Intraoperative Tranexamic Acid Reduces Blood Transfusion in Children Undergoing Craniosynostosis Surgery

Dadure, Christophe; Sauter, Magali; Bringuier, Sophie; Bigorre, M.; Raux, Olivier; Rochette, A.; Canaud, N.; Capdevila, Xavier

doi:10.1097/aln.0b013e318210f9e3

Cited by 212 publications

(206 citation statements)

References 35 publications

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“…Tranexamic acid has been used to decrease intraoperative blood loss during cardiac surgery. In a randomized double-blind study 33 published in 2011, patients undergoing surgical correction of craniosynostosis who were treated with erythropoietin before surgery and with tranexamic acid during the operation sustained significantly lower volumes of blood loss and received less transfused blood than did the control patients.…”

Section: Intraoperative Periodmentioning

confidence: 99%

“…Transfusion requirements can be 15% to 90% of the patient's circulating red cell volume. 33,34 Numerous techniques intended to reduce intraoperative blood loss during craniosynostosis surgery have been studied, including use of autologous blood obtained before surgery, short-term nomovolemic hemodilution, and intraoperative blood salvage. 12,15 Tranexamic acid is a synthetic antifibrinolytic drug that competitively decreases the activation of plasminogen to plasmin and suppresses fibrinolysis by inhibiting plasminogen and the binding of plasmin to fibrin.…”

Section: Intraoperative Periodmentioning

confidence: 99%

“…Coagulopathy may be consumptive or dilutional and may require specific correction with fresh-frozen plasma, platelets, or cryoprecipitate. 3,33,34 Intravenous solutions with dextrose and physiological saline are administered to maintain adequate intake and output balance and prevent electrolyte imbalances. Blood samples are obtained for laboratory tests to monitor the hematocrit level and the serum level of sodium; alterations in the sodium concentration can precipitate seizures.…”

Section: Postoperative Carementioning

confidence: 99%

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Craniosynostosis: Caring for Infants and Their Families

Burokas

2013

Critical Care Nurse

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Craniosynostosis is a developmental anomaly with premature closure of the cranial sutures causing an abnormally shaped skull in an infant. Recommended surgical treatment involves cranial vault reconstruction to open the closed suture, increase intracranial volume, and allow the brain to grow normally. Parents work with a multidisciplinary team during the evaluation process and face various preoperative and postoperative stressors. Critical care nurses can improve the care of the infants and their families by being knowledgeable about the anatomy, assessment, and surgical and nursing management of infants with this anomaly and its impact on the patients’ families. This article discusses the definitions, diagnosis, and treatment of craniosynostosis and support for parents of infants with this malformation.

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Section: Intraoperative Periodmentioning

confidence: 99%

Section: Intraoperative Periodmentioning

confidence: 99%

Section: Postoperative Carementioning

confidence: 99%

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Craniosynostosis: Caring for Infants and Their Families

Burokas

2013

Critical Care Nurse

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“…Preoperatively, autologous donations, EPO administration, new upper age limits for surgical correction, and surgical patient screening have been attempted. 10,17,18,29 Changes in anesthetic management have also been attempted to decrease perioperative transfusion rates, including acute normovolemic hemodilution (ANH), acceptance of lower hemoglobin levels, the use of autologous blood cell recycling, 14 induced hypotension, infusion of antifibrinolytic agents (amicar, tranexamic acid, aprotinin), 4,22 and factor administration (activated factor VIIa, prothrombin complex concentrate [PCC]).…”

Section: Discussionmentioning

confidence: 99%

Minimizing transfusion requirements for children undergoing craniosynostosis repair: the CHoR protocol

