title: Continuous or discontinuous tranexamic acid effectively inhibits fibrinolysis in children undergoing cardiac surgery with cardiopulmonary bypass.
abstract: Tranexamic acid is given continuously or discontinuously as an anti-fibrinolytic therapy during cardiac surgery, but the effects on fibrinolysis parameters remain poorly investigated. We sought to assess the effects of continuous and discontinuous tranexamic acid on fibrinolysis parameters in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Children requiring cardiac surgery or repeat surgery by sternotomy with CPB for congenital heart disease were randomized to receive either continuous or discontinuous tranexamic acid. Blood tranexamic acid, D-dimers, tissue plasminogen activator (tPA), tPA-plasminogen activator inhibitor 1 (tPA-PAI1) complexes, fibrinogen and fibrin monomers were measured and compared to values obtained from children who did not receive tranexamic acid. Tranexamic acid inhibited the CPB-induced increase in D-dimers, with a similar potency between continuous and discontinuous regimens. Time courses for tPA, fibrin monomers, and fibrinogen were also similar for both regimen, and there was a significant difference in tPA-PAI1 complex concentrations at the end of surgery, which may be related to a significantly higher tranexamic acid concentration. Continuous and discontinuous regimen are suitable for an effective inhibition of fibrinolysis in children undergoing cardiac surgery with CPB, but the continuous regimen was previously shown to be more effective to maintain stable tranexamic acid concentrations.
authors.affiliation: aDépartement d'Anesthésie bLaboratoire d'Hémostase, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson cService de Biologie Clinique, Hôpital Foch, Suresnes dLaboratoire de Pharmacologie, UPRES EA220, Hôpital Foch, Suresnes eLaboratoire de Pharmacologie - Toxicologie, Hôpital Raymond Poincaré, AP-HP, Garches, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Couturier
authors.forename: Marina
authors.initials: M
authors.lastname: Rubatti
authors.forename: Carmen
authors.initials: C
authors.lastname: Credico
authors.forename: Virginie
authors.initials: V
authors.lastname: Louvain-Quintard
authors.forename: Vregina
authors.initials: V
authors.lastname: Anerkian
authors.forename: Sylvie
authors.initials: S
authors.lastname: Doubine
authors.forename: Marc
authors.initials: M
authors.lastname: Vasse
authors.forename: Stanislas
authors.initials: S
authors.lastname: Grassin-Delyle
mesh_terms: D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000097:blood
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid