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Background <p>The reconstructive surgeries involved in craniosynostosis may cause severe hemorrhage, possibly leading to blood product transfusion and massive transfusion-related complications. Several studies have found that tranexamic acid (TXA) reduces blood loss and transfusion requirement in craniosynostosis surgery. This study aimed to compare the significance of blood loss and transfusion requirement during craniosynostosis surgery with and without the administration of TXA in our center.</p> Methods <p>This retrospective cohort study comprised patients with craniosynostosis who underwent craniosynostosis surgery in Hospital Kuala Lumpur and Hospital Tunku Azizah from 2009 to 2023. The patients were categorized into the TXA group (with prophylactic TXA administration) and the non-TXA group (without prophylactic TXA administration). Data extracted from medical records included demographics; diagnosis; associated syndrome; type of craniosynostosis surgery; TXA loading dose; preoperative, intraoperative, and postoperative hemoglobin and hematocrit levels; and blood product transfusion volume. The estimated blood loss and blood transfusion requirement were calculated and compared between the two groups.</p> Results <p>A total of 52 patients (29 in the TXA group and 23 in the non-TXA group) were analyzed. Most patients had multi-suture craniosynostosis (63.5%). The most common craniosynostosis surgeries performed were cranial vault remodeling and fronto-orbital advancement, at 65.4%. The mean loading dose of TXA was 13.66 ± 2.48&#xa0;mg/kg, and the mean maintenance dose was 5.24 ± 2.75&#xa0;mg/kg/h. The estimated blood loss was significantly lower in the TXA group than in the non-TXA group (<i>p</i> = 0.015). The volume of transfused blood products was higher in the TXA group than in the non-TXA group, but this difference was not statistically significant (<i>p</i> = 0.218).</p> Conclusions <p>This study affirmed the efficacy of TXA and supported its usage in the reduction of blood loss during craniosynostosis surgery. The significance of different TXA maintenance doses and durations in reducing blood loss and transfusion requirement during craniosynostosis surgery should be considered in future research. </p> <p>Level of Evidence: Level III, therapeutic study.</p>

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Efficacy of prophylactic systemic use of tranexamic acid to reduce blood loss during open craniosynostosis surgery – a single center retrospective cohort study

  • 期刊论文

  • 发表日期：

    2025年8月6日

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  • Phong Jhiew Khoo,
  • Wan Azman Wan Sulaiman,
  • Mohammad Ali Mat Zain,
  • Khai Luen Koh,
  • Najib Majdi Yaacob,
  • Mohd Saifullah Mohd Arif Kor

摘要

Background

The reconstructive surgeries involved in craniosynostosis may cause severe hemorrhage, possibly leading to blood product transfusion and massive transfusion-related complications. Several studies have found that tranexamic acid (TXA) reduces blood loss and transfusion requirement in craniosynostosis surgery. This study aimed to compare the significance of blood loss and transfusion requirement during craniosynostosis surgery with and without the administration of TXA in our center.

Methods

This retrospective cohort study comprised patients with craniosynostosis who underwent craniosynostosis surgery in Hospital Kuala Lumpur and Hospital Tunku Azizah from 2009 to 2023. The patients were categorized into the TXA group (with prophylactic TXA administration) and the non-TXA group (without prophylactic TXA administration). Data extracted from medical records included demographics; diagnosis; associated syndrome; type of craniosynostosis surgery; TXA loading dose; preoperative, intraoperative, and postoperative hemoglobin and hematocrit levels; and blood product transfusion volume. The estimated blood loss and blood transfusion requirement were calculated and compared between the two groups.

Results

A total of 52 patients (29 in the TXA group and 23 in the non-TXA group) were analyzed. Most patients had multi-suture craniosynostosis (63.5%). The most common craniosynostosis surgeries performed were cranial vault remodeling and fronto-orbital advancement, at 65.4%. The mean loading dose of TXA was 13.66 ± 2.48 mg/kg, and the mean maintenance dose was 5.24 ± 2.75 mg/kg/h. The estimated blood loss was significantly lower in the TXA group than in the non-TXA group (p = 0.015). The volume of transfused blood products was higher in the TXA group than in the non-TXA group, but this difference was not statistically significant (p = 0.218).

Conclusions

This study affirmed the efficacy of TXA and supported its usage in the reduction of blood loss during craniosynostosis surgery. The significance of different TXA maintenance doses and durations in reducing blood loss and transfusion requirement during craniosynostosis surgery should be considered in future research.

Level of Evidence: Level III, therapeutic study.