title: Topical and low-dose intravenous tranexamic acid in cyanotic cardiac surgery.
abstract: Background Coagulopathy is a major problem in surgery for cyanotic congenital heart disease. Tranexamic acid has been used both topically and systemically and plays a vital role in pediatric cardiac surgery by reducing blood loss and blood product requirement. We aimed to determine the anti-fibrinolytic effectiveness of low-dose systemic or topical tranexamic acid or a combination of both. Methods Seventy-five patients were divided in 3 groups of 25. Group A patients were given tranexamic acid 20 mg kg-1intravenously after sternotomy and 20 mg kg-1after heparin reversal. Group B patients were given tranexamic acid 50 mg kg-1in 20 mL of saline intrapericardially before sternal closure, with the drain clamped for 20 min. Group C patients were given tranexamic acid 20 mg kg-1intravenously after sternotomy and 50 mg kg-1intrapericardially before sternal closure. A number of clinical variables were recorded in the first 3 postoperative days. Ventilator time, intensive care unit stay, and outcome were also recorded. Results Chest tube drainage and blood product requirements were lowest in group C. Blood urea and serum creatinine levels were higher in groups A and C ( p < 0.05). Intensive care unit stay and ventilator time were similar in all 3 groups. No patient died and none had a seizure or other neurological event or thromboembolic complication postoperatively. Conclusion The combination of low-dose intravenous and topical tranexamic acid reduces postoperative blood loss and blood product requirement without incurring neurological, renal or thromboembolic complications. We recommend the routine use of topical and low-dose systemic tranexamic acid in cyanotic pediatric cardiac surgery.
authors.affiliation: 1 Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center Ahmedabad, Gujarat, India.
authors.forename: Jigar
authors.initials: J
authors.lastname: Patel
authors.affiliation: 1 Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center Ahmedabad, Gujarat, India.
authors.forename: Mrugesh
authors.initials: M
authors.lastname: Prajapati
authors.affiliation: 2 Department of Medical Officer, UN Mehta Institute of Cardiology and Research Center Ahmedabad, Gujarat, India.
authors.forename: Hardik
authors.initials: H
authors.lastname: Patel
authors.affiliation: 1 Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center Ahmedabad, Gujarat, India.
authors.forename: Hemang
authors.initials: H
authors.lastname: Gandhi
authors.affiliation: 1 Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center Ahmedabad, Gujarat, India.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Deodhar
authors.affiliation: 3 Department of Research, UN Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India.
authors.forename: Himani
authors.initials: H
authors.lastname: Pandya
mesh_terms: D061605:Administration, Intravenous; D000287:Administration, Topical; D000293:Adolescent; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D004311:Double-Blind Method; D004322:Drainage / Q000295:instrumentation; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006330:Heart Defects, Congenital / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Antifibrinolytic agents; Blood loss; Cardiopulmonary bypass; Cyanosis; Heart defects; Tranexamic acid; congenital; surgical