Potential Benefit of Combined Topical and Intravenous Administration of Tranexamic Acid in Congenital Heart Surgery

Abstract

This study was designed to compare the effect of combined topical and IV tranexamic acid vs. IV tranexamic acid only in congenital cardiac surgery. 90 Patients were randomly allocated by computer generated randomization and using opaque sealed envelopes into two groups, 45 patients in each group. Group A: (the intravenous group) The patients received a loading bolus dose of TxA (10 mg/kg) over a period of five minutes followed by an infusion of 1 mg/kg/h till the end of surgery. Another 10 mg/kg will be administered into the prime of the cardiopulmonary bypass. The patients will have 20 ml of normal saline poured intrapericardially by the surgeon after protamine administration. Group B: (the intravenous plus intrapericardial topical application) In addition to intravenous administration this group received 50 mg of TxA diluted in 20 ml of normal saline and administered intrapericardially after protamine administration and hemostasis before sternal closure. Patient's baseline and demographic data between two groups were comparable. The estimated blood loss postoperatively in first 24hrs. Were less in the combined group than the IV group. Requirements of blood transfusion also were statically significant in combined group than IV group from aspects of volume of PRBCs transfusion, Total number of patients exposed to transfusion and transfusion rate. There is no difference regarding ICU stay and need of surgical re exploration. There is no patient developed seizures.