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Does tranexamic acid reduce transfusion requirements in children with cerebral palsy undergoing osteotomies? A
Claudia De Dios Domínguez1, Luis Guillermo Pérez Cadena2, Manuel Gilberto Pérez Cadena2
1University of Cantabria, Santander, Spain.
Insights
Tranexamic acid (TXA) reduces overall transfusion rates and total blood loss in children with cerebral palsy undergoing osteotomies. However, it may increase hospital stay, with no significant impact on estimated blood loss or hemoglobin levels.
Area of Science:
- Orthopedic Surgery
- Pediatric Surgery
- Pharmacology
Background:
- Children with cerebral palsy often experience hip displacement, necessitating osteotomies.
- These procedures carry a high risk of significant blood loss and the need for transfusions.
- Tranexamic acid (TXA) is a known antifibrinolytic agent with potential to mitigate bleeding during surgery.
Purpose of the Study:
- To evaluate the efficacy of tranexamic acid (TXA) in reducing blood loss and transfusion requirements in pediatric patients with cerebral palsy undergoing osteotomy.
- To conduct a comprehensive meta-analysis of existing studies to determine the impact of TXA in this specific patient population.
Main Methods:
- A systematic meta-analysis was performed, including randomized controlled trials and observational cohort studies published up to April 17, 2024.
- Studies compared the administration of TXA versus a control group in children undergoing osteotomies.
- Primary outcome was overall transfusion rate; secondary outcomes included blood loss, hemoglobin/hematocrit levels, and length of stay.
Main Results:
- TXA administration significantly decreased the overall transfusion rate (RR=0.65) and postoperative transfusion rate (RR=0.53).
- Total blood loss (TBL) was significantly reduced with TXA use (MD=-139.41).
- A notable finding was an increased length of hospital stay in the TXA group (MD=0.47), while estimated blood loss (EBL) and hematological parameters showed no significant difference.
Conclusions:
- Tranexamic acid effectively reduces transfusion needs and total blood loss in children with cerebral palsy undergoing osteotomy.
- The use of TXA may be associated with a longer hospital stay.
- Further research may be needed to explore the reasons for increased length of stay and optimize TXA protocols.
Introduction:
Children with cerebral palsy have postural alterations and hip displacements are common among them, for which osteotomies must be carried out, involving great blood loss. Tranexamic acid (TXA), a fibrinolysis inhibitor, has been shown to reduce bleeding in osteotomies. However, the effectiveness of TXA in children with cerebral palsy has not been well studied, so a comprehensive meta-analysis is required to evaluate its impact.
Objective:
We conducted a meta-analysis to investigate the effectiveness of tranexamic acid administration in reducing blood loss and transfusions during osteotomies in children with cerebral palsy.
Methods:
Databases were searched until April 17, 2024, for randomized controlled trials and observational cohort studies comparing TXA use versus a control group. The primary outcome was overall transfusion.Secondary outcomes included intraoperative transfusion, postoperative transfusion, postoperative hemoglobin (Hb), postoperative hematocrit (Hct), drop in Hct, drop in Hb, length of stay, total blood loss (TBL) and estimated blood loss (EBL). The analysis utilized pooled relative risk ratios (RR) for categorical variables, and mean difference (MD) for numerical variables. We utilized the fixed-effects model utilizing the Mantel-Haenszel method.
Results:
The analysis included 7 articles, which collectively provided data on 943 patients. It was found thatTXA administration decreases overall transfusion rate (RR = 0,65, 95 % CI: 0.47 to 0,90, p = 0,008),postoperative transfusion rate (RR = 0.53, 95 % CI: 0.36 to 0,79, p = 0.002) and TBL (MD = -139,41, 95 % CI: 221,34 to -57,48, p = 0,0009). There was less length of stay in the control group (MD = 0,47, 95 % CI: 0.10 to0,84, p = 0,01). TXA doesn't demonstrate significant differences in EBL, intraoperative transfusion rate, postoperative Hb, postoperative Hct, drop in Hct or drop in Hb.
Conclusion:
TXA reduces the need of transfusion and total blood loss and increased length of hospital stay. And TXA doesn't demonstrate significant differences in EBL, intraoperative transfusion rate, postoperative Hb, postoperative Hct, drop in Hct or drop in Hb.
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