Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid infusion: a randomised trial

Christian Fenger-Eriksen; Alexander D'Amore Lindholm; Sven Erik Nørholt; Gorm von Oettingen; Mona Tarpgaard; Lisbeth Krogh; Niels Juul; Anne Mette Hvas; Mads Rasmussen

doi:10.1016/j.bja.2019.02.017

Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid infusion: a randomised trial

Christian Fenger-Eriksen^*, Alexander D'Amore Lindholm, Sven Erik Nørholt, Gorm von Oettingen, Mona Tarpgaard, Lisbeth Krogh, Niels Juul, Anne Mette Hvas, Mads Rasmussen

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Background: Tranexamic acid (TXA) reduces intraoperative blood loss and transfusion during paediatric craniosynostosis surgery. Additional reduction of postoperative blood loss may further reduce exposure to allogeneic blood products. We studied the effect of combined intra- and postoperative TXA treatment on postoperative blood loss in children. Methods: Thirty children admitted for craniosynostosis surgery were randomised to combined intra- and postoperative TXA treatment or placebo. The primary endpoint was postoperative blood loss. Secondary endpoints included total blood loss, transfusion requirements, and clot stability evaluated by tissue plasminogen activator-stimulated clot lysis assay. Results: TXA reduced postoperative blood loss by 18 ml kg ⁻¹ (95% confidence interval 8.9) and total blood loss from a mean of (standard deviation [SD]; 20) ml kg ⁻¹ to 28 (14) ml kg ⁻¹ (P<0.001). Intraoperative red blood cell (RBC) and fresh frozen plasma (FFP) transfusions were reduced in the treatment group from RBC 14.0 (5.2) ml kg ⁻¹ to 8.2 (5.1) ml kg ⁻¹ (P=0.01) and from FFP 13.0 (6.3) ml kg ⁻¹ to 7.8 (5.9) ml kg ⁻¹ (P=0.03). Postoperative RBC transfusion median was 5 (inter-quartile range [IQR] 0–6) ml kg ⁻¹ in the placebo group and 0 (0–5.7) ml kg ⁻¹ in the TXA group. Resistance to lysis was higher in the treatment group (P<0.001). Conclusions: Combined intra- and postoperative tranexamic acid treatment reduced postoperative and overall blood loss and transfusion requirements. Improved clot stability represents a possible mechanism for blood loss reduction.

Original language	English
Journal	British Journal of Anaesthesia
Volume	122
Issue	6
Pages (from-to)	760-766
Number of pages	7
ISSN	0007-0912
DOIs	https://doi.org/10.1016/j.bja.2019.02.017
Publication status	Published - Jun 2019

Keywords

antifibrinolytics
blood transfusion
coagulation
craniosynostosis
fibrinolysis
general surgery
haemorrhage
paediatric

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10.1016/j.bja.2019.02.017

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Fenger-Eriksen, C., D'Amore Lindholm, A., Nørholt, S. E., von Oettingen, G., Tarpgaard, M., Krogh, L., Juul, N., Hvas, A. M., & Rasmussen, M. (2019). Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid infusion: a randomised trial. British Journal of Anaesthesia, 122(6), 760-766. https://doi.org/10.1016/j.bja.2019.02.017

@article{329a27f3cff44c09a34f57096e64c7b1,

title = "Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid infusion: a randomised trial",

abstract = " Background: Tranexamic acid (TXA) reduces intraoperative blood loss and transfusion during paediatric craniosynostosis surgery. Additional reduction of postoperative blood loss may further reduce exposure to allogeneic blood products. We studied the effect of combined intra- and postoperative TXA treatment on postoperative blood loss in children. Methods: Thirty children admitted for craniosynostosis surgery were randomised to combined intra- and postoperative TXA treatment or placebo. The primary endpoint was postoperative blood loss. Secondary endpoints included total blood loss, transfusion requirements, and clot stability evaluated by tissue plasminogen activator-stimulated clot lysis assay. Results: TXA reduced postoperative blood loss by 18 ml kg −1 (95% confidence interval 8.9) and total blood loss from a mean of (standard deviation [SD]; 20) ml kg −1 to 28 (14) ml kg −1 (P<0.001). Intraoperative red blood cell (RBC) and fresh frozen plasma (FFP) transfusions were reduced in the treatment group from RBC 14.0 (5.2) ml kg −1 to 8.2 (5.1) ml kg −1 (P=0.01) and from FFP 13.0 (6.3) ml kg −1 to 7.8 (5.9) ml kg −1 (P=0.03). Postoperative RBC transfusion median was 5 (inter-quartile range [IQR] 0–6) ml kg −1 in the placebo group and 0 (0–5.7) ml kg −1 in the TXA group. Resistance to lysis was higher in the treatment group (P<0.001). Conclusions: Combined intra- and postoperative tranexamic acid treatment reduced postoperative and overall blood loss and transfusion requirements. Improved clot stability represents a possible mechanism for blood loss reduction. ",

keywords = "antifibrinolytics, blood transfusion, coagulation, craniosynostosis, fibrinolysis, general surgery, haemorrhage, paediatric",

author = "Christian Fenger-Eriksen and {D'Amore Lindholm}, Alexander and N{\o}rholt, {Sven Erik} and {von Oettingen}, Gorm and Mona Tarpgaard and Lisbeth Krogh and Niels Juul and Hvas, {Anne Mette} and Mads Rasmussen",

year = "2019",

month = jun,

doi = "10.1016/j.bja.2019.02.017",

language = "English",

volume = "122",

pages = "760--766",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Oxford University Press",

number = "6",

}

Fenger-Eriksen, C, D'Amore Lindholm, A, Nørholt, SE , von Oettingen, G, Tarpgaard, M, Krogh, L , Juul, N , Hvas, AM & Rasmussen, M 2019, 'Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid infusion: a randomised trial', British Journal of Anaesthesia, vol. 122, no. 6, pp. 760-766. https://doi.org/10.1016/j.bja.2019.02.017

Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid infusion: a randomised trial. / Fenger-Eriksen, Christian; D'Amore Lindholm, Alexander; Nørholt, Sven Erik et al.
In: British Journal of Anaesthesia, Vol. 122, No. 6, 06.2019, p. 760-766.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid infusion

T2 - a randomised trial

AU - Fenger-Eriksen, Christian

AU - D'Amore Lindholm, Alexander

AU - Nørholt, Sven Erik

AU - von Oettingen, Gorm

AU - Tarpgaard, Mona

AU - Krogh, Lisbeth

AU - Juul, Niels

AU - Hvas, Anne Mette

AU - Rasmussen, Mads

PY - 2019/6

Y1 - 2019/6

N2 - Background: Tranexamic acid (TXA) reduces intraoperative blood loss and transfusion during paediatric craniosynostosis surgery. Additional reduction of postoperative blood loss may further reduce exposure to allogeneic blood products. We studied the effect of combined intra- and postoperative TXA treatment on postoperative blood loss in children. Methods: Thirty children admitted for craniosynostosis surgery were randomised to combined intra- and postoperative TXA treatment or placebo. The primary endpoint was postoperative blood loss. Secondary endpoints included total blood loss, transfusion requirements, and clot stability evaluated by tissue plasminogen activator-stimulated clot lysis assay. Results: TXA reduced postoperative blood loss by 18 ml kg −1 (95% confidence interval 8.9) and total blood loss from a mean of (standard deviation [SD]; 20) ml kg −1 to 28 (14) ml kg −1 (P<0.001). Intraoperative red blood cell (RBC) and fresh frozen plasma (FFP) transfusions were reduced in the treatment group from RBC 14.0 (5.2) ml kg −1 to 8.2 (5.1) ml kg −1 (P=0.01) and from FFP 13.0 (6.3) ml kg −1 to 7.8 (5.9) ml kg −1 (P=0.03). Postoperative RBC transfusion median was 5 (inter-quartile range [IQR] 0–6) ml kg −1 in the placebo group and 0 (0–5.7) ml kg −1 in the TXA group. Resistance to lysis was higher in the treatment group (P<0.001). Conclusions: Combined intra- and postoperative tranexamic acid treatment reduced postoperative and overall blood loss and transfusion requirements. Improved clot stability represents a possible mechanism for blood loss reduction.

AB - Background: Tranexamic acid (TXA) reduces intraoperative blood loss and transfusion during paediatric craniosynostosis surgery. Additional reduction of postoperative blood loss may further reduce exposure to allogeneic blood products. We studied the effect of combined intra- and postoperative TXA treatment on postoperative blood loss in children. Methods: Thirty children admitted for craniosynostosis surgery were randomised to combined intra- and postoperative TXA treatment or placebo. The primary endpoint was postoperative blood loss. Secondary endpoints included total blood loss, transfusion requirements, and clot stability evaluated by tissue plasminogen activator-stimulated clot lysis assay. Results: TXA reduced postoperative blood loss by 18 ml kg −1 (95% confidence interval 8.9) and total blood loss from a mean of (standard deviation [SD]; 20) ml kg −1 to 28 (14) ml kg −1 (P<0.001). Intraoperative red blood cell (RBC) and fresh frozen plasma (FFP) transfusions were reduced in the treatment group from RBC 14.0 (5.2) ml kg −1 to 8.2 (5.1) ml kg −1 (P=0.01) and from FFP 13.0 (6.3) ml kg −1 to 7.8 (5.9) ml kg −1 (P=0.03). Postoperative RBC transfusion median was 5 (inter-quartile range [IQR] 0–6) ml kg −1 in the placebo group and 0 (0–5.7) ml kg −1 in the TXA group. Resistance to lysis was higher in the treatment group (P<0.001). Conclusions: Combined intra- and postoperative tranexamic acid treatment reduced postoperative and overall blood loss and transfusion requirements. Improved clot stability represents a possible mechanism for blood loss reduction.

KW - antifibrinolytics

KW - blood transfusion

KW - coagulation

KW - craniosynostosis

KW - fibrinolysis

KW - general surgery

KW - haemorrhage

KW - paediatric

UR - http://www.scopus.com/inward/record.url?scp=85063678491&partnerID=8YFLogxK

U2 - 10.1016/j.bja.2019.02.017

DO - 10.1016/j.bja.2019.02.017

M3 - Journal article

C2 - 30952386

AN - SCOPUS:85063678491

SN - 0007-0912

VL - 122

SP - 760

EP - 766

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 6

ER -

Reduced perioperative blood loss in children undergoing craniosynostosis surgery using prolonged tranexamic acid infusion: a randomised trial

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