Blood-saving effect of tranexamic acid in pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass

Objective To evaluate the blood-saving effect of tranexamic acid in pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass(CPB). Methods A total of 56 children of both sexes, aged 11 months-14 yr, with body mass index of 9.8-21.4 kg/m2, of ASA physical statusⅡ or Ⅲ, with left ventricular ejection fraction >50%, scheduled for elective radical correction of tetralogy of Fallot with CPB, were randomly divided into 2 groups using a random number table: tranexamic acid group(TA group, n=30)and normal saline group(NS group, n=26). Anesthesia was induced with iv midazolam, sufentanil, vecuronium and propofol.The children were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of 1%-2% sevoflurane and infusion of propofol, sufentanil and vecuronium.After induction of anesthesia, a loading dose of tranexamic acid 10 mg/kg was intravenously infused over 20 min before skin incision, followed by infusion at a rate of 10 mg·kg-1·h-1 until the end of surgery in TA group, while the equal volume of normal saline was given instead in NS group.The volume of chest tube drainage at 24 h after surgery and volume of allogeneic red blood cells, fresh frozen plasma, platelet and cryoprecipitate transfused were recorded.The requirement for re-thoracotomy for bleeding, and the incidence of hepatic artery and portal vein thrombosis were also recorded. Results Compared to NS group, the volume of chest tube drainage at 24 h after surgery and volume of allogeneic red blood cells, fresh frozen plasma, platelet and cryoprecipitate transfused were significantly reduced in TA group.No re-thoracotomy was required in TA group, and the rate of re-thoracotomy was 15% in NS group.No hepatic artery and portal vein thrombosis were detected in group TA. Conclusion Tranexamic acid(loading dose 10 mg/kg, maintenance dose 10 mg·kg-1·h-1)can provide blood-saving effect and has high security in pediatric patients undergoing radical correction of tetralogy of Fallot with CPB. Key words: Tranexamic acid; Tetralogy of Fallot; Cardiopulmonary bypass; Child