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Child Health Guideline Identifier

Anaesthesia - paediatric cardiac antifibrinolytic treatment

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Antifibrinolytics should be used in all patients undergoing Cardiopulmonary Bypass (CPB)

Tranexamic acid

Tranexamic acid is the default antifibrinolytic:

Give a loading dose of: 30mg/kg (maximum 1.5gms) at induction plus 30mg/kg in the bypass circuit (maximum 500mg)
Then an infusion of: 5mg/kg/hr (maximum 500mg/hr) until after bypass

Aprotinin

Aprotinin should be considered for redo surgery (depends on case and discussion with surgeon) and used for all neonates and infants undergoing complex surgery on bypass. This includes all aortic arch surgery, single ventricle surgery, and TGA repair.

Give a loading dose of: 4ml/kg (40,000IU/kg)
Then an infusion of: 1ml/kg/hr (10,000IU/kg/hr)
 PLUS Add aprotinin to the prime based on pump volume NOT patient weight. Use 5ml/100mls of prime which is about what we give the patient (slightly more maybe depending on what you think the blood volume is) 
 Standard priming volumes are:  • Neonate/infant prime about 350mls =17.5ml
 • 10-15kg prime 650ml = 32.5ml
 • >15kg prime 850 ml = 42.5ml
  • Maximum dose is 2,000,000IU load, 2,000,000IU added to the bypass circuit, and infuse to patient 500,000IU/hr.
  • Always give a small test dose to the patient BEFORE adding a dose to the CPB prime.
  • Do not use if the patient has received it in the last 3 months and, if exposed previously, give a small test dose.
  • Run the ACT >650secs when using aprotinin. Do not exceed the maximum adult doses.

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Document Control

  • Date last published: 07 June 2017
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Anaesthesia
  • Author(s): D Buckley
  • Editor: Michael Tan
  • Review frequency: 2 years

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