571 - Antifibrinolytic use in hypoproliferative thrombocytopenia

Poster Number: 571
Publication Number: 571.321

Christina M. Tempesta, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Caroline Jedlicka, Weill Cornell Medicine, NEW YORK, NY, United States; Samantha U. Mayadunna, Wagner College, Staten Island, NY, United States; Marianne E. Nellis, Weill Cornell Medicine, New York, NY, United States

Background: Despite platelet transfusions, bleeding is common in children with cancer and hypoproliferative thrombocytopenia. Antifibrinolytic (AF) agents such as tranexamic acid (TXA) and aminocaproic acid (EACA) decrease bleeding and need for blood transfusions in surgical and trauma settings and, therefore, may be helpful in thrombocytopenic bleeding.

Objective: To evaluate the effectiveness of antifibrinolytics (TXA or EACA) to decrease bleeding and need for platelet transfusions.

Design/Methods: A systematic literature review was conducted by searching Ovid MEDLINE® (1946 to October 26, 2021), Ovid EMBASE (1974 to October 26, 2021), and Cochrane Library (Wiley). Studies were included that involved children under the age of 21 with hypoproliferative thrombocytopenia who received TXA or EACA. Each abstract and full text was reviewed by two members. Data was extracted by one person for each included article. Bias assessment of each included article was performed by two individuals for each article and the results averaged.

Results: The literature search identified 1271 studies of which 3 were included for full text review. No studies were focused only on our population of interest. One study identified 44 thrombocytopenic patients ages 17-82 with hematologic malignancy who received prophylactic EACA. Fifty-nine percent of the patients did not bleed and 25% had minor bleeds not requiring platelet transfusion. In another study of 19 pediatric patients, inhaled TXA resulted in cessation of pulmonary hemorrhage within 48 hours in 18 (95%) children (and in 4 out of 4 patients with malignancy). The third study showed that diffuse alveolar hemorrhage (DAH) stopped completely within 24 hours of inhaled TXA in 10 out of 18 (56%) children (1 out of 3 children with malignancy). None of the studies noted any complications (seizures or deep vein thromboses) related to TXA or EACA use.Conclusion(s): EACA may be associated with a low risk of major spontaneous bleeding in patients with hematological disorders who are experiencing severe, refractory thrombocytopenia. In addition, inhaled TXA may control intractable DAH due to a variety of causes in critically ill pediatric patients. However, studies investigating the use of EACA or inhaled or systemic TXA in children with malignancy are extremely limited and this topic requires further investigation before conclusions can be made regarding their efficacy.