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Tranexamic acid in hip and spine surgery for children with cerebral palsy - a PRISMA-compliant scoping review
Daniel Gould1, Haoze Cui2, Norine Ma3
1Department of Paediatrics, The Royal Children's Hospital, University of Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia. daniel.gould@unimelb.edu.au.
Insights
Tranexamic acid (TXA) is used in pediatric CP surgeries, but optimal dosing and timing remain unclear. This review found mixed evidence on TXA efficacy and no studies on its postoperative use.
Area of Science:
- Pediatric Surgery
- Orthopedic Surgery
- Pharmacology
Background:
- Children with cerebral palsy (CP) often require major hip/spine surgeries with significant blood loss.
- Tranexamic acid (TXA) is used to mitigate blood loss, but optimal administration protocols are uncertain.
- Existing reviews focus on specific populations or dosing, lacking a comprehensive overview.
Purpose of the Study:
- To conduct a scoping review mapping the available evidence on tranexamic acid (TXA) use in pediatric hip and spine surgeries for children with CP.
- To identify gaps in the literature regarding TXA dosing, timing, and efficacy in this patient group.
Main Methods:
- A prospectively registered scoping review of heterogeneous literature.
- Screening of 14,609 records, with 52 included studies plus additional grey literature and citation searching.
- Inclusion of cohort studies, with a focus on spine surgery (76.9%).
Main Results:
- TXA dosing varied widely (loading doses 5–100 mg/kg, infusions 1–10 mg/kg/h), with doses unreported in 35.2% of studies.
- Primary outcomes included blood loss and transfusion needs; TXA was generally reported as safe.
- No studies reported postoperative TXA administration, despite a high proportion of transfusions occurring postoperatively.
Conclusions:
- While generally safe, the efficacy of TXA in pediatric CP surgeries shows mixed evidence, particularly in higher-risk patients.
- Significant gaps exist in understanding optimal TXA protocols, especially concerning postoperative administration.
- Further research is needed to establish evidence-based guidelines for TXA use in this vulnerable population.
Abstract:
Many children with cerebral palsy (CP) are frail and require major hip and/or spine surgeries associated with substantial blood loss. Tranexamic acid (TXA) is commonly used to reduce blood loss, but there is uncertainty around the optimal dose and timing of administration. There have been reviews in sub-populations and specific dosing regimens, but a broad overview of the available literature is lacking. The aim of this review was to map available evidence on TXA in hip and spine surgery for children with CP. Given the heterogeneous literature, a prospectively registered scoping review was conducted. Eligibility criteria were broad. Three screeners were involved, with the senior author consulted when disagreements were not resolved through discussion.Titles and abstracts of 14,609 records were screened, with 52 records included. Two additional records were obtained from grey literature and citation searching. Cohort studies (50.0%) were the most common. Most records (76.9%) were on spine surgery. TXA dose varied widely. Loading doses range from 5 to 100 mg/kg and intraoperative infusions from 1 to 10 mg/kg/h. Dose was not reported in 35.2% of records. Primary outcome measures included blood loss and transfusion requirements. TXA was generally reported to be safe. None of the included records reported postoperative TXA administration.While TXA is generally considered safe, there was mixed evidence on efficacy. Much of the evidence was drawn from studies in which TXA was used in patients at higher risk of bleeding or with reduced physiological reserve. There was no evidence for TXA being used postoperatively, when a large proportion of transfusions occur.
