title: Intraoperative tranexamic acid reduces blood transfusion in children undergoing craniosynostosis surgery: a randomized double-blind study.
abstract: BACKGROUND
  Surgical correction of craniosynostosis in children is associated with substantial intraoperative bleeding. Tranexamic acid (TXA) decreases intraoperative blood loss during cardiac or orthopedic surgery in children. We hypothesized that intraoperative TXA would reduce blood transfusion relative to placebo in patients pretreated with erythropoietin.
  
  
  METHODS
  Forty consecutive children, American Society of Anesthesiologists status 1 or 2, scheduled to undergo surgical correction of craniosynostosis were randomly assigned to receive either intravenous TXA or saline, 0.9%, intraoperatively. All children received preoperative erythropoietin (600 U/kg once a week for 3 weeks before surgery). Perioperative blood loss, number and volume of transfusions, percentage of children who underwent transfusion, and side effects were noted after surgery and at the end of the study. Surgeon satisfaction and cost of treatment were also recorded.
  
  
  RESULTS
  There was no significant difference between groups in demographic or surgical data. In the TXA group, the volume of packed erythrocytes transfused was significantly reduced by 85% (from 11 to 1.6 ml/kg) intraoperatively and by 57% (from 16.6 to 7.2 ml/kg) throughout the study period (P < 0.05). Compared with the placebo group, the percentage of children requiring blood transfusion was lower in the TXA group during surgery (9 [45%] of 20 vs. 2 [11%] of 19 children; P < 0.05) and during the whole study period (14 [70%] of 20 vs. 7 [37%] of 19; P < 0.05). Preoperative and postoperative hematologic parameters were comparable in both groups. There were no adverse events.
  
  
  CONCLUSIONS
  In children undergoing surgical correction of craniosynostosis and pretreated with erythropoietin, intraoperative TXA reduces the transfusion requirement.
authors.affiliation: Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France. chdadure@yahoo.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Dadure
authors.forename: Magali
authors.initials: M
authors.lastname: Sauter
authors.forename: Sophie
authors.initials: S
authors.lastname: Bringuier
authors.forename: Michelle
authors.initials: M
authors.lastname: Bigorre
authors.forename: Olivier
authors.initials: O
authors.lastname: Raux
authors.forename: Alain
authors.initials: A
authors.lastname: Rochette
authors.forename: Nancy
authors.initials: N
authors.lastname: Canaud
authors.forename: Xavier
authors.initials: X
authors.lastname: Capdevila
mesh_terms: D000293:Adolescent; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D004311:Double-Blind Method; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D004921:Erythropoietin; D014148:Tranexamic Acid