Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid infusion: a randomised trial

Fenger-Eriksen, Christian; Lindholm, Alexander D'Amore; Nørholt, Sven Erik; Öettingen, Gorm von; Tarpgaard, Mona; Krogh, L.; Juul, Niels; Hvas, Anne Mette; Rasmussen, Mads

doi:10.1016/j.bja.2019.02.017

Cited by 36 publications

(78 citation statements)

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“…Thirteen studies were eligible for our review. Of the 13 studies, 4 were prospective, randomized, double-blind controlled trials [9,10,14,15], 9 were retrospective studies, tailored as a "before-after" studies, comparing blood loss and transfusion without/with TXA [16][17][18][19][20][21][22][23][24]. Study characteristics are presented in Table 1 and 2.…”

Section: Selection Of Reports and Study Designmentioning

confidence: 99%

“…Protocols of TXA administration varied from one study to another. A loading dose was commonly used, with doses ranging from 10 mg/kg [14,15,18,[20][21][22] to 100 mg/kg [16], usually infused over 15 minutes after induction of general anesthesia and before skin incision. A continuous infusion until skin closure was performed in all studies, with different protocols: 5 mg/kg/h [10,14,18,[20][21][22][23] or 10 mg/kg/h [9,16,17,19,24].…”

Section: Analysis Of Protocolsmentioning

confidence: 99%

“…No TXA was used postoperatively except in two recent studies [15,22]. Kurnik et al [22] compared a continous infusion during the 24 hours after the end of surgery to an infusion J o u r n a l P r e -p r o o f stopped 4 hours postoperatively.…”

Section: Analysis Of Protocolsmentioning

confidence: 99%

“…Blood loss volume showed no difference between the 2 groups, neither did length of stay in the pediatric intensive care unit. Fenger-Eriksen et al [15] used a protocol with a bolus dose of 10 ml/kg before incision followed by 8 hours' continuous infusion of 3 mL/kg/h.…”

Section: Analysis Of Protocolsmentioning

confidence: 99%

“…Various parameters were studied in these reports including age, gender, weight, primary or redo surgery, ASA status, urine output, pre-and postoperative hematocrit/hemoglobin/platelet In 10 of the 13 studies, results were obviously the same: the use of TXA significantly reduces the volume of PRBC transfusion when compared to the placebo group [9,10,14,15] or to a group without TXA [17-19, 21, 23, 24]. In 2 studies [16,20], the volume of PRBC transfused was similar between the TXA+ / TXA-groups of patients undergoing open procedures.…”

Section: Blood Loss and Blood Transfusionmentioning

confidence: 99%

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Reducing blood loss in pediatric craniosynostosis surgery by use of tranexamic acid

Eustache

Riffaud

2019

Neurochirurgie

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Introduction. Craniosysnostosis surgical corrections are routine procedures in the pediatric neurosurgical field. However, these procedures result in significant blood loss. Tranexamic acid (TXA) is an antifibrinolytic drug which has demonstrated a significant reduction in perioperative blood loss in many pediatric surgical procedures such as cardiac surgery and scoliosis surgery. We conducted a systematic review to evaluate protocols of TXA use in pediatric craniosynostosis procedures and its effect on intra-operative blood loss and transfusions. Material and methods. A comprehensive literature review of the National Library of Medicine (PubMed) database was performed to identify relevant studies. We included any clinical study reporting on blood loss or blood transfusion for pediatric craniosynostosis surgery with intraoperative use of tranexamic acid, with the following limits: publication date from inception to May 2019; reports in English. Results. Thirteen studies were eligible for our review. Of the 13 studies, 4 were prospective, randomized, double-blind controlled trials, 9 were retrospective studies, tailored as a "beforeafter" studies, comparing blood loss and transfusion without/with TXA. TXA significantly decreases the number and volume of packed red blood cell transfusions and the rate of transfusion in children undergoing craniosynostosis surgery. Significantly fewer fresh frozen plasma transfusions were required in the TXA groups in 2 randomized studies. Length of stay in hospital was significantly lower with the use of TXA in three studies. Advantages of TXA administration also include an excellent patient tolerance of side effects, ease of administration and low cost. Conclusion. TXA significantly reduces blood loss and the need for transfusions in children undergoing craniosynostosis surgery. TXA administration should be a routine part of strategy to reduce blood loss and limit transfusions in these procedures.

