Implementation of a Tranexamic Acid Protocol to Reduce Blood Loss During Cranial Vault Remodeling for Craniosynostosis

Abstract

The introduction of TXA for nonsyndromic single-suture synostosis repair at our institution has significantly reduced blood loss and blood product and plasma transfusion during and following primary cranial vault remodeling for single suture craniosynostosis. Postoperative hematocrit was similar in the TXA-treated and untreated groups despite reduced red cell transfusion in the treated group. In addition, TXA use in this population has eliminated the need for plasma transfusion, and is associated with a shorter hospital stay. No difference in postoperative complications was observed. Our data provide support for further investigation of TXA treatment to improve clinical outcomes in children undergoing pediatric cranial vault remodeling.

Impact of Cardiac Risk Factors on Complications Following Cranial Vault Remodeling: Analysis of the 2012 to 2016 National Safety Quality Improvement Program-Pediatric Database

“…19 On the other hand, a single-center, retrospective review of 259 patients before and after implementation of a TXA protocol found that TXA was not associated with higher postoperative hemoglobin, but significantly reduced intraoperative transfusion requirements. 20 Additionally, a single-center, retrospective study of pre-and postimplementation of postoperative furosemide administration in CVR patients found a significant reduction in transfusion rates. 21 The use of furosemide was implemented because the perceived anemia was thought to be mostly attributable to hemodilution.…”

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

“…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.…”

“…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].…”

“…Use of TXA may significantly reduce cost of these surgical procedures by reducing length of hospital stay [18,23,24]. Furthermore, Dadure et al [9] reported a reduction in the median cost of perioperative treatment for blood loss in the TXA group greater than 200 US$.…”

“…In this study, as expected, the use of TXA was significantly associated with a lower total volume of packed red blood cell (PRBC) transfused. No significant correlation between duration of surgery or length of hospitalization was observed between the 2 groups with/without TXA.Martin et al[23] collected a large cohort of patients less than 15 months of age operated on for single suture nonsyndromic craniosynostosis by the same interdisciplinary surgical team (a craniofacial surgeon and a pediatric neurosurgeon). They used the same TXA protocols as Goobie et al[10], and TXA-use was associated with a significant reduction in estimated intraoperative blood loss, cell saver volume transfused, red cell transfusion volume and length of stay in hospital.Engel et al[18] studied the value of TXA during fronto-orbital advancement in isolated metopic craniosynostosis only, with the same resulting benefit in reduction of blood loss and J o u r n a l P r e -p r o o f transfusion with TXA.…”