Tranexamic Acid Utilization in Craniosynostosis Surgery

Özet

AIM: To analyze the impact of Tranexamic acid (TXA) on perioperative hemodynamics in craniosynostosis surgery.MATERIAL and METHODS: Data of thirty-six children (operated between 2014-2017) were categorized into two groups dependingon TXA delivery. Patient demographics, preoperative, intraoperative, postoperative data on hemostasis and metabolic outcomeswere recorded. Blood loss from the drains, estimated blood loss (EBV loss), volume of blood transfusions, hemodynamic alerationsand complications were extracted. Postoperative outcome involved variables at admission, 2nd, 6th, 12th, 24th hours. A multiplelogistic regression analysis was also performed.RESULTS: Demographics presented mean age of 8.14 ± 3.53 months, male/female ratio:1.76/1, procedure length 3.98 ± 0.78hours. Intraoperative analysis indicated TXA deliveries manifested fewer blood transfusion volumes (p=0.002) due to lower EBV loss(4.02 ± 1.19 ml/kg vs. 5.97 ± 1.61 ml/kg, p<0.001) with better metabolic outcome.Postoperative outcomes presented all children manifested hematocrit decline after surgey. TXA did not influence postoperativehemodynamic alterations (p=0.090, p=0.112), despite reduced blood loss from the drains and transfusion necessity (p=0.015,p=0.0175). Intraoperative transfusion volumes and EBV loss were associated with postoperative hemodynamics (OR: 3.033, 95% CI:1.286-7.154; p=0.011; OR: 0.280, 95% CI: 0.081-0.972; p=0.045, respectively). ROC analysis indicated 10.13 ml/kg of intraoperativeblood transfusion requirement as the cut off value for hemodynamic instability with 91% sensitivity and 80% specificity. One unitincrease in intraoperative transfused blood volume increased the odds of developing hemodynamic alterations by 3.033 times.CONCLUSION: Intraoperative TXA is crucial for successful surgical management; however postoperative period carries outparamount importance due to excessive bleeding after surgery. In case of severe intraoperative transfusion necessity, postoperativeTXA utilization might be considered to minimize potential risks by balancing the pros and cons of the drug.