title: Efficacy of tranexamic acid as compared to aprotinin in open heart surgery in children.
abstract: BACKGROUND
  Coagulopathy is a major issue in children undergoing high-risk pediatric cardiac surgery. Use of anti-fibrinolytics is well documented in adults, but recently there are questions raised about safety and effectiveness of their use on routine use. Tranexamic acid is a potent anti-fibrinolytic, but its role is not fully understood in children. This study aims to study the benefits tranexamic acid in controlling postoperative bleeding in pediatric cardiac surgical patients.
  
  
  RESULTS
  Fifty consecutive children who underwent cardiac surgery were randomized prospectively to receive either aprotinin (Group A; n = 24) or tranexamic acid (Group B; n = 26) from September 2009 to February 2010 were studied. Primary end points were early mortality, postoperative drainage, reoperation for bleeding and complications. Mean age and body weight was smaller in Group A (Age: 48.55 vs. 64.73 months; weight 10.75 vs. 14.80 kg) respectively. Group A had more cyanotic heart disease than Group B (87.5% vs. 76.92%). Mean cardiopulmonary bypass time (144.33 vs. 84.34 min) and aortic cross-clamp time (78.5 vs. 41.46 min) were significantly higher in group A. While the blood and products usage was significantly higher in Group A, there was no difference in indexed postoperative drainage in first 4, 8 and 12 h and postoperative coagulation parameters. Mean C-reactive protein was less in Group A than B and renal dysfunction was seen more in Group A (25% vs. 7.6%). Mortality in Group A was 16.66% and 7.6% in Group B.
  
  
  CONCLUSIONS
  Anti-fibrinolytics have a definitive role in high-risk children who undergo open-heart surgery. Tranexamic acid is as equally effective as aprotinin with no additional increase in morbidity or mortality.
authors.affiliation: Department of Cardiothoracic Surgery, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India, .
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Muthialu
authors.forename: Soundaravalli
authors.initials: S
authors.lastname: Balakrishnan
authors.forename: Rajani
authors.initials: R
authors.lastname: Sundar
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Muralidharan
mesh_terms: D000933:Antifibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D007611:Aprotinin / Q000009:adverse effects* / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000097:blood / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control*; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D007611:Aprotinin