A Study Of Tranexamic Acid On Hemostasis And Infiammatory Mediators In Cardiopulmonary Bypass In Infants

Objective To evaluate the effects of Tranexamic Acid (TA) on hemostasis and inflammatory mediators in cardiopulmonary in infantsMethod In a prospected, randomized, double blinded study. One hundred and twenty infants weighted less than 10kg undergoing cardiopulmonary bypass were investigated. The infants were recruited and assigned to three groups:TA1 group (40cases), TA2 group (40cases) and control group (40 cases). In group TA1, patients received tranexamic acid 30mg/kg after induction of anesthesia followed by continuous infusion at the rate of 16mg/kg/h and 2mg/kg in the pump prime. In group TA2, patients received tranexamic acid 30mg/kg after induction of anesthesia,30mg/kg in pump prime and 30mg/kg after weaning of bypass. In group control, patients received the same volume saline of above groups. Total blood loss and allogenic transfusion requirements during the period from the end of operation until 24h after admission to the CICU were recorded. D-dimer was tested at four time points:before operation, during CPB,6h and 24h postoperatively. Interleukin-8, CRP and WBC were tested at five time points:before operation, at the end of operation,6h,12h and 24h postoperatively.Results Baseline demographic data was similar among the groups. D-dimer values were increased from the beginning of CPB and remained higher till 24h operatively among the three groups. The values in treatment groups were significantly lower than control group at three time points:during CPB,6h and 24h operatively (P<0.05、P<0.001、P<0.001).The blood loss was significantly lower in two treatment groups compared to control group within 6h after operation (P<0.05), but total blood loss seemed no different. No difference was found in allogenic transfusion units among groups. Serum level of Interleukin-8 increased at the end of operation and remained higher until 12h and began to decrease 24h operatively, the level in control group was greatly higher than that in treatment groups (P<0.01). The serum concentration of CPR was elevated obviously 12h after operation, and remained significantly higher in control group 24h operatively. No difference was found in WBC count among groups. Perioperative data and surgical complications carried no difference among groups. No mortality was observed in the study.Conclusion Tranexamic acid could effectively reduce postoperative bleeding and inhibit fibrinolysis and inflammation. Continues infusion of tranexamic acid shows no significant advantage to divided dose.