Evaluating the Safety and Efficacy of Tranexamic Acid Administration in Pediatric Cranial Vault Reconstruction

Crantford, John C.; Wood, Benjamin C.; Claiborne, Jeffrey R.; Ririe, Doug G.; Couture, Daniel E.; Thompson, James T.; David, Lisa R.

doi:10.1097/scs.0000000000001271

Cited by 42 publications

(53 citation statements)

References 22 publications

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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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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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“…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%

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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“…The aim of the present study was to test this hypothesis and to examine the mechanism involved. It is well known that tranexamic acid inhibits protease activity by blocking the activation of plasminogen to plasmin, a serine protease 3 , 4 . However, we found here that plasmin/plasminogen expression is undetectable in keratinocytes, and instead, tranexamic acid appears to block the adverse effects of Cry j1 on keratinocytes and epidermal permeability barrier homeostasis via a pathway involving thrombin and protease-activated receptor 1 (PAR-1) or a PAR-1-like receptor.…”

Section: Introductionmentioning

confidence: 99%

Tranexamic acid blocks the thrombin-mediated delay of epidermal permeability barrier recovery induced by the cedar pollen allergen, Cry j1

Nakanishi

Kumamoto

Denda

2018

Sci Rep

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We previously demonstrated that Cry j1, the major pollen allergen of Cryptomeria japonica (Japanese cedar), transiently increases protease activity and intracellular Ca2+ concentration in cultured human keratinocytes, and delays recovery after stratum corneum barrier disruption in human skin ex vivo. Topical application of tranexamic acid or trypsin-type serine protease inhibitors accelerates barrier recovery. We hypothesized that tranexamic acid might prevent the transient protease activity increase and the barrier recovery delay induced by Cry j1. Here, we tested this hypothesis and examined the mechanism involved. In cultured human keratinocytes, knock-down of protease-activated receptor 1 (PAR-1) reduced the transient increase of calcium induced by Cry j1, whereas knock-down of PAR-2 did not. Knock-down of thrombin significantly reduced the transient increases of calcium concentration and protease activity. Tranexamic acid, soybean trypsin inhibitor, or bivalirudin (a thrombin inhibitor) also reduced the calcium elevation induced by Cry j1 and/or thrombin. Co-application of tranexamic acid or bivalirudin with Cry j1 to human skin ex vivo blocked the delay of barrier recovery. These results suggest that thrombin and PAR-1 or PAR-1-like receptor might mediate the adverse effects of Cry j1 on human epidermal keratinocytes, and could open up a new strategy for treating inflammatory skin diseases.

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Evaluating the Safety and Efficacy of Tranexamic Acid Administration in Pediatric Cranial Vault Reconstruction

Cited by 42 publications

References 22 publications

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

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

Tranexamic acid blocks the thrombin-mediated delay of epidermal permeability barrier recovery induced by the cedar pollen allergen, Cry j1

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