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Role of tranexamic acid in craniosynostosis surgery: Systematic review and meta-analysis
James A Zapata-Copete1, Juan Camilo Gómez-Ospina2, Herney Andrés García-Perdomo2
1Plastic Surgery Section, Surgery Department, Universidad del Valle. Cali, Colombia; Plastic Surgery Research Group (PLASTICUV), Universidad del Valle. Cali, Colombia; Urological Research Group (UROGIV), Universidad del Valle. Cali, Colombia.
Insights
Tranexamic acid (TXA) significantly reduces blood loss and transfusion needs in pediatric craniosynostosis surgery compared to placebo. This finding supports TXA
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pharmacology
Background:
- Craniosynostosis surgery in children often involves significant blood loss.
- Blood transfusions carry inherent risks.
- Effective methods to reduce perioperative blood loss are crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of tranexamic acid (TXA) in minimizing blood loss and transfusion requirements during pediatric craniosynostosis repair.
- To compare TXA with placebo or no intervention in this specific surgical population.
Main Methods:
- A systematic review and meta-analysis of 11 studies involving 752 patients.
- Inclusion of randomized controlled trials, observational studies, case-control, and cohort studies.
- Primary outcomes: blood loss and transfusion necessity; Secondary outcomes: hemoglobin, hematocrit, and adverse events. Risk of bias assessed using Cochrane Collaboration tool.
Main Results:
- TXA significantly reduced blood loss (MD -15.47 mL; 95% CI -23.82 to -7.11) and the need for transfusions (MD -8.18 units; 95% CI -12.24 to -4.11) compared to placebo.
- Results were consistent across study types, and secondary outcomes favored TXA.
- No adverse effects associated with TXA use were reported in the included studies.
Conclusions:
- Tranexamic acid is effective in reducing blood loss and transfusion requirements in children undergoing craniosynostosis surgery.
- The findings support the integration of TXA into surgical protocols for these procedures.
- TXA appears to be a safe adjunct for managing perioperative bleeding in pediatric craniosynostosis repair.
Objective:
This study aimed to determine the efficacy and harms of using tranexamic acid (TXA) versus placebo/no intervention to reduce blood loss and the need for transfusion in children undergoing surgical correction of craniosynostosis.
Methods:
We searched MEDLINE (OVID), EMBASE, LILACS, CENTRAL, and other sources. We included clinical trials, prospective, retrospective observational studies, case-control studies, and cohort studies. The primary outcomes were blood loss and the need for a transfusion, and secondary outcomes were hemoglobin, hematocrit, and adverse effects. We assessed the risk of bias with the Cochrane Collaboration tool. We performed the statistical analysis in R and reported information about the mean difference (MD) with a 95% confidence interval (CI). We evaluated heterogeneity with the I2 test. We produced forest plots to show the amount of evidence available for each outcome and made subgroup analyses.
Results:
We included 11 studies in qualitative and quantitative analysis accounting for 752 patients. In general, the risk of all bias was assessed as low for non-randomized studies, and we found high performance and detection bias in one randomized study. TXA significantly reduced blood loss and need for transfusion compared to placebo/no intervention with an MD of -15.47 (95%CI -23.82, -7.11) and -8.18 (95%CI -12.24, -4.11), respectively. These differences were maintained regardless of the type of study, secondary outcomes also favored TXA, and there was no report of adverse effects.
Conclusions:
TXA reduces blood loss and the need for transfusion when compared to placebo/no intervention. The available studies on this topic suggest its use in these patients and its implementation in surgery protocols.
