30 - The efficacy of antifibrinolytics in children undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis.

Poster Number: 30
Publication Number: 30.102

Katherine Schertz, Weill Cornell Medicine, NEW YORK, NY, United States; Oliver Karam, Children's Hospital of Richmond at VCU, Richmond, VA, United States; Michelle Demetres, Weill Cornell Medicine, New York, NY, United States; Samantha U. Mayadunna, Wagner College, Staten Island, NY, United States; David Faraoni, Texas Children’s Hospital, Houston, TX, United States; Marianne E. Nellis, Weill Cornell Medicine, New York, NY, United States

Background: Fibrinolytic activation during cardiopulmonary bypass (CPB) is a known source of bleeding in patients undergoing cardiac surgery. Administration of antifibrinolytics has been well studied in the adult population as a method to reduce blood loss and decrease the need for transfusions, but its efficacy in the pediatric population is unclear. In this systematic review and meta-analysis, we sought to assess the efficacy of antifibrinolytics during and after CPB in children.

Objective: To determine the effect of intraoperative administration of antifibrinolytics, including tranexamic acid (TXA), aminocaproic acid (EACA), or aprotinin, on chest tube output and/or the need for blood product transfusion after CPB compared to placebo.

Design/Methods: We conducted a systematic review and meta-analysis of several databases from inception to November 15, 2021. Adult-only studies, non-human studies, and case series were excluded. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Chest tube bleeding and volume of post-operative transfusion of blood components were evaluated.

Results: Seventy studies including 28,735 patients were analyzed. TXA compared to placebo resulted in a mean decrease in chest tube output of 9.1 (95% CI 6.0-12.3) ml/kg, a mean decrease in red blood cell (RBC) transfusion of 4.5 (95% CI 2.4-6.6) ml/kg, a mean decrease in platelet transfusion of 2.9 (95% CI 0.1-5.8) ml/kg, and a mean decrease in plasma of transfusion of 4.0 (95% CI 0.6-7.2) ml/kg at 24-hour after surgery. Aprotinin compared to placebo resulted in a mean decrease in chest tube output of 4.3 (2.4-6.2) ml/kg, a mean decrease in RBC transfusion of 2.3 (0.5-4.1) ml/kg, a mean decrease in platelet transfusion of 4.6 (0.6-8.6) ml/kg, and a mean decrease in plasma transfusion of 7.7 (2.1-13.2) ml/kg. EACA compared to placebo resulted in a mean decrease in chest tube output of 9.2 (2.3-21.0) ml/kg, a mean decrease in RBC transfusion of 7.2 (2.4-12.1) ml/kg, a mean decrease in platelet transfusion of 10.7 (2.9-18.5) ml/kg, and a mean decrease in plasma transfusion of 2.5 (0.5-4.5) ml/kg. TXA compared to aprotinin resulted in a mean decrease in chest tube output by 4.0 (CI 95% 1.9-6.0) ml/kg. There were no studies that compared TXA to EACA.Conclusion(s): TXA, EACA and aprotinin are potentially effective at decreasing blood loss and blood product requirement following CPB in children undergoing cardiac surgery. When compared to aprotinin, TXA and EACA show a greater effect on bleeding and transfusion requirement.
CV_KS_51821.pdf