller in Group A (Age: 48.55 vs. 64.73 months; weight 10.75 vs. 14.80 kg) respectively. Group A had more cyanotic heart disease than Group B (87.5% vs. 76.92%). Mean cardiopulmonary bypass time (144.33 vs. 84.34 min) and aortic cross-clamp time (78.5 vs. 41.46 min) were significantly higher in group A. While the blood and products usage was significantly higher in Group A, there was no difference in indexed postoperative drainage in first 4, 8 and 12 h and postoperative coagulation parameters. Mean C-reactive protein was less in Group A than B and renal dysfunction was seen more in Group A (25% vs. 7.6%). Mortality in Group A was 16.66% and 7.6% in Group B.
Conclusion:
Anti-fibrinolytics have a definitive role in high-risk children who undergo open-heart surgery. Tranexamic acid is as equally effective as aprotinin with no additional increase in morbidity or mortality.
