title: The value of tranexamic acid during fronto-orbital advancement in isolated metopic craniosynostosis.
abstract: Craniofacial surgery in infants still harbors the risk of significant blood loss and the need for red blood cell (RBC) transfusion. Hence, the aim of the present study was to investigate the antifibrinolytic effect of tranexamic acid (TXA) on intraoperative blood loss and RBC transfusion rates during fronto-orbital advancement (FOA) in isolated metopic synostosis. A total of 33 children with metopic synostosis were operated on using standardized FOA, of which 16 patients (48.5%) were treated without intraoperative TXA (non-TXA group) and 17 patients (51.5%) received TXA intraoperatively (TXA group). To accurately evaluate the calculated blood loss (CBL) we analyzed the values for pre- and postoperative hematocrit and the volume of the RBC transfusion. The mean CBL and the mean weight-adjusted CBL was significantly lower for patients receiving TXA compared with the non-TXA group (158.8 ml vs. 198.5 ml, p = 0.0001; and 19.1 ml/kg vs. 22.3 ml/kg, p = 0.0293, respectively). In addition, the mean RBC transfusion and the mean weight-adjusted RBC transfusion was significantly lower for the TXA group (252.2 ml vs. 280.0 ml, p = 0.0001; and 27.9 ml/kg vs. 31.3 ml/kg, p = 0.0345, respectively). The mean duration of the surgical procedure did not differ statistically between the groups (132 min vs. 136 min, p = 0.4081), hence the lower CBL in the TXA-group was not related to a shorter cutting-suture time. As the use of intraoperative TXA minimizes blood transfusion volumes in children who undergo FOA, antifibrinolytics, such as TXA, should be considered for routine use in pediatric craniofacial surgery.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Engel
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, Germany.
authors.forename: Jens P
authors.initials: JP
authors.lastname: Bodem
authors.affiliation: Department of Anesthesiology (Head: Prof. Dr. Markus Weigand, MD), University Clinic Heidelberg, Heidelberg, Germany.
authors.forename: Cornelius J
authors.initials: CJ
authors.lastname: Busch
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Horn
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Mertens
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hoffmann
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, Germany. Electronic address: chr.freudlsperger@med.uni-heidelberg.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Freudlsperger
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods*; D003398:Craniosynostoses / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Calculated blood loss; Fronto-orbital advancement; Metopic synostosis; Red blood cell transfusion; Tranexamic acid; Trigonocephaly