Title: To Compare two Different Doses of Tranexemic Acid in Congenital Cyanotic Heart Disease Patients Undergoing Open Heart Surgery

Authors: Sanjeeta Umbarkar, Swati Narnaware

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i6.42

Abstract

Background: Blood conservation continues to be an important focus of interest in the field of cardiac surgery, given the increased awareness of blood-borne diseases and problems arising from multiple donor transfusions that are routine part of cardiac surgery.[1] the search for methods and pharmacological agents to reduce blood loss after cardiac surgery is on-going.Use of antifibrinolytic has been studied and used in adult cardiac patients widely but there are not many studies regarding use of Tranexemic Acid in Cyanotic Congenital heart disease patients undergoing open heart surgery.

Methods: After ethic comitee permission 114 patients divided into two groups A and B .Group A –Injection Tranexemic Acid 10mg /kg IV followed by infusion of 1mg/kg till end of surgery and Group B –three bolus doses of Injection Tranexemic Acid 10mg/kg IV,Blood loss,coagulation parametres,outcome of surgery studied with detail.

Result: It was found that three bolus doses of IV Tranexemic acid 10mg per kg is superior to IV  bolus  Followed by continuous infusion.

Keywords: Tranexemic acid, Congenital Cyanotic heart disease, Boluses, Blood loss.

References

    

1.      Janssens M: Hartstein G Treatment of excessive mediastinal bleeding after cardiopulmonary bypass. Ann Thoracic Surg 62 : 1951-1954, 1996

2.      Karski JM, Teasdale SJ, Norman PH, et al : Prevention of postbypass bleeding with tranexamic acid. J Cardiothoracic Vasc Anaesth 7:431-435, 1993

3.      Horrow JC,Van riper DF,Strong MD et al:The dose response relationship of tranexamic acid. Anaesthesiology 1995;82:383 -92

4.      Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs 1985;29:236 -61

5.      Horrow JC Hlavacek MD, strong D, et al: prophylactic tranexamic acid decreases bleeding after cardiac operations. J Thorac Cardiovasc Surg1990; 99: 70-4

6.      Jansenns M,Hartstein G,David JL :reductions in the requirements for allogenic blood products:pharmacologic methods.Ann Thoracic Surg1996;62:1944-50

7.      Reichert C, Zonis Z Seear M, et al: The effect of preoperative tranexamic acid on blood loss after cardiac operations in children. J Thorac Cardiovasc Surg 111 : 982-987,1996

8.      Isseta C, Samat C, Kotaiche M. low dose aprotinin or tranexamic acid treatment in cardiac surgery. Anaesthesiology 1991;75:80A

9.      Horrow JC, Van Riper DF, Strong D, et al :Haemostatic effects of desmopressin and tranexamic acid during cardiac surgery. Circulation 1991;84:2063- 70

10.  Vacharaksa K :  Tranexamic acid for reducing the need for blood and blood component therapy in children undergoing surgery for congenital cyanotic heart disease, J Med Assoc Thai. 2002 Sep;85 Suppl 3:S904-9

11.  Dubber AH, Mc nicol GP, Douglas as. amino methyl cyclohexane carboxylic acid (amcha), a new synthetic fibrinolytic inhibitor. br j haematol. 1965 mar;11:237–245. [pubmed]

12.  Nilsson I M, Andersson L Bjorkmann S.E.(1965),Acta Medica Scandinavia Supplemen. No.448

13.  Gibbs JR, Corkill AG. Use of an anti-fibrinolytic agent (tranexamic acid) in the management of ruptured intracranial aneurysms. Postgrad Med J. 1971 Apr;47(546):199–200.PubMed

14.  Reid RW,Zimmerman AA,Laussen PC,Mayer JE,Gorlin JB,Burrows FA.The efficacy of tranexamic acid versus placebo in decreaseing blood loss in pediatric patients undergoing repeat cardiac surgery.Anesth Analg 1997;84:990-6

