Which may be effective to reduce blood loss after cardiac operations in cyanotic children: tranexamic acid, aprotinin or a combination?

• Published in: Pediatric anesthesia 2005-01, Vol.15 (1), p.41-46
• Main Authors: BULUTCU, FÜSUN S., ÖZBEK, UĞUR, POLAT, BÜLENT, YALÇIN, YALIM, KARACI, A.R., BAYINDIR, OSMAN
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antifibrinolytic Agents - therapeutic use; aprotinin; Aprotinin - therapeutic use; Biological and medical sciences; Blood Loss, Surgical - prevention & control; Cardiac Surgical Procedures; Child; children; cyanosis; Cyanosis - physiopathology; Double-Blind Method; Drug Therapy, Combination; Female; heart disease; Hemostatics - therapeutic use; Humans; Male; Medical sciences; Prospective Studies; tranexamic acid; Tranexamic Acid - therapeutic use
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2004.01366.x

Summary Background:  Children with cyanotic heart disease undergoing cardiac surgery in which cardiopulmonary bypass is used are at increased risk of postoperative bleeding. In this study, the authors investigated the possibility of reducing postoperative blood loss by using aprotinin and tranexamic acid alone or a combination of these two agents. Methods:  In a prospective, randomized, blind study, 100 children undergoing cardiac surgery were investigated. In group 1 (n = 25) patients acted as the control and did not receive either study drugs. In group 2 (n = 25) patients received aprotinin (30.000 KIU·kg−1 after induction of anesthesia, 30.000 KIU·kg−1 in the pump prime and 30.000 KIU·kg−1 after weaning from bypass). In group 3 (n = 25) patients received tranexamic acid (100 mg·kg−1 after induction of anesthesia, 100 mg·kg−1 in the pump prime and 100 mg·kg−1 after weaning from bypass). In group 4 (n = 25) patients received a combination of the two agents in the same manner. Total blood loss and transfusion requirements during the period from protamine administration until 24 h after admission to the intensive care unit were recorded. In addition, hemoglobin, platelet counts and coagulation studies were recorded. Results:  Postoperative blood loss was significantly higher in the control group (group 1) compared with children in other groups who were treated with aprotinin, tranexamic acid or a combination of the two agents (groups 2, 3 and 4) during the first 24 h after admission to cardiac intensive care unit (40 ± 18 ml·kg−1·24 h−1, aprotinin; 35 ± 16 ml·kg−1·24 h−1, tranexamic acid; 34 ± 19 ml·kg−1·24 h−1, combination; 35 ± 15 ml·kg−1·24 h−1). The total transfusion requirements were also significantly less in the all treatment groups. Time taken for sternal closure was longer in the control group (68 ± 11 min) compared with treatment groups 2, 3 and 4, respectively (40 ± 18, 42 ± 11, 42 ± 13 min, P