THE EFFECT OF PREOPERATIVE TRANEXAMIC ACID ON BLOOD-LOSS AFTER CARDIAC OPERATIONS IN CHILDREN

Children undergoing cardiac operations in which cardiopulmonary bypass is used are at risk of significant postoperative blood loss, The acqu ired coagulopathy is complex but is thought to be due, in part, to exc essive fibrinolysis. We examined the possibility of reducing postopera tive blood loss in children by using the antifibrinolytic drug tranexa mic acid. Using a prospective, randomized, double-blind study design, we administered a single dose of tranexamic acid (50 mg/kg intravenous ly) or saline placebo, before skin incision, in 88 children undergoing cardiac operations. Postoperative blood loss and fluid replacement we re recorded for the next 24 hours. In addition, hemoglobin, platelet c ounts, and coagulation measures were recorded every 6 hours. When all patients were examined, there was no significant difference in postope rative blood loss between the treated and placebo groups (21.2 +/- 12 ml/kg per 24 hours, tranexamic acid, vs 27.2 +/- 20.3 mls/kg per 24 ho urs, placebo), However, when the children with cyanosis were analyzed separately, there was a highly significant difference in blood loss be tween the groups during the first 6 hours (11.2 +/- 3.7 ml/kg per 6 ho urs, tranexamic acid, vs 27.2 +/- 11.4 mls/kg per 6 hours, placebo; p < 0.002), as well as the overall 24 hour study period (23.7 +/- 7.5 ml s/kg per 24 hours, tranexamic acid, vs 48.9 +/- 27.6 mls/kg per 24 hou rs, placebo; p < 0.02). Also significantly less blood and blood produc ts were administered to the treated cyanosed group. Tranexamic acid pr oduced a significant reduction in postoperative blood loss and blood p roduct requirements in children with cyanosis undergoing heart operati ons. The drug had no effect in children without cyanosis or those requ iring a second thoracotomy.