Efficacy of Tranexamic Acid in Pediatric Craniosynostosis Surgery

Goobie, Susan M.; Meier, Petra M.; Pereira, Luis M.; McGowan, Francis X.; Prescilla, Randy; Scharp, Laurie A.; Rogers, Gary F.; Proctor, Mark R.; Meara, John G.; Soriano, Sulpicio G.; Zurakowski, David; Sethna, Navil F.

doi:10.1097/aln.0b013e318210fd8f

Cited by 286 publications

(274 citation statements)

References 47 publications

(49 reference statements)

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“…The calculated blood loss formula was used to determine the volume of blood lost per kilogram during the operation. The following formula, developed and described for this population by Kearney et al [10], was also used in a recent publication by Goobie et al [11]: …”

Section: Methodsmentioning

confidence: 99%

Factors Influencing Blood Loss and Postoperative Morbidity in Children Undergoing Craniosynostosis Surgery: A Retrospective Study

Ali¹,

Başaran²,

Yornuk³

et al. 2013

Pediatr Neurosurg

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Background: Craniosynostosis is a condition resulting from the premature fusion of cranial sutures. Corrective surgery is often associated with a large amount of blood loss, with transfusion of red blood cells (RBC) and fresh frozen plasma (FFP). The aims of this study were to determine the variables associated with increased blood loss and postoperative complications. Methods: A retrospective analysis was performed of 42 pediatric patients who underwent craniosynostosis surgery. We analyzed the following: demographic parameters, duration of surgery, intraoperative blood loss, RBC, FFP and fluid transfusion, urine output, and hemodynamic parameters. In addition, we recorded the postoperative length of stay in the intensive care unit and hospital, postoperative blood loss and early complications. Results: The mean age, weight and surgical duration were 9.2 ± 3.2 months, 9.3 ± 2.0 kg and 255.8 ± 46.7 min, respectively. Intraoperative blood loss was 61.2 ± 15.3 ml/kg and RBC, FFP and fluid transfusion were 27.3 ± 7.1 ml/kg, 16.5 ± 4.7 ml/kg and 21.7 ± 4.6 ml/kg/h, respectively. Greater intraoperative blood loss was associated with longer surgical duration (p = 0.001, correlation coefficient = 0.495, R² = 0.245) and lower patient weight (p < 0.001, correlation coefficient = -0.557, R² = 0.311). Longer hospital stay was associated with greater intraoperative blood loss (p < 0.001, correlation coefficient = 0.754, R² = 0.568) and greater intraoperative RBC transfusion (p < 0.001, correlation coefficient = 0.795, R² = 0.632). Conclusion: Severe blood loss occurred in all children who underwent craniosynostotic corrections. Furthermore, the duration of surgery, patient weight and certain surgical procedures correlated with greater blood loss. Careful hemodynamic monitoring and evaluation of a patient's hematocrit value and volume status together may be helpful in maintaining the balance between insufficient and excessive blood product transfusion.

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Section: Methodsmentioning

confidence: 99%

Factors Influencing Blood Loss and Postoperative Morbidity in Children Undergoing Craniosynostosis Surgery: A Retrospective Study

Ali¹,

Başaran²,

Yornuk³

et al. 2013

Pediatr Neurosurg

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“…Advantages of antifibrinolytics administration for reducing blood loss include patient tolerance of side effects (lysine analogues), ease of administration, inexpensive cost (the lysine analogues), and efficacy [7,8]. Specifically, aprotinin (a non-specific serine protease inhibitor) and two lysine-analogues, tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA), have demonstrated efficacy in reducing blood loss in pediatric cardiac surgery (pCS) [7] and pediatric spine surgery (pSS) [8], and their use is becoming more prevalent in pediatric craniofacial surgery (pCF) [9,10].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the use of antifibrinolytic agents in pediatric surgery and implications for craniofacial use

2012

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A systematic review aimed to evaluate the efficacy and safety of aprotinin, epsilon-aminocaproic acid (EACA), and tranexamic acid (TXA) in reducing perioperative blood loss, risk for transfusion, and total perioperative transfusion volume in major pediatric surgery. Medline, Embase, and Cochrane Reviews were searched for relevant articles published from January 1990 to January 2012. Additional studies were identified by cross-referencing citations and extracting data from recent published reviews. Data were recorded and analyzed using Cochrane's RevMan5.1 software. Thirty-four studies were included in this review of which 21 provided level 1b evidence, 11 were level 2b, and two were level 3b. As compared to control groups, antifibrinolytics reduced perioperative blood loss by standardized mean difference (SMD) of -0.70 (-0.89, -0.50; p<0.00001), total transfusion volume by SMD of -0.78 (-0.95, -0.61; p < 0.00001), and Odds Ratio (OR) for transfusion was 0.39 (0.23, 0.64; p=0.002). The OR for adverse events attributable to treatment was not statistically significant across groups (OR = 0.96; p = 0.58). Antifibrinolytics are effective in reducing blood loss and transfusion requirements in major pediatric surgery. TXA and EACA also appear to have reasonable side-effect profiles. Application to craniofacial surgery is promising, though further investigation is necessary.

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“…This inhibits the proteolytic action of plasmin on fibrin clots and platelet receptors, inhibiting fibrinolysis at the surgical wound (Dunn and Goa, 1999). Recently, TXA has been described as a useful adjuvant for reducing blood loss and transfusion requirements in craniofacial surgery (Goobie et al, 2011;Holcomb, 2011;Maugans et al, 2011;Oppenheimer et al, 2014). As recent investigations have been criticized for the heterogenous study population due to different surgical techniques, the present study evaluates the effectiveness of TXA in reducing intraoperative blood loss and RBC transfusion in a homogenous study population of children with isolated metopic synostosis treated with FOA.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the low circulating blood volume of infants, FOA is usually accompanied by the need for red blood cell (RBC) transfusions (Maugans et al, 2011;Oppenheimer et al, 2014). Meticulous hemostasis and early transfusion can minimize the results of blood loss; several complications related to extensive perioperative bleeding have been published and vary from severe hypotension, metabolic acidosis, cardiac arrest, transfusion reactions, venous air embolism, coagulopathies, infections, acute lung injury, postoperative ventilation and death (Goobie et al, 2011). Tranexamic acid (TXA; trans 4-aminomethyl cyclohexane carboxylic acid; Cyklokapron) is a synthetic lysine analog that competitively blocks the conversion of plasminogen into plasmin.…”

Section: Introductionmentioning

confidence: 99%

The value of tranexamic acid during fronto-orbital advancement in isolated metopic craniosynostosis

Engel¹,

Bodem²,

Busch³

et al. 2015

Journal of Cranio-Maxillofacial Surgery

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Efficacy of Tranexamic Acid in Pediatric Craniosynostosis Surgery

Abstract: TXA is effective in reducing perioperative blood loss and transfusion requirement in children undergoing craniosynostosis reconstruction surgery.

Cited by 286 publications

References 47 publications

Factors Influencing Blood Loss and Postoperative Morbidity in Children Undergoing Craniosynostosis Surgery: A Retrospective Study

Factors Influencing Blood Loss and Postoperative Morbidity in Children Undergoing Craniosynostosis Surgery: A Retrospective Study

A systematic review of the use of antifibrinolytic agents in pediatric surgery and implications for craniofacial use

The value of tranexamic acid during fronto-orbital advancement in isolated metopic craniosynostosis

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