Ulnar Artery Thrombosis Following Tranexamic Acid Administration for Craniosynostosis Repair

Chung, E.K.; Karlberg, Helena

doi:10.1097/scs.0000000000004905

Cited by 9 publications

(6 citation statements)

References 10 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%

“…Administering intraoperative TXA is crucial for successful management during the surgery; but the postoperative period is of paramount importance due to excessive bleeding (3).…”

Section: █ Conclusionmentioning

confidence: 99%

“…C raniosynostosis is premature fusion of the cranial sutures and may lead to a cranial growth restriction if no intervention occurs (3). Surgical intervention is the treatment of choice; however, it embodies substantial risks of perioperative bleeding due to the enriched capillary Blood management protocols have been implemented to reduce transfusion requirements for cranial vault surgery.…”

Section: █ Introductionmentioning

confidence: 99%

“…Erythropoietin alpha (EPO) and intravenous iron administration prior to surgery (25), intraoperative blood salvage (18), autologous bank donations (20), acute normovolemic hemodilution (12), and lower hemoglobin thresholds for the transfusion requirement have been implemented in recent years (34). The use of tranexamic acid (TXA) as an antifibrinolytic drug to reduce perioperative bleeding has gained popularity and is used during various procedures (3,9,27,29). TXA is a synthetic analog of lysine that acts on plasminogen molecules by blocking lysine binding sites; hence, it inhibits the conversion of plasminogen to plasmin (21).…”

Section: █ Introductionmentioning

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%

“…Administering intraoperative TXA is crucial for successful management during the surgery; but the postoperative period is of paramount importance due to excessive bleeding (3).…”

Section: █ Conclusionmentioning

confidence: 99%

Section: █ Introductionmentioning

confidence: 99%

Section: █ Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Utilization of tranexamic acid in craniosynostosis surgery

Ongun

Dursun²,

Kazan³

2019

Turkish Neurosurgery

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“…No significant difference was detected in the incidence of postoperative seizures between patients who received TXA and those who did not. Recently, Chung E et al [31] described a case of ulnar artery thrombosis following ulnar arterial line placement in a patient who received TXA for cranial vault reconstructive surgery.…”

Section: J O U R N a L P R E -P R O O Fmentioning

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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Tranexamic acid

2019

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Ulnar Artery Thrombosis Following Tranexamic Acid Administration for Craniosynostosis Repair

Cited by 9 publications

References 10 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

Tranexamic acid

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