Vega¹,

Lyon²,

Kierce³

et al. 2014

PED

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Object Children with craniosynostosis may require cranial vault remodeling to prevent or relieve elevated intracranial pressure and to correct the underlying craniofacial abnormalities. The procedure is typically associated with significant blood loss and high transfusion rates. The risks associated with transfusions are well documented and include transmission of infectious agents, bacterial contamination, acute hemolytic reactions, transfusion-related lung injury, and transfusion-related immune modulation. This study presents the Children's Hospital of Richmond (CHoR) protocol, which was developed to reduce the rate of blood transfusion in infants undergoing primary craniosynostosis repair. Methods A retrospective chart review of pediatric patients treated between January 2003 and Febuary 2012 was performed. The CHoR protocol was instituted in November 2008, with the following 3 components; 1) the use of preoperative erythropoietin and iron therapy, 2) the use of an intraoperative blood recycling device, and 3) acceptance of a lower level of hemoglobin as a trigger for transfusion (< 7 g/dl). Patients who underwent surgery prior to the protocol implementation served as controls. Results A total of 60 children were included in the study, 32 of whom were treated with the CHoR protocol. The control (C) and protocol (P) groups were comparable with respect to patient age (7 vs 8.4 months, p = 0.145). Recombinant erythropoietin effectively raised the mean preoperative hemoglobin level in the P group (12 vs 9.7 g/dl, p < 0.001). Although adoption of more aggressive surgical vault remodeling in 2008 resulted in a higher estimated blood loss (212 vs 114.5 ml, p = 0.004) and length of surgery (4 vs 2.8 hours, p < 0.001), transfusion was performed in significantly fewer cases in the P group (56% vs 96%, p < 0.001). The mean length of stay in the hospital was shorter for the P group (2.6 vs 3.4 days, p < 0.001). Conclusions A protocol that includes preoperative administration of recombinant erythropoietin, intraoperative autologous blood recycling, and accepting a lower transfusion trigger significantly decreased transfusion utilization (p < 0.001). A decreased length of stay (p < 0.001) was seen, although the authors did not investigate whether composite transfusion complication reductions led to better outcomes.

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“…Craniosynostosis is not an uncommon pediatric disease requiring early surgical intervention and is associated with considerable blood loss [53]. There are two RCTs of TXA vs control in craniosynostosis surgery [54,55]: Goobie et al showed significant decrease in blood loss of 54 mL kg-1 and decreased volume of blood transfused by 23 mL kg -1 ; Dadure et al [55] found a decrease in transfusion requirement by 85% (11 to 1.6 mL kg -1 ) intraoperatively and by 57% (16.6 to 7.2 mL kg -1 ) postoperatively. Moreover, Goobie et al [44] describes a dose regimen for craniosynostosis using a twocompartment model, suggesting a 10 mg kg -1 loading TXA followed by a 5 mg kg -1 h -1 infusion to produce a threshold plasma concentration of 16 µg mL -1 .…”

Section: Ppediatric Cardiac and Non-cardiac Surgerymentioning

confidence: 99%

Tranexamic acid: a clinical review

Jerath

Wąsowicz

2015

Anaesthesiol Intensive Ther

250

151

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Blood loss and subsequent transfusions are associated with major morbidity and mortality. The use of antifibrinolytics can reduce blood loss in cardiac surgery, trauma, orthopedic surgery, liver surgery and solid organ transplantation, obstetrics and gynecology, neurosurgery and non-surgical diseases. The evidence of their efficacy has been mounting for years. Tranexamic acid (TXA), a synthetic lysine-analogue antifibrinolytic, was first patented in 1957 and its use has been increasing in contrast to aprotinin, a serine protease inhibitor antifibrinolytic. This review aims to help acute care physicians navigate through the clinical evidence available for TXA therapy, develop appropriate dose regimens whilst minimizing harm, as well as understand its broadening scope of applications. Many questions remain unanswered regarding other clinical effects of TXA such as anti-inflammatory response to cardiopulmonary bypass, the risk of thromboembolic events, adverse neurological effects such as seizures, and its morbidity and mortality, all of which necessitate further clinical trials on its usage and safety in various clinical settings.

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Intraoperative Tranexamic Acid Reduces Blood Transfusion in Children Undergoing Craniosynostosis Surgery

Cited by 212 publications

References 35 publications

Craniosynostosis: Caring for Infants and Their Families

Craniosynostosis: Caring for Infants and Their Families

Minimizing transfusion requirements for children undergoing craniosynostosis repair: the CHoR protocol

Tranexamic acid: a clinical review

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