Abstract
<jats:p>Objective. To determine effective and safe loading and maintenance doses of tranexamic acid in the perioperative period in children to improve the outcomes of anesthesiological care and postoperative intensive care. Materials and Methods. Data from 40 pediatric patients who received tranexamic acid during the perioperative period were analyzed. The loading dose of tranexamic acid was the same for all patients–10 mg/kg. Depending on the maintenance dose, patients were divided into two groups: Group 1 (20 patients) – maintenance dose was 1 mg/kg × h; Group 2 (20 patients) – 2.5 mg/kg × h. Results. Baseline parameters did not differ between the two groups. In patients of the first group, a statistically significant decrease in red blood cell parameters, prolongation of activated partial thromboplastin time, an increase in the international normalized ratio, a decrease in fibrinogen concentration, and a significant increase in D–dimer levels were most frequently observed postoperatively compared with preoperative values. In patients in Group 2, only a statistically significant decrease in platelet count, an increase in the international normalized ratio, and an increase in D–dimer levels were recorded postoperatively. After surgery, no statistically significant intergroup differences were found in red blood cell parameters, standard coagulometric and viscoelastic parameters, except for D–dimer levels, which were 2.1 times higher in Group 1 than in Group 2. Additionally, after surgery, the number of patients with hyperfibrinolysis in Group 1 was twice that in Group 2 (p = 0.006). No differences in the intraoperative use of blood components were observed between the groups. No adverse effects were observed with the use of tranexamic acid at the indicated doses. Conclusions. Hyperfibrinolysis in the perioperative period is rare in children. Its risk factors include massive blood loss and a complicated postoperative course requiring reoperation. The intraoperative use of tranexamic acid does not prevent massive blood loss. Hyperfibrinolysis may occur as a result of massive blood loss, but it is not the cause (primary mechanism) of its occurrence. Intraoperative administration of tranexamic acid to pediatric patients at a loading dose of 10 mg/kg × h in combination with a maintenance dose of 2.5 mg/kg × h is safe and effective for reducing blood loss and the incidence of hyperfibrinolysis after surgery compared to a maintenance dose of 1 mg/kg × h.</jats:p>