Fig. 4.
Simulated concentrations of tranexamic acid obtained with the dosing schemes described previously in the literature, for children with a body weight between 5 and 40 kg. We assumed that the total duration of the surgical procedure was 4 h, that there was 2 h between the first bolus dose and the cardiopulmonary bypass (CPB) initiation, that the CPB duration was 70 min, and that the continuous infusion (when present) was started immediately after the end of the bolus dose and maintained until the end of the procedure. Unless stated otherwise, we considered that all the discontinuous doses were given over 30 min, except the doses into the CPB prime volume over 5 min. Discontinuous schemes were a 50-mg/kg bolus (A),7,11,14 two 20-mg/kg doses (B),7 or three 10- (C) or 100-mg/kg (D) doses (with one into the CPB prime volume).6–8 Continuous schemes were a 10-mg/kg bolus followed with a 1-mg·kg−1·h−1 infusion (E),7 a 100-mg/kg bolus given over 15 min followed by a 10-mg·kg−1·h−1 infusion and another 100 mg/kg dose in the CPB prime volume (F),9 and a 50-mg/kg bolus followed by a 15-mg·kg−1·h−1 infusion and another 50-mg/kg dose in the CPB prime volume (G).10 The gray horizontal lines in each plot represent the threshold target concentration of 20 µg/ml.