The value of tranexamic acid during fronto-orbital advancement in isolated metopic craniosynostosis

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

“…Although blood loss is considered to be more difficult to evaluate, results showed similar conclusions in favour of the benefit of TXA. When considered, the mean calculated blood loss [10,14,15,18] or the estimated blood loss [19-21, 23, 24] were significantly lower in the TXA+ group, except for Dadure et al [9]. The same positive results were observed for fresh frozen plasma transfusions in the 2 recent randomized studies: significantly fewer fresh frozen plasma transfusions were required in the TXA groups [14,15].…”

“…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.…”

“…Protocols of TXA administration varied from one study to another. 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$.…”

“…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. Interestingly, the mean duration of the postoperative hospital stay was significantly lower in the TXA group.…”