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Updated: Feb 7, 2026
A Mouse Distraction Osteogenesis Model
Published on: November 14, 2018
Effects of Tranexamic Acid Based on its Population Pharmacokinetics in Pediatric Patients Undergoing Distraction
Eun Jung Kim1, Yong Oock Kim2, Kyu Won Shim3
1Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Tranexamic acid (TXA) infusion significantly reduced blood loss and transfusion needs in children undergoing distraction osteogenesis for craniosynostosis. This treatment also prevented post-operative D-dimer increases without impacting overall hemostasis.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Anesthesiology
Background:
- Distraction osteogenesis for craniosynostosis often leads to substantial hemorrhage and necessitates multiple blood transfusions.
- The efficacy of tranexamic acid (TXA) in mitigating surgical bleeding and transfusion requirements is established, but its specific role in TXA infusion for craniosynostosis requires further elucidation.
Purpose of the Study:
- To evaluate the effectiveness of intraoperative tranexamic acid (TXA) infusion in reducing blood loss and transfusion requirements during distraction osteogenesis for craniosynostosis.
- To assess the impact of TXA infusion on perioperative coagulation parameters, D-dimer levels, and postoperative outcomes.
Main Methods:
- A prospective study involving 48 children undergoing distraction osteogenesis for craniosynostosis.
- Participants were randomized to receive either intraoperative TXA infusion (n=23) or normal saline (control, n=25).
- Rotational thromboelastometry (ROTEM) was utilized for perioperative coagulation monitoring.
Main Results:
- The TXA group exhibited significantly lower intraoperative blood loss (81 vs. 116 mL/kg; P=0.003) and required fewer red blood cell and fresh frozen plasma transfusions.
- Postoperative clotting time was prolonged and clot strength was reduced in the control group compared to the TXA group.
- The control group showed a significant increase in D-dimer levels post-surgery, alongside longer mechanical ventilation durations and more respiratory complications.
Conclusions:
- Intraoperative TXA infusion, guided by population pharmacokinetic analysis, effectively minimizes blood loss and transfusion needs in craniosynostosis distraction osteogenesis.
- TXA infusion also prevents the postoperative rise in D-dimer levels and does not adversely affect systemic hemostasis.
Abstract:
Background: Distraction osteogenesis for craniosynostosis is associated with significant hemorrhage. Additionally, patients usually require several transfusions. Tranexamic acid (TXA) is effective for reducing blood loss and the need for transfusions during surgeries. However, the significance of TXA infusion has not been thoroughly described yet. Methods: Forty-eight children undergoing distraction osteogenesis for craniosynostosis were administered intraoperative TXA infusion (loading dose of 10 mg/kg for 15 min, followed by continuous infusion at 5 mg/kg/h throughout surgery; n = 23) or normal saline (control, n = 25). Rotational thromboelastometry (ROTEMTM) was conducted to monitor changes in coagulation perioperatively. Results: Blood loss during surgery was significantly lower in the TXA-treated group than it was in the control group (81 vs. 116 mL/kg, P = 0.003). Furthermore, significantly fewer transfusions of red blood cells and fresh frozen plasma were required in the TXA group. In the control group, clotting time during the postoperative period was longer than it was during the preoperative period. Similarly, clot strength was weaker during the postoperative period. D-dimer levels dramatically increased in the control group compared with the TXA group after surgery. The duration of mechanical ventilation and the number of postoperative respiratory-related complications were significantly greater in the control group than they were in the TXA group. Conclusions: TXA infusion based on population pharmacokinetic analysis is effective in reducing blood loss and the need for transfusions during the surgical treatment of craniosynostosis. It can also prevent the increase in D-dimer levels without affecting systemic hemostasis.
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