Minimizing transfusions in primary cranial vault remodeling: the role of aminocaproic acid.
BACKGROUND
Cranial vault remodeling (CVR) for craniosynostosis is a procedure with the potential for significant blood loss. Aminocaproic acid (ACA) has been used at our institution during CVR for its antifibrinolytic effects. The purpose of this study was to investigate the effect of ACA on blood loss and transfusion rates during primary CVR.


METHODS
Three hundred eighty-three patients with craniosynostosis underwent primary CVR at a single institution by a single surgeon over 15 years. Patients were included if they received either ACA or no antifibrinolytic. The estimated blood loss (EBL) and volume of blood transfused was recorded. Thrombotic-related complications were identified. Comparisons were made between subgroups using independent Student t test and Fisher exact test.


RESULTS
Among the study population, 148 patients met inclusion criteria. ACA was given to 30 patients, while 118 patients received no antifibrinolytic. There was no difference in the average intraoperative EBL between the ACA (322 mL) and control groups (327 mL, P > 0.05). Additionally, the incidence of transfusion was not significantly different between subgroups (97% vs. 86%, respectively, P > 0.05). Patients treated with ACA, however, received lower average perioperative transfusion volumes (25.5 mL/kg) compared to control patients (53.3 mL/kg, P < 0.0001). Furthermore, patients in the ACA subgroup were less likely to require a second unit of blood (21% vs. 43%, P < 0.0001) and therefore had fewer exposures to donor blood antigens (ARR = 22%, NNT = 4.6).


CONCLUSIONS
The use of intraoperative ACA minimizes blood transfusion volumes and donor exposures in children who undergo primary CVR for craniosynostosis. Antifibrinolytics should be considered for routine use in pediatric craniofacial surgery.
From the *Section of Plastic Surgery, University of Michigan Health System, Ann Arbor; †University of Michigan Medical School, Ann Arbor; and ‡Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan.
Adam J
AJ
Oppenheimer
Kavitha
K
Ranganathan
Benjamin
B
Levi
Jennifer M
JM
Strahle
Joseph
J
Kapurch
Karin M
KM
Muraszko
Steven R
SR
Buchman
D015119:Aminocaproic Acid / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000502:physiology; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D015331:Cohort Studies; D003398:Craniosynostoses / Q000601:surgery*; D017707:Erythrocyte Transfusion; D006400:Hematocrit; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery; D013927:Thrombosis / Q000209:etiology
D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid