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Tranexamic Acid in Hip Reconstructions in Children with Cerebral Palsy: A Double-Blind Randomized Controlled Clinical
Alexandre Zuccon1, Paulo Rogério Cardozo Kanaji1, Dávia Serafini Barcellos1
1Disabled Children's Care Association of São Paulo (AACD-SP), São Paulo 04027-000, Brazil.
Insights
Tranexamic acid (TXA) effectively reduces intraoperative bleeding in pediatric patients with cerebral palsy undergoing hip surgery. This study confirms TXA
Area of Science:
- Orthopedic Surgery
- Pediatric Medicine
- Hematology
Background:
- Surgical treatment for hip dislocation in cerebral palsy (CP) necessitates careful management of blood loss and transfusions.
- Tranexamic acid (TXA) is recognized for controlling bleeding in orthopedic procedures, but its efficacy in CP hip surgery is understudied.
Purpose of the Study:
- To assess the efficacy and safety of tranexamic acid (TXA) in minimizing bleeding during hip surgery for pediatric patients with cerebral palsy.
Main Methods:
- A randomized study involving 31 pediatric patients with CP undergoing hip dislocation surgery.
- Patients were divided into a control group (n=10) and a TXA group (n=21).
- Analyzed intraoperative bleeding (IB), hemoglobin levels, and length of hospital stay (LHS).
Main Results:
- TXA significantly reduced intraoperative bleeding (p=0.02).
- Hemoglobin variance was lower in the TXA group, though not statistically significant (p=0.06).
- No significant differences were observed in length of hospital stay or transfusion rates.
Conclusions:
- Tranexamic acid is effective and safe for reducing intraoperative bleeding in pediatric cerebral palsy patients undergoing hip surgery.
Abstract:
Surgical treatment is indicated for hip dislocation in patients with cerebral palsy (CP), but it requires care due to the state of nutrition and associated clinical comorbidities. The use of resources that minimize blood loss and the need for blood transfusions are essential to avoid complications. Tranexamic acid (TXA) has been highlighted for orthopedic surgeries to control intraoperative bleeding; however, there is a lack of large studies for its use in hip surgeries in patients with CP. This study aims to evaluate the efficacy and safety of tranexamic acid to reduce bleeding in pediatric patients with cerebral palsy undergoing surgical treatment for hip instability. A sample of 31 patients with CP who underwent surgical treatment for hip dislocation (hip adductor stretching, varization osteotomy of the proximal femur and acetabuloplasty using the Dega technique) was randomly divided into groups: control (n = 10) and TXA (n = 21). Preoperative and 24 h hemoglobin concentrations, the length of hospital stay (LHS), and intraoperative bleeding (IB) were analyzed. TXA significantly reduced the IB (p = 0.02). The variance in hemoglobin concentration was lower for the TXA group, but without statistical significance (p = 0.06). There was no difference in LHS. Also, no statistical difference was observed for the number of transfusions (p = 0.08). The findings provide evidence of the effectiveness of TXA in decreasing intraoperative bleeding and its safety for use in pediatric patients with cerebral palsy.
