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Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid

Christian Fenger-Eriksen1, Alexander D'Amore Lindholm1, Sven Erik Nørholt2

  • 1Department of Anaesthesiology, Aarhus University Hospital, Denmark.

British Journal of Anaesthesia
|April 7, 2019
PubMed

Insights

Combined tranexamic acid (TXA) treatment significantly reduced blood loss and transfusion needs in children undergoing craniosynostosis surgery. This approach improved clot stability, offering a potential method to minimize blood loss.

Area of Science:

  • Pediatric Surgery
  • Anesthesiology
  • Hematology

Background:

  • Tranexamic acid (TXA) is known to reduce intraoperative blood loss in pediatric craniosynostosis surgery.
  • Further reduction in postoperative blood loss could minimize exposure to allogeneic blood products.

Purpose of the Study:

  • To investigate the efficacy of combined intraoperative and postoperative TXA in reducing postoperative blood loss in pediatric craniosynostosis surgery.

Main Methods:

  • A randomized controlled trial involving 30 children undergoing craniosynostosis surgery.
  • Participants received either combined intra- and postoperative TXA or a placebo.
  • Primary endpoint was postoperative blood loss; secondary endpoints included total blood loss, transfusion requirements, and clot stability.

Main Results:

  • TXA significantly reduced postoperative blood loss by 18 ml/kg and total blood loss from 52 ml/kg to 28 ml/kg (P<0.001).
  • Transfusions of red blood cells (RBCs) and fresh frozen plasma (FFP) were significantly reduced in the TXA group.
  • Clot stability, assessed by tissue plasminogen activator-stimulated clot lysis assay, was significantly higher in the TXA group (P<0.001).

Conclusions:

  • Combined intra- and postoperative TXA effectively reduces both postoperative and overall blood loss in pediatric craniosynostosis surgery.
  • The treatment also decreases the need for blood transfusions.
  • Enhanced clot stability is a likely mechanism contributing to the observed reduction in blood loss.
Abstract

Keywords:
antifibrinolyticsblood transfusioncoagulationcraniosynostosisfibrinolysisgeneral surgeryhaemorrhagepaediatric

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