Effectiveness of Prophylactic Tranexamic Acid in Reducing Blood Loss in Children Undergoing Open Nephrectomy for Wilms Tumor: A Randomized Controlled Study.

Introduction Nephrectomy for Wilms tumor is often associated with significant intraoperative blood loss. Tranexamic acid (TXA) is effective in reducing intraoperative bleeding during a wide variety of surgeries in adults and cranial and cardiac surgeries in children. This study aimed to determine the effect of TXA in reducing blood loss in nephrectomy for Wilms tumor, a common malignancy among children. The primary objective was to assess its effect on the amount of intraoperative blood loss. Secondary objectives were to measure packed red blood cells (PRBC) transfusion requirements and evaluate intraoperative hemodynamic parameters. Materials and methods In this randomized controlled study, 30 children belonging to the TXA group (intervention arm) received a loading dose of intravenous TXA 50 mg/kg over 10 minutes immediately after induction, followed by its infusion at 5 mg/kg/h. Thirty patients belonging to the normal saline (NS) group (control arm) received intravenous NS of the same volume, without any active drug. Results The TXA group has significantly lower intraoperative surgical blood (216.33 vs 306.33 mL; p=0.001). The mean volume of PRBC transfused was also lower in the TXA group (167.0 vs 199.8 mL; p=0.045). The serum lactate at the end of surgery in the TXA group was lower than the control group (1.82 vs 2.63 mmol/L; p=0.001). Mean arterial blood pressure (MAP) and heart rate were similar in both groups. No adverse events were identified either intraoperatively or in the immediate postoperative period. Conclusion Intravenous TXA is significantly effective in decreasing intraoperative blood loss in children undergoing nephrectomy.