15.  Dunn CJ, Goa : tranexamic acid  a review of its use in surgery and other indications/.www.ncbi.nlm.nih.gov/pubmed/10400410

16.  Chauhan S et al, Dose comparison of tranexamic acid in pediatric cardiac surgery, Indian J Med Res. 2003 Aug;118:86-9.,  Department of cardiac anaesthesia,Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India

17.  Giordano et al Ann Thorac Surg. 2012 Oct;94(4):1302-6. doi: 10.1016/j. athoracsur.2012.04.078. Epub 2012 Jul 21.

18.  Sagripanti A, Carpi A: Antithrombotic and prothrombotic activities of the vascular endothelium.  Biomed Pharmacother  2000; 54:107-111.

19.  19 .Freedman JE, Loscalzo J: Nitric oxide and its relationship to thrombotic disorders.  J Thromb Haemost  2003; 1:1183-1188.

20.  Kato H: Regulation of functions of vascular wall cells by tissue factor pathway inhibitor: Basic and clinical aspects.  Arterioscler Thromb Vasc Biol  2002; 22:539-548.

21.  May AE, Neumann FJ, Preissner KT: The relevance of blood cell–vessel wall        adhesive interactions for vascular thrombotic disease.  Thromb Haemost 1999; 82:962-970.

22.  Wu KK Thiagarajan P: Role of endothelium in thrombosis and hemostasis.  Annu Rev Med  1996; 47:315-331.

23.  Grignani G, Maiolo A: Cytokines and hemostasis.  Haematologica  2000; 85:967-972.

24.  Westrick RJ, Eitzman DT: Plasminogen activator inhibitor-1 in vascular thrombosis.  Curr Drug Targets  2007; 8:966-1002.

25.  Parolari A, Mussoni L, Frigerio M, et al: Increased prothrombotic state lasting as long as one month after on-pump and off-pump coronary surgery.  J Thorac Cardiovasc Surg  2005; 130:303-308.

26.  Kassis J, Hirsh J, Podor TJ: Evidence that postoperative fibrinolytic shutdown is mediated by plasma factors that stimulate endothelial cell type Iplasminogen activator inhibitor biosynthesis.  Blood  1992; 80:1758-1764.

27.  Hartwig JH: The platelet: form and function.  Semin Hematol  2006; 43:S94-100.

28.  Andrews RK, Berndt MC: Platelet physiology and thrombosis.  Thromb Res  2004; 114:447-  

29.  Chen J, Lopez JA: Interactions of platelets with subendothelium and endothelium.  Microcirculation  2005; 12:235-246.

30.  Chaer RA, Graham JA, Mureebe L: Platelet function and pharmacologic inhibition.  Vasc Endovascular Surg  2006; 40:261-267.[30]

31.  Furie B, Furie BC: Thrombus formation in vivo.  J Clin Invest  2005; 115:3355-3362.

32.  Fullard JF: The role of the platelet glycoprotein IIb/IIIa in thrombosis and haemostasis.  Curr Pharm Des  2004; 10:1567-1576.

33.  Hoffman M: Remodeling the blood coagulation cascade.  J Thromb Thrombolysis  2003; 16:17-20.

34.  Coughlin SR: Protease-activated receptors in hemostasis, thrombosis and vascular biology.  J Thromb Haemost  2005; 3:1800-1814.

35.  Schenone M, Furie BC, Furie B: The blood coagulation cascade.  Curr Opin Hematol  2004; 11:272-277.

36.  Mann KG, Brummel-Ziedins K, Orfeo T, Butenas S: Models of blood coagulation.  Blood Cells Mol Dis  2006; 36:108-117.

37.  Gomez K, McVey JH: Tissue factor initiated blood coagulation.  Front Biosci  2006; 11:1349-1359.

38.  KE, Osterud B: Eilertsen Tissue factor: (patho)physiology and cellular biology.  Blood Coagul Fibrinolysis  2004; 15:521-538.

