Use of tranexamic acid in craniosynostosis surgery

Martin, Justin P.; Wang, Jessica S.; Hanna, Kasandra R.; Stovall, Madeline; Lin, Kant Y.

doi:10.1177/229255031502300413

Cited by 30 publications

(37 citation statements)

References 33 publications

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“…Furthermore, no trial specifically compared TXA efficacy between each craniosynostosis operation. [21][22][23][24][25][26][27] This is potentially a major confounder; by extrapolation of the findings of Howe and Cooper, there is potentially a significant clinical variation in TXA-mediated blood loss reduction between the different craniosynostosis operations. Given FOR and CVR are known to involve significantly more blood loss and require more transfusions than the less invasive techniques such as SC and PVE, it is reasonable to presume that the clinical benefit of TXA would be far more evident in FOR and CVR procedures.…”

Section: Discussionmentioning

confidence: 99%

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

Varidel

Marucci

2021

Journal of Craniofacial Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

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

Varidel

Marucci

2021

Journal of Craniofacial Surgery

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“…34 While Ausen et al 34 investigated a different elective procedure and method of drug delivery, their results mirror our own and revealed that blood loss may also be reduced after surgery in a more invasive elective cosmetic procedure. In the pediatric literature, a number of high-quality studies [35][36][37][38][39][40] investigating the role of tranexamic acid in craniosynostosis procedures have consistently shown that tranexamic acid reduces both intraoperative blood loss and rates of transfusion. The benefits of tranexamic acid in burn surgery are similarly promising 41,42 ; however, more studies are needed before determining causality, dosing regimens, and contraindications in this acutely ill population.…”

Section: Discussionmentioning

confidence: 99%

Role of Tranexamic Acid in Reducing Intraoperative Blood Loss and Postoperative Edema and Ecchymosis in Primary Elective Rhinoplasty

McGuire

Nurmsoo

Samargandi

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Blood loss from surgical procedures is a major issue worldwide as the demand for blood products is increasing. Tranexamic acid is an antifibrinolytic agent commonly used to reduce intraoperative blood loss.OBJECTIVE To systematically examine the role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty.DATA SOURCES A systematic review and meta-analysis was undertaken in an academic medical setting using Medline, Embase, and Google Scholar from inception to June 30, 2018. All references of included articles were screened for potential inclusion. The search was mapped to Medical Subject Headings, and the following terms were used to identify potential articles: reconstruction or rhinoplasty and tranexamic acid or anti-fibrinolysis or antifibrinolysis and bleeding or ecchymosis or bruising or edema or complications.STUDY SELECTION The population of interest consisted of adult patients undergoing primary elective rhinoplasty. The intervention was the use of tranexamic acid. The control group was composed of patients receiving a placebo. Primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis. In vitro or animal studies were excluded, and only English-language articles were included.DATA EXTRACTION AND SYNTHESIS The PRISMA guidelines were followed, and articles were assessed using the Cochrane Collaboration's tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Random-effects meta-analysis was performed to determine the overall effect size. MAIN OUTCOMES AND MEASURESThe primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis.RESULTS Five studies (comprising 332 patients) were included in the qualitative analysis, all of which were randomized clinical trials published within the past 5 years. The mean (SD) patient age was 27 ( 7) years (age range, 16-42 years), while the mean (SD) sample size was 66 (19) (range, 50-96). Meta-analysis of 4 studies (271 patients) indicated that tranexamic acid treatment resulted in a mean reduction in intraoperative blood loss of −41.6 mL (95% CI, −69.8 to −13.4 mL) compared with controls (P = .004). Three studies indicated that postoperative edema and ecchymosis were reduced with tranexamic acid treatment compared with controls; however, there was no significant difference compared with corticosteroid use. Four studies were considered of high methodological quality, with a low risk of bias. The overall quality of evidence was high.CONCLUSIONS AND RELEVANCE Tranexamic acid has the ability to significantly reduce intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty.LEVEL OF EVIDENCE 4.

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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%

“…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%

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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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Use of tranexamic acid in craniosynostosis surgery

Abstract: TXA decreased blood product transfusion requirements in patients undergoing CVR for sagittal craniosynostosis, and should be a routine part of the strategy to reduce blood loss in these procedures.

Cited by 30 publications

References 33 publications

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

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

Role of Tranexamic Acid in Reducing Intraoperative Blood Loss and Postoperative Edema and Ecchymosis in Primary Elective Rhinoplasty

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

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