Tranexamic acid: an alternative to aprotinin as antifibrinolytic therapy in pediatric congenital heart surgery.
OBJECTIVE
There has been concern about the usage of aprotinin, an antifibrinolytic drug that was often used in pediatric cardiac surgery until 2006. At our center, these concerns led to the replacement of aprotinin with tranexamic acid for antifibrinolytic treatment.


METHODS
In this retrospective observational study, two groups of pediatric patients were studied during two different periods, receiving either aprotinin (n=70) or tranexamic acid (n=70) upon cardiac surgery. Data were collected from children with cyanotic heart defects, children who weighed less than 10 kg, and children who underwent re-operation.


RESULTS
There was no difference in terms of blood loss or amount of erythrocyte concentrates and fresh frozen plasma transfused. Only the intraoperative amount of platelet concentrate received by children in the tranexamic acid group was 29 ml (p=0.013) higher. There was no significant difference in the length of stay at the intensive care unit, in renal function values, or in the rate of rethoracotomy.


CONCLUSIONS
The results of this study suggest that tranexamic acid represents an adequate alternative to aprotinin in congenital cardiac surgery.
Schindler
Ehrenfried
E
Pediatric Anesthesiology, German Pediatric Heart Center, Sankt Augustin, Germany. e.schindler@asklepios.com
Photiadis
Joachim
J
Sinzobahamvya
Nicodème
N
Döres
Albert
A
Asfour
Boulos
B
Hraska
Victor
V
D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D007611:Aprotinin / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010949:Plasma; D012086:Reoperation; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D007611:Aprotinin