Tranexamic Acid Reduces Blood Loss in Craniosynostosis Surgery

Kurnik, Nicole M.; Pflibsen, Lacey R; Bristol, Ruth E.; Singh, Davinder

doi:10.1097/scs.0000000000003731

Cited by 38 publications

(33 citation statements)

References 12 publications

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“…TXA is a commonly used drug for its antifibrinolytic activity in various surgeries (2)(3)(4)9,19,21). However little known is about how much of the blot-clotting effect expedites postoperative recovery.…”

Section: █ Discussionmentioning

confidence: 99%

“…Nevertheless, both clinical and pharmacokinetic studies are needed to investigate the precise dosing and the length of postoperative drug utilization for safer therapeutic management. Documented drug-related adverse effects are scarce (21), even if doses reach the limits of recommendations (ranging from 10-100 mg/kg loading dose followed by 5-10 mg/ kg/hour maintenance infusion) (9,13,19,22). The Pediatric Craniofacial Surgery Perioperative Registry database review announced a seizure rate of 0.6% in 1,638 children undergoing cranial vault surgery between 2010 and 2015; the outcomes were insignificant for children regardless of whether they received an intraoperative antifibrinolytic drug (8).…”

Section: A B D Cmentioning

confidence: 99%

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Utilization of tranexamic acid in craniosynostosis surgery

Ongun

Dursun²,

Kazan³

2019

Turkish Neurosurgery

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AIM:To analyze the impact of Tranexamic acid (TXA) on perioperative hemodynamics in craniosynostosis surgery.MATERIAL and METHODS: Data of thirty-six children (operated between 2014-2017) were categorized into two groups depending on TXA delivery. Patient demographics, preoperative, intraoperative, postoperative data on hemostasis and metabolic outcomes were recorded. Blood loss from the drains, estimated blood loss (EBV loss), volume of blood transfusions, hemodynamic alerations and complications were extracted. Postoperative outcome involved variables at admission, 2 nd , 6 th , 12 th , 24 th hours. A multiple logistic regression analysis was also performed. RESULTS:Demographics presented mean age of 8.14 ± 3.53 months, male/female ratio:1.76/1, procedure length 3.98 ± 0.78 hours. Intraoperative analysis indicated TXA deliveries manifested fewer blood transfusion volumes (p=0.002) due to lower EBV loss (4.02 ± 1.19 ml/kg vs. 5.97 ± 1.61 ml/kg, p<0.001) with better metabolic outcome.Postoperative outcomes presented all children manifested hematocrit decline after surgey. TXA did not influence postoperative hemodynamic alterations (p=0.090, p=0.112), despite reduced blood loss from the drains and transfusion necessity (p=0.015, p=0.0175). Intraoperative transfusion volumes and EBV loss were associated with postoperative hemodynamics (OR: 3.033, 95% CI: 1.286-7.154; p=0.011; OR: 0.280, 95% CI: 0.081-0.972; p=0.045, respectively). ROC analysis indicated 10.13 ml/kg of intraoperative blood transfusion requirement as the cut off value for hemodynamic instability with 91% sensitivity and 80% specificity. One unit increase in intraoperative transfused blood volume increased the odds of developing hemodynamic alterations by 3.033 times. CONCLUSION:Intraoperative TXA is crucial for successful surgical management; however postoperative period carries out paramount importance due to excessive bleeding after surgery. In case of severe intraoperative transfusion necessity, postoperative TXA utilization might be considered to minimize potential risks by balancing the pros and cons of the drug.

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Section: █ Discussionmentioning

confidence: 99%

Section: A B D Cmentioning

confidence: 99%

Utilization of tranexamic acid in craniosynostosis surgery

Ongun

Dursun²,

Kazan³

2019

Turkish Neurosurgery

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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%

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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“…Please refer to Table 1 for several references of pro-coagulant TXA in plastic, reconstructive, and craniomaxillofacial surgery [19,20,21], as well as to Table 2, outlining studies analyzing the use of topical thrombin [22,23].…”

Section: Introductionmentioning

confidence: 99%

Local Pro- and Anti-Coagulation Therapy in the Plastic Surgical Patient: A Literature Review of the Evidence and Clinical Applications

et al. 2019

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The risks of systemic anti-coagulation or its reversal are well known but accepted as necessary under certain circumstances. However, particularly in the plastic surgical patient, systemic alteration to hemostasis is often unnecessary when local therapy could provide the needed adjustments. The aim of this review was to provide a summarized overview of the clinical applications of topical anti- and pro-coagulant therapy in plastic and reconstructive surgery. While not a robust field as of yet, local tranexamic acid (TXA) has shown promise in achieving hemostasis under various circumstances, hemostats are widely used to halt bleeding, and local anticoagulants such as heparin can improve flap survival. The main challenge to the advancement of local therapy is drug delivery. However, with increasingly promising innovations underway, the field will hopefully expand to the betterment of patient care.

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Tranexamic Acid Reduces Blood Loss in Craniosynostosis Surgery

Abstract: Intraoperative TXA administration has a correlation with reduced blood transfusion requirements, as well as EBL, in patients undergoing open calvarial vault remodeling. There were no adverse events related to TXA administration.

Cited by 38 publications

References 12 publications

Utilization of tranexamic acid in craniosynostosis surgery

Utilization of tranexamic acid in craniosynostosis surgery

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

Local Pro- and Anti-Coagulation Therapy in the Plastic Surgical Patient: A Literature Review of the Evidence and Clinical Applications

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