PMID- 30952386
OWN - NLM
STAT- MEDLINE
DCOM- 20190603
LR  - 20190603
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 122
IP  - 6
DP  - 2019 Jun
TI  - Reduced perioperative blood loss in children undergoing craniosynostosis surgery 
      using prolonged tranexamic acid infusion: a randomised trial.
PG  - 760-766
LID - S0007-0912(19)30129-1 [pii]
LID - 10.1016/j.bja.2019.02.017 [doi]
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 52 ml kg(-1) (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.
CI  - Copyright (c) 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Fenger-Eriksen, Christian
AU  - Fenger-Eriksen C
AD  - Department of Anaesthesiology, Aarhus University Hospital, Denmark. Electronic 
      address: chfen@dadlnet.dk.
FAU - D'Amore Lindholm, Alexander
AU  - D'Amore Lindholm A
AD  - Department of Anaesthesiology, Aarhus University Hospital, Denmark.
FAU - Norholt, Sven Erik
AU  - Norholt SE
AD  - Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, 
      Denmark.
FAU - von Oettingen, Gorm
AU  - von Oettingen G
AD  - Department of Neurosurgery, Aarhus University Hospital, Denmark.
FAU - Tarpgaard, Mona
AU  - Tarpgaard M
AD  - Department of Anaesthesia, Copenhagen University Hospital, Rigshospitalet, 
      Copenhagen, Denmark.
FAU - Krogh, Lisbeth
AU  - Krogh L
AD  - Department of Anaesthesiology, Aarhus University Hospital, Denmark.
FAU - Juul, Niels
AU  - Juul N
AD  - Department of Anaesthesiology, Aarhus University Hospital, Denmark.
FAU - Hvas, Anne Mette
AU  - Hvas AM
AD  - Department of Clinical Biochemistry, Centre for Haemophilia and Thrombosis, 
      Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus 
      University, Denmark.
FAU - Rasmussen, Mads
AU  - Rasmussen M
AD  - Department of Anaesthesiology, Aarhus University Hospital, Denmark.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20190402
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
RN  - 0 (Antifibrinolytic Agents)
RN  - 6T84R30KC1 (Tranexamic Acid)
SB  - IM
MH  - Anesthesia, General/methods
MH  - Antifibrinolytic Agents/administration & dosage/*therapeutic use
MH  - Blood Loss, Surgical/*prevention & control
MH  - Child, Preschool
MH  - Craniosynostoses/*surgery
MH  - Double-Blind Method
MH  - Erythrocyte Transfusion
MH  - Female
MH  - Fibrinolysis/drug effects
MH  - Humans
MH  - Infant
MH  - Infusions, Intravenous
MH  - Male
MH  - Perioperative Care/methods
MH  - Postoperative Hemorrhage/*prevention & control
MH  - Tranexamic Acid/administration & dosage/*therapeutic use
OTO - NOTNLM
OT  - antifibrinolytics
OT  - blood transfusion
OT  - coagulation
OT  - craniosynostosis
OT  - fibrinolysis
OT  - general surgery
OT  - haemorrhage
OT  - paediatric
EDAT- 2019/04/07 06:00
MHDA- 2019/06/04 06:00
CRDT- 2019/04/07 06:00
PHST- 2018/11/27 00:00 [received]
PHST- 2019/01/07 00:00 [revised]
PHST- 2019/02/03 00:00 [accepted]
PHST- 2019/04/07 06:00 [pubmed]
PHST- 2019/06/04 06:00 [medline]
PHST- 2019/04/07 06:00 [entrez]
AID - S0007-0912(19)30129-1 [pii]
AID - 10.1016/j.bja.2019.02.017 [doi]
PST - ppublish
SO  - Br J Anaesth. 2019 Jun;122(6):760-766. doi: 10.1016/j.bja.2019.02.017. Epub 2019 
      Apr 2.