Tranexamic Acid in Craniosynostosis Surgery: A Systematic Review and Meta-Analysis

Abstract

Blood loss is a potential cause of morbidity and mortality in craniosynostosis surgery. Recent reports have suggested that the use of tranexamic acid (TXA), an antifibrinolytic agent, mitigates this blood loss. A comprehensive systematic review and subsequent meta-analysis was undertaken, with the view to clarify the effectiveness of TXA in reducing blood loss and transfusion requirements in craniosynostosis surgery. Medline and PubMed databases were searched using the preferred reporting items for systematic reviews and meta-analyses technique, and 7003 articles were assessed based on predefined selection criteria. Seven trials were identified, of which 2 were randomized controlled trials and the remainder retrospective cohort studies. All trials were assessed using the Jadad and strengthening the reporting of observational studies in epidemiology scores. The meta-analysis found a clear statistical reduction in blood loss in those patients who received TXA perioperatively, with a combined blood loss reduction of 7.06 ml/ kg (95% confidence interval À8.97 to À5.15, P < 0.00001). The blood loss reduction was found to extrapolate to a reduction in perioperative transfusion requirements by 8.47 ml/kg in this cohort (95% confidence interval À10.9 to À6.04, P < 00001). There were no TXA-related adverse outcomes recorded in the 258 patients who received TXA across all trials. The trials included in this meta-analysis were limited by underpowered population sizes and significant heterogeneity in blood loss recording techniques. Further, there was significant heterogeneity amongst operations performed. The current literature appears to support the use of TXA in craniosynostosis surgery, but further high quality randomized controlled trials are indicated, ideally including a subgroup analysis between the operations performed.

Effect of Tranexamic Acid on the Reduction of Blood Loss in Craniosynostosis Surgery: A Systematic Review and Meta-analysis

“…However, their pooled data needed to be more significant to reach a consensus about the benefits of TXA in CS. 1 In our meta-analysis, we analyzed data from more than 1500 operations and found results similar to Alistair MS et al Hence, we encourage perioperative systemic administration of TXA in patients undergoing CS to reduce the blood loss and, possibly, the associated complications.…”

“…It represents a potential cause of significant morbidity and mortality in craniosynostosis surgery (CS). 1 Particularly, patients undergoing CS require blood transfusions to replace the blood that is lost. 2 Current techniques, particularly calvarial vault remodeling, are associated with complication rates as high as 16.5%, and more than 80% of patients eventually require blood transfusions.…”

Use of Tranexamic Acid in Aesthetic Surgery: A Retrospective Comparative Study of Outcomes and Complications

“…12 However, other studies have not found a significant effect of TXA on the length of hospital stay. 14,15 Overall, although the evidence on the effect of TXA on length of hospital stay and postoperative recovery is not entirely consistent, there is some evidence to suggest that TXA can have a beneficial effect in certain surgical contexts. However, it is important to note that TXA is not appropriate for all patients and can carry some risks, particularly in patients with a history of blood clots.…”

“…2 A number of studies have investigated the effect of TXA on the length of hospital stay, and the results have been somewhat mixed. 5,14,15 Some studies have found that TXA can significantly reduce the length of hospital stay, particularly in patients undergoing total knee or hip replacement surgery. 12 However, other studies have not found a significant effect of TXA on the length of hospital stay.…”

“…8 The need for blood transfusion during major surgery has been reduced by 32%-37% after the administration of TXA intravenously. 9,10 Although TXA has been proven to have numerous advantages and benefits in cardiac, 11 orthopedic, 12 and spine surgery, 13 there is little literature on its use in aesthetic plastic surgery or body contouring other than in craniofacial 14 and facial plastic, 15 where it has been previously studied. A study on the use of TXA and its effectiveness in reducing perioperative blood loss during abdominoplasty, belt lipectomy, and body contouring surgery has not yet been conducted.…”