[Effect of tranexamic acid on postoperative bleeding in pediatric heart surgery].
OBJECTIVE
To assess the effects of a single dose of tranexamic acid on bleeding and requirement for blood product transfusion in children undergoing cardiac surgery with cardiopulmonary bypass.


METHODS
A prospective study of closed cohorts undergoing pediatric heart surgery was carried out. The children weighed between 4 and 10 kg. Reoperated and cyanotic patients were included in the sample. The treatment group received 50 mg x kg(-1) of tranexamic acid before surgery. Analyzed data collected during the first 24 hours after surgery were biochemical parameters, bleeding, use of blood products, and D-dimer levels.


RESULTS
Fifty-three patients, 25 in the treatment group, were enrolled. Patients on treatment had 24.8% less bleeding in the first 24 hours after surgery (P = .02). The transfusion of blood products was 20% less in the treatment group, although the difference was not significant except in the subgroup of patients who were reoperated. In that group the amount of blood products transfused was 72% less than in the control group (P = .05). D-dimer levels were also lower in the treatment group (P = .003). No adverse effects attributable to the treatment were observed.


CONCLUSIONS
A single preoperative dose of tranexamic acid to inhibit fibrinolysis reduces bleeding 24.8% in pediatric patients undergoing heart surgery with cardiopulmonary bypass. The effect is greater in reoperated patients, leading to a reduction in their requirement for transfusion. The use of this therapy in these patients is therefore highly justified.
Varela Crespo
C A
CA
Servicio de Anestesia y Reanimación Pediátrica, Hospital Universitario Infantil La Paz, Madrid. carlosvarelac@yahoo.es
Sanabria Carretero
P
P
Palomero Rodríguez
M A
MA
Tormo las de Heras
C
C
Rodríguez Pérez
E
E
Goldman Tarlousky
L
L
D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers; D016063:Blood Loss, Surgical; D001798:Blood Proteins / Q000032:analysis; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D019106:Postoperative Hemorrhage / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D011292:Premedication; D011446:Prospective Studies; D012086:Reoperation; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D015415:Biomarkers; D001798:Blood Proteins; D014148:Tranexamic Acid