ABSTRACT
Objective This study was designed to investigate and compare the possibility of reducing postoperative blood requirements by using Tranexamic acid TX either intravenously or topically in pediatric patients with cyanotic heart disease. Study Design Double-blind, r and omized fashion Setting Children's Hospital - Assiut University- Egypt Participants 120 children undergoing repair of cyanotic congenital heart disease. Measurements and Main Results: Patients were r and omized into three equal groups 40 patients in each one; Control C group did not receive either study drug, Intravenous Tranexamic acid ITX group received Intravenous TX 50 mg / kg at the induction of anesthesia followed by infusion of 1 mg/kg/hr. till 6 hours postoperatively while the topical Tranexamic acid group TTX received topical TX 50 mg / kg poured into the precordial cavity before sternal closure. Total blood loss and transfusion requirement within the first 24 hours postoperatively were recorded together with hematocrit percentage, platelet counts and coagulation studies. In addition; chest closure time, duration of mechanical ventilation, length of Intensive Care Unit ICU stay and length of hospital stay were recorded and the occurrence of re-exploration for excess bleeding, or any other thrombotic or adverse events were recorded. Postoperative blood loss during the first 24 h was significantly higher in the C group 29.13 +/- 8.69 ml/kg compared to the other two groups who were treated with Tranexamic acid either intravenously or topically. ITX group patientrecorded less blood loss 13.05 +/- 7.88 ml/kg in comparison to TTX group 17.40 +/- 8.117 ml/kg. The amount of packed red blood cells and Fresh Frozen Plasma FFP transfusion in the first 24 hours administrated were significantly less in the ITX group patients 10.75 +/- 6.53, 12.00 +/- 5.86 ml/kg followed by TTX group patients 12.60 +/- 6.90, 10.50 +/- 6.77 ml/kg compared to control group of patients 25.00 +/- 6.53, 25.95 +/- 8.05 ml/kg. The control group had the largest re-exploration rate. ITX group had the shortest ventilation time, ICU and hospital stay. No significant difference between the three groups as regard the coagulation parameters except for significant lowest level of fibrin degradation product in ITX group. No side effects were recorded among the three groups. Conclusion: Tranexamic acid effectively reduces postoperative blood loss and the need for transfusion of allogeneic blood products in patients with cyanotic congenital heart disease. However, the intravenous regimen seems to be more effective than the topical one. Key words: Pediatric cyanotic heart disease; Tranexamic acid; Postoperative; Blood transfusion