39.  Gailani D, Renne T: The intrinsic pathway of coagulation: A target for treating thromboembolic disease?.  J Thromb Haemost  2007; 5:1106-1112.

40.  Hoffman M: A cell-based model of coagulation and the role of factor VIIa.  Blood Rev  2003; 17(Suppl 1):S1-S5.[40]

41.  Esmon CT: Crosstalk between inflammation and thrombosis.  Maturitas  2004; 47:305-314.

42.  Furie B, Furie BC: In vivo thrombus formation.  J Thromb Haemost  2007; 5(Suppl 1):12-17.

43.  Mosesson MW: Fibrinogen and fibrin structure and functions.  J Thromb Haemost  2005; 3:1894-1904.

44.  Crawley JT, Zanardelli S, Chion CK, Lane DA: The central role of thrombin in hemostasis.  J Thromb Haemost  2007; 5(Suppl 1):95-101.

45.  Barshtein G, Ben-Ami R, Yedgar S: Role of red blood cell flow behavior in hemodynamics and hemostasis.  Expert Rev Cardiovasc Ther  2007; 5:743-752.

46.  Medcalf RL: Fibrinolysis, inflammation, and regulation of the plasminogen activating system.  J Thromb Haemost  2007; 5(Suppl 1):132-142.

47.  Cesarman-Maus G, Hajjar KA: Molecular mechanisms of fibrinolysis.  Br J Haematol  2005; 129:307-321

48.  Despotis GJ, Joist JH, Goodnough LT: Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes.  Clin Chem  1997; 43:1684-1696

49.  Manno CS, Hedberg KW, Kim HC, et al: Comparison of the hemostatic effects of fresh whole blood, stored whole blood, and components after open heart surgery in children. Blood 1991; 77:930.

50.  Greeley WJ, Bushman GA, Kong DL, et al: Effects of cardiopulmonary bypass on eicosanoid metabolism during pediatric cardiovascular surgery. J Thorac Cardiovasc Surg 1988; 95:842

51.  51.. Andrew M, Paes B, Milner R, et al: Development of the human coagulation system in the full-term infant. Blood 1987; 70:165.

52.  52.. Colon-Otero G, Gilchrist GS, Holcomb GR, et al: Preoperative evaluation of hemostasis in patients with heart disease. Mayo Clin Proc 1987; 62:379.

53.  J. Anthony Ware, William H. Reaves, Janet K. Horak and R. Thomas  : Ann Thorac Surg 1983;36:289-294

54.  Kottke-Marchant K, Sapatnekar S: Hemostatic abnormalities in cardiopulmonary bypass: Pathophysiologic and transfusion considerations. Semin Cardiothorac Vasc Anesth 2001; 5:187-206.

55.  Boyle Jr EM, Verrier ED, Spiess BD: Endothelial cell injury in cardiovascular surgery: The procoagulant response. Ann Thorac Surg 1996; 62:1549-1557.

56.  Boisclair MD, Lane DA, Philippou H, et al: Mechanisms of thrombin generation during surgery and cardiopulmonary bypass. Blood 1993; 82:3350-3357.

57.  Burman JF, Chung HI, Lane DA, et al: Role of factor XII in thrombin generation and fibrinolysis during cardiopulmonary bypass. Lancet 1994; 344:1192-1193.

58.  Edmunds Jr LH, Colman RW: Thrombin during cardiopulmonary bypass. Ann Thorac Surg 2006; 82:2315-2322.

59.  Edmunds Jr LH: Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1998; 66:S12-S16.

60.  Collen D: The plasminogen (fibrinolytic) system. Thromb Haemost 1999; 82:259-

Corresponding Author

Sanjeeta Umbarkar

Department of  Anaesthesia, Seth G.S. Medical  College  & K.E.M.Hospital, Mumbai

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., 9323273435