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Section: Selection Of Reports and Study Designmentioning

confidence: 99%

Section: Analysis Of Protocolsmentioning

confidence: 99%

Section: Analysis Of Protocolsmentioning

confidence: 99%

Section: Analysis Of Protocolsmentioning

confidence: 99%

Section: Blood Loss and Blood Transfusionmentioning

confidence: 99%

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Reducing blood loss in pediatric craniosynostosis surgery by use of tranexamic acid

Eustache

Riffaud

2019

Neurochirurgie

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Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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IMPORTANCE Tranexamic acid (TXA) is an efficient antifibrinolytic agent; however, concerns remain about the potential adverse effects, particularly vascular occlusive events, that may be associated with its use.OBJECTIVE To examine the association between intravenous TXA and total thromboembolic events (TEs) and mortality in patients of all ages and of any medical disciplines.DATA SOURCE Cochrane Central Register of Controlled Trials and MEDLINE were searched for eligible studies investigating intravenous TXA and postinterventional outcome published between 1976 and 2020.STUDY SELECTION Randomized clinical trials comparing intravenous TXA with placebo/no treatment. The electronic database search yielded a total of 782 studies, and 381 were considered for full-text review. Included studies were published in English, German, French, and Spanish. Studies with only oral or topical tranexamic administration were excluded.DATA EXTRACTION AND SYNTHESIS Meta-analysis, subgroup and sensitivity analysis, and meta-regression were performed. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Vascular occlusive events and mortality.RESULTS A total of 216 eligible trials including 125 550 patients were analyzed. Total TEs were found in 1020 (2.1%) in the group receiving TXA and 900 (2.0%) in the control group. This study found no association between TXA and risk for total TEs (risk difference = 0.001; 95% CI, −0.001 to 0.002; P = .49) for venous thrombosis, pulmonary embolism, venous TEs, myocardial infarction or ischemia, and cerebral infarction or ischemia. Sensitivity analysis using the risk ratio as an effect measure with (risk ratio = 1.02; 95% CI, 0.94-1.11; P = .56) and without (risk ratio = 1.03; 95% CI, 0.95-1.12; P = .52) studies with double-zero events revealed robust effect size estimates. Sensitivity analysis with studies judged at low risk for selection bias showed similar results. Administration of TXA was associated with a significant reduction in overall mortality and bleeding mortality but not with nonbleeding mortality. In addition, an increased risk for vascular occlusive events was not found in studies including patients with a history of thromboembolism. Comparison of studies with sample sizes of less than or equal to 99 (risk difference = 0.004; 95% CI, −0.006 to 0.014; P = .40), 100 to 999 (risk difference = 0.004; 95% CI, −0.003 to 0.011; P = .26), and greater than or equal to 1000 (risk difference = −0.001; 95% CI, −0.003 to 0.001; P = .44) showed no association between TXA and incidence of total TEs. Meta-regression of 143 intervention groups showed no association between TXA dosing and risk for venous TEs (risk difference, −0.005; 95% CI, −0.021 to 0.011; P = .53).CONCLUSIONS AND RELEVANCE Findings from this systematic review and meta-analysis of 216 studies suggested that intravenous TXA, irrespective of dosing, is not associated with increased risk of any TE. These results help clarify the incidence of...

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Craniofacial Syndromes

Mavridis

Wimalachandra

Rodrigues

2022

Pediatric Neurosurgery for Clinicians

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Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid infusion: a randomised trial

Cited by 36 publications

References 16 publications

Reducing blood loss in pediatric craniosynostosis surgery by use of tranexamic acid

Reducing blood loss in pediatric craniosynostosis surgery by use of tranexamic acid

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

Craniofacial Syndromes

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