Background: To determine the effect of high dose tranexamic acid in decreasing immediate postoperative bleeding in children less than ten kilo body weight after complex cardiac surgery and also to evaluate the safety ...Background: To determine the effect of high dose tranexamic acid in decreasing immediate postoperative bleeding in children less than ten kilo body weight after complex cardiac surgery and also to evaluate the safety of high dose in small children. Methods: Between January-December 2015, 25 children weighing less than ten kilogram body weight underwent complex cardiac surgery for cyanotic congenital heart disease. All children were given dose of 100 mg/kg tranexamic acid at the time of anaesthetic induction and also 100 mg/kg into the CPB prime. The Median age and weight was 80 days (3 - 365) and 4.69 kg (2.4 - 7.8) respectively. The Median preoperative Hb was 10 g/dl (9.6 - 19.5 g/dl). Cardiac surgery included total intracardiac repair for TOF in 10 pts (40%), TAPVC repair in 6 (24%), arterial switch operation in 6 pts (24%), BD glenn in 1, repair of DORV with VSD in 1 and VSD closure with scimitar vein reimplantation in 1 pt. Median CPB time was 127 minutes (97 - 343) and cross clamp time was 99 (67 - 200) minutes. Moderate to deep hypothermia was maintained in all with median temperature of 24°C (18 - 32). Three children (12%) had elective open chest in view of anticipated bleeding. Results: The Median postoperative drainage was 127 ml, (range 10 - 1250 ml). The median postoperative use of whole blood was 95 ml (range 10 - 275), packed cell was 187 ml (range 50 - 400 ml), frozen plasma was 88 ml (range 30 - 170), platelet concentrate was 57 ml, (range 10 - 100 ml) and cryoprecipitate was median 47.5 ml, (range 30 - 80 ml). No neurological dysfunction and renal dysfunction has been observed in any of the pts. Out of 4 mortalities (16%), only one was attributed to bleeding (4%) due to usage of ECMO. No late neurological or renal dysfunction has been observed in remaining 21 pts on follow up. Conclusion: High dose Tranexamic acid can be safely used in small children during complex cardiac surgery with significant reduction in postoperative bleeding and blood product usage without any higher incidence of neurological, renal dysfunction or myocardial infarction.展开更多
Background:Thromboembolic events are a cause of significant morbidity and mortality in the Fontan population.We previously reported on coagulation profile changes in a cohort of patients with hypoplastic left heart sy...Background:Thromboembolic events are a cause of significant morbidity and mortality in the Fontan population.We previously reported on coagulation profile changes in a cohort of patients with hypoplastic left heart syndrome(HLHS)from Stage I through Fontan completion.In this report,we examine their clinical status,anticoagulation and incidence of thromboembolic events up to 20 years post Fontan.Methods:A retrospective chart review was conducted for twenty(20)surviving patients,from 1998 through December 2020.Patients who underwent orthotopic heart transplantation(OTx)were followed until their transplant.Patients who were found in the original study to have a factor VIII activity level>160%,were examined separately.Results:Most patients had follow-up within the last two years(2018–2020).Two patients underwent OTx and two patients died.Anticoagulation strategy was variable.Most patients were on aspirin monotherapy.There was a total of twelve thrombotic events(63.2%).These included six cerebrovascular accidents(two of which were fatal).Three out of the seven patients with elevated factor VIII activity from the original study had thromboembolic events(42.9%).Fontan complications were variable.Some degree of Fontan Associated Liver Disease was universal.Conclusions:This retrospective review of a group of single-ventricle patients post Fontan,illustrates the variability in anticoagulation therapy that exists in this population.A large proportion of patients suffered a significant thromboembolic event,including the patients with elevated factor VIII.Further investigation into the patients with elevated factor VIII may help determine whether a different antithrombotic strategy post Fontan would be beneficial.展开更多
文摘Background: To determine the effect of high dose tranexamic acid in decreasing immediate postoperative bleeding in children less than ten kilo body weight after complex cardiac surgery and also to evaluate the safety of high dose in small children. Methods: Between January-December 2015, 25 children weighing less than ten kilogram body weight underwent complex cardiac surgery for cyanotic congenital heart disease. All children were given dose of 100 mg/kg tranexamic acid at the time of anaesthetic induction and also 100 mg/kg into the CPB prime. The Median age and weight was 80 days (3 - 365) and 4.69 kg (2.4 - 7.8) respectively. The Median preoperative Hb was 10 g/dl (9.6 - 19.5 g/dl). Cardiac surgery included total intracardiac repair for TOF in 10 pts (40%), TAPVC repair in 6 (24%), arterial switch operation in 6 pts (24%), BD glenn in 1, repair of DORV with VSD in 1 and VSD closure with scimitar vein reimplantation in 1 pt. Median CPB time was 127 minutes (97 - 343) and cross clamp time was 99 (67 - 200) minutes. Moderate to deep hypothermia was maintained in all with median temperature of 24°C (18 - 32). Three children (12%) had elective open chest in view of anticipated bleeding. Results: The Median postoperative drainage was 127 ml, (range 10 - 1250 ml). The median postoperative use of whole blood was 95 ml (range 10 - 275), packed cell was 187 ml (range 50 - 400 ml), frozen plasma was 88 ml (range 30 - 170), platelet concentrate was 57 ml, (range 10 - 100 ml) and cryoprecipitate was median 47.5 ml, (range 30 - 80 ml). No neurological dysfunction and renal dysfunction has been observed in any of the pts. Out of 4 mortalities (16%), only one was attributed to bleeding (4%) due to usage of ECMO. No late neurological or renal dysfunction has been observed in remaining 21 pts on follow up. Conclusion: High dose Tranexamic acid can be safely used in small children during complex cardiac surgery with significant reduction in postoperative bleeding and blood product usage without any higher incidence of neurological, renal dysfunction or myocardial infarction.
文摘Background:Thromboembolic events are a cause of significant morbidity and mortality in the Fontan population.We previously reported on coagulation profile changes in a cohort of patients with hypoplastic left heart syndrome(HLHS)from Stage I through Fontan completion.In this report,we examine their clinical status,anticoagulation and incidence of thromboembolic events up to 20 years post Fontan.Methods:A retrospective chart review was conducted for twenty(20)surviving patients,from 1998 through December 2020.Patients who underwent orthotopic heart transplantation(OTx)were followed until their transplant.Patients who were found in the original study to have a factor VIII activity level>160%,were examined separately.Results:Most patients had follow-up within the last two years(2018–2020).Two patients underwent OTx and two patients died.Anticoagulation strategy was variable.Most patients were on aspirin monotherapy.There was a total of twelve thrombotic events(63.2%).These included six cerebrovascular accidents(two of which were fatal).Three out of the seven patients with elevated factor VIII activity from the original study had thromboembolic events(42.9%).Fontan complications were variable.Some degree of Fontan Associated Liver Disease was universal.Conclusions:This retrospective review of a group of single-ventricle patients post Fontan,illustrates the variability in anticoagulation therapy that exists in this population.A large proportion of patients suffered a significant thromboembolic event,including the patients with elevated factor VIII.Further investigation into the patients with elevated factor VIII may help determine whether a different antithrombotic strategy post Fontan would be beneficial.
