Effect of tranexamic acid on markers of inflammation in children undergoing craniofacial surgery

Abstract

Background Tranexamic acid (TXA) reduces blood loss and transfusion requirements during craniosynostosis surgery in small children. Possible interaction from TXA on the inflammatory system is unknown. Objective To evaluate the effect of TXA on a wide range of inflammatory markers in children receiving TXA in a randomized, blinded, and placebo controlled study design. Methods Thirty children undergoing craniosynostosis surgery with significant blood loss received TXA (bolus dose of 10 mg kg−1 followed by 8 hours continuous infusion of 3 mg kg−1 h−1) or placebo in a randomized, double‐blinded study design. Using a new proximity extension assays employing a panel of inflammatory biomarkers samples was used for analysis of blood samples obtained pre‐operatively, 4 and 24 hours after operation. Results Ninety‐two inflammatory parameters were measured. TXA did not affect any of the measured parameters as compared with placebo. Among 34 of the 92 pro‐ and antiinflammatory parameters investigated changes were observed between pre‐operative, 4 or 24 hours, respectively, reflecting immune activation during surgical stress. Conclusion TXA administration in a low‐dose regimen including bolus followed by 8 hours infusion during craniosynostosis surgery did not change any of 92 inflammatory markers as compared with placebo.

Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

“…19,[47][48][49][50] The majority of included studies were RCTs, [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40]43,44,[46][47][48][49][50] while five were cohort studies including a control group. 19,34,41,42,45 The participants in most of the articles were undergoing elective surgery (n ¼ 3,563) 19-39,41--47,49,50 of which 13 studies investigated total knee arthroplasty patients which, at least partly, is an inflammatory condition (n ¼ 1,918), 20,22,24,25,27,34,35,[37][38][39]42,...…”

“…19 The studies were grouped depending on the control group. Fourteen studies compared patients receiving TXA with a group receiving either placebo or no medication 19,20,25,26,29,30,32,34,36,40,42,[48][49][50] while 14 other studies compared different dosing schemes of TXA. [21][22][23][24]28,33,[37][38][39]41,43,44,46,47 Finally, five studies examined the difference of the inflammatory effect of TXA between different administration forms of TXA.…”

“…[21][22][23][24]28,33,[37][38][39]41,43,44,46,47 Finally, five studies examined the difference of the inflammatory effect of TXA between different administration forms of TXA. 21,27,31,35,45 Inflammatory Biomarkers ►Table 1 shows a summary of the 14 included studies that investigated inflammatory markers in TXA patients and compared them to either a group receiving placebo or no medication, [19][20][21]25,26,29,30,32,34,36,40,42,[48][49][50] while ►Table 2 presents a summary of 14 articles that investigated inflammatory biomarkers in surgical patients receiving TXA and compared them to a single group or several groups receiving either fewer or lower doses of TXA. [21][22][23][24]28,33,[37][38][39]41,43,44,46,...…”

Tranexamic acid in plastic surgery: routes of administration and dosage considerations

“…Of the reviewed studies, fifteen assessed the use of TXA in craniofacial surgery procedures [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Of these, nine were retrospective cohort studies [29-31, 34, 35, 38-40, 42], and six were randomized controlled clinical trials [32,33,36,37,41,43]. Study sample ranged from 25 to 187 patients, apart from a single retrospective cohort study of 1638 patients.…”

“…Eight studies reported a notable decline in transfusion requirements, owing to decreased intraoperative bleeding, ranging from 19 to 85% [28,[31][32][33][34][37][38][39]. Other notable outcomes included a clearer surgical field [36], shorter length of hospital stay [40], lower drop in postoperative hemoglobin level, higher postoperative estimated red cell volume [30], and decreased surgical drain Fig.…”