Comparative analysis of tranexamic acid use in minimally invasive versus open craniosynostosis procedures

Intraoperatively administered tranexamic acid (TXA) lessens blood loss during orthopedic and cardiovascular surgery. Its use for craniosynostosis surgery warrants investigation. Therefore, we analyzed our use of TXA during minimally invasive (MI) and open craniosynostosis procedures.

Fifty-six patients were retrospectively studied: 20 in the MI group, 10 receiving TXA; 36 in the open group, 16 receiving TXA. Study variables were weight-adjusted estimated blood loss (EBL) and calculated blood loss (CBL), transfusion and incidence, transfusion volume, and complications. Calculated blood loss was determined by a novel formula based on red cell mass.

In the MI group, median EBL was significantly lower for TXA recipients (9.62 vs 15.94 mL/kg, P = 0.0231), whereas median CBL was not (36.59 vs 34.12 mL/kg, P = 0.7976). Transfusion incidences were 80% TXA versus 100% control (P = 0.4737). Median transfusion volume trended lower (10.76 vs 19.43 mL/kg, P = 0.0723).In the open group, median EBL and CBL for TXA recipients were lower but not significantly different than for nonrecipients (21.86 vs 23.40 mL/kg, P = 0.7416; 53.54 vs 80.13; P = 0.3137). All patients had a transfusion. Median transfusion volume for TXA recipients versus nonrecipients was 34.01 versus 40.35 mL/kg (P = 0.3137). Tranexamic acid greatly minimized the range of EBL and CBL in both surgical groups. There was a significant correlation between the CBL and EBL (P < 0.0001). There were no adverse events.

Intraoperative TXA administration is safe with modest benefit suggested, especially in the MI group. Calculated blood loss correlated well with EBL at lower blood loss volumes, implicating it as a potential measurement of true blood loss.