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Efficacy and Safety of Antifibrinolytic Drugs in Pediatric Surgery: A Systematic Review

Nadia Thrane Hovgesen1, Julie Brogaard Larsen1, Christian Fenger-Eriksen2

  • 1Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.

Seminars in Thrombosis and Hemostasis
|June 30, 2021
PubMed

Insights

Antifibrinolytic drugs effectively reduce blood loss in pediatric surgery. Tranexamic acid is recommended, with a specific dosing regimen for optimal safety and efficacy in children.

Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Pediatric Surgery
  • Pharmacology

Background:

  • Antifibrinolytic drugs are crucial for minimizing blood loss and transfusion needs during surgery and trauma.
  • Optimal dosing strategies for antifibrinolytics in pediatric patients remain undetermined.

Purpose of the Study:

  • To systematically review the efficacy and safety of antifibrinolytic drugs in pediatric surgery and trauma.
  • To determine the optimal dosing regimen for antifibrinolytics in pediatric populations.

Main Methods:

  • A comprehensive literature search was conducted across PubMed, Embase, Cochrane, and Web of Science.
  • Included were 50 randomized controlled trials (RCTs) involving pediatric patients (0-18 years) undergoing cardiac surgery, noncardiac surgery, or trauma.
  • Studies evaluated tranexamic acid, aprotinin, and epsilon-aminocaproic acid for effects on blood loss, transfusions, reoperations, and rebleeds.

Main Results:

  • All evaluated antifibrinolytic drugs demonstrated significant reductions in postoperative blood loss and transfusion requirements in pediatric surgery.
  • No significant difference in adverse events was observed between antifibrinolytic and placebo groups.
  • Effect sizes for blood loss reduction were consistent across varying cumulative doses.

Conclusions:

  • Antifibrinolytic agents are both effective and safe for use in pediatric surgical patients.
  • Tranexamic acid (TXA) is recommended as the drug of choice due to its evidence base and safety profile.
  • A proposed dosing regimen includes a 10-15 mg/kg loading dose followed by a 1-5 mg/kg/h continuous infusion during surgery.

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