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Tranexamic Acid reducing blood transfusion in children undergoing craniosynostosis surgery
Guodong Song1, Ping Yang, Songsong Zhu
1Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu 610041, China.
Insights
Tranexamic acid (TXA) significantly reduces packed red blood cell transfusions in pediatric craniosynostosis surgery. However, its effectiveness in decreasing blood loss remains uncertain, warranting further research.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pharmacology
Background:
- Craniosynostosis surgery in children involves significant blood loss.
- Tranexamic acid (TXA) is used in other surgeries to reduce bleeding, but its role in craniosynostosis is unclear.
- This meta-analysis evaluates TXA's efficacy in pediatric craniosynostosis procedures.
Purpose of the Study:
- To determine if TXA reduces packed red blood cell (PRBC) transfusions.
- To assess if TXA decreases blood loss during pediatric craniosynostosis surgery.
Main Methods:
- A meta-analysis of published comparative studies.
- Searched PubMed and EMBASE databases up to June 2012.
- Included 4 studies with 138 patients.
Main Results:
- TXA significantly reduced PRBC transfusions (WMD = -10.81, P < 0.00001).
- Overall meta-analysis showed a significant reduction in blood loss (WMD = -20.53, P = 0.0006).
- Subgroup analysis of randomized controlled trials indicated no significant reduction in blood loss (P = 0.14).
Conclusions:
- TXA effectively reduces PRBC transfusions in pediatric craniosynostosis surgery.
- Controversy exists regarding TXA's efficacy in reducing blood loss.
- Further randomized controlled trials are needed to clarify TXA's effect on blood loss in these patients.
Background:
Surgical correction of craniosynostosis in children is associated with substantial intraoperative bleeding. Intraoperatively administered tranexamic acid (TXA) can lessen blood loss during orthopedic and cardiovascular surgery, but its efficacy in craniosynostosis surgery is uncertain. Therefore, a meta-analysis performed with published comparative studies was to determine whether TXA could reduce packed red blood cells (or erythrocytes) (PRBCs) transfused and blood loss during pediatric craniosynostosis surgery.
Methods:
Two PubMed and EMBASE electronic databases were searched until June 2012. Eligible studies were restricted in comparative controlled trials.
Results:
Four studies in 3 articles with 138 patients were included. The results showed that intraoperative administration of TXA can significantly reduce transfusion of PRBCs (weighed mean difference [WMD] = -10.81, 95% confidence interval [CI] = -16.84 to -4.78, P < 0.00001). In the level of blood loss, the meta-analysis on 4 studies showed that the difference was statistically significant (WMD = -20.53, 95% CI = -32.26 to -8.80, P = 0.0006) between the TXA groups and the control groups. However, the subgroup analysis on randomized controlled trials showed that TXA did not significantly reduce blood loss during surgery compared with the placebo group (WMD = -30.79, 95% CIs = -71.72 to 10.14, P = 0.14).
Conclusions:
Tranexamic acid can significantly reduce the transfusion of PRBCs in children undergoing craniosynostosis surgery. However, there is a controversy on the efficacy of TXA in reducing blood loss. Therefore, new randomized controlled trials to assess the effects of TXA in children with craniosynostosis surgery should be conducted.
