Topical versus low-dose systemic tranexamic acid in pediatric cardiac surgery: A randomized clinical study

J Card Surg. 2020 Dec;35(12):3368-3373. doi: 10.1111/jocs.15082. Epub 2020 Sep 28.


Objectives: The current study aimed to compare the benefits of topical and low-dose systemic tranexamic acid administration in pediatric cardiac surgery.

Methods: A total of 117 children undergoing cardiac surgery for congenital heart disease were assigned into three groups. Patients in the systemic group received 20 mg/kg-1 tranexamic acid through the cardiopulmonary bypass followed by another dose of 20 mg/kg-1 after cardiopulmonary bypass separation. Patients in the topical group were administered with 50 mg/kg-1 tranexamic acid poured into the pericardium, while the control group received no antifibrinolytics. The outcome measures of bleeding and blood products transfusion were recorded over the first 48 h postoperatively.

Results: Chest tube drainage was significantly lower in both topical and systemic groups than the control group, but it did not differ between the case groups. Blood products requirement did not show a difference between groups. Neurological or thromboembolic events did not variate among the groups, and no deaths occurred in this study.

Conclusion: Topical or systemic tranexamic acid administration reduced postoperative blood loss effectively without adding an extra risk.

Keywords: blood loss; congenital heart disease; perioperative management; tranexamic acid.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Antifibrinolytic Agents*
  • Blood Loss, Surgical / prevention & control
  • Blood Transfusion
  • Cardiac Surgical Procedures*
  • Child
  • Humans
  • Postoperative Hemorrhage / prevention & control
  • Tranexamic Acid*


  • Antifibrinolytic Agents
  • Tranexamic Acid