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Monday, April 04, 2011
How to limit blood loss: craniosynostosis
This month in Anesthesiology there are two papers describing randomized controlled trials in children having surgical correction of craniosynostosis. They compare the effect of tranexamic acid versus placebo on blood loss. Both trials found strong evidence for a reduction in transfusion of blood with the use of tranexamic acid. The trials were in subtly different populations and used different doses of tranexamic acid. In the paper by Dadure et al. from Montpellier, France, the children’s ages ranged from 3 to 15 months and the tranexamic acid group received a loading dose of 15 mg/kg and then an infusion of 10 mg/kg/hr. The children were treated preoperatively with erythropoietin. Goobie et al. from Boston, Massachusetts, studied older children (the mean age was between 23 and 25 months) and they used a larger dose of tranexamic acid, namely a 50mg/kg loading dose followed by a subsequent infusion of 5/mg/kg/hr. The surgery in the Boston group was considerably longer than that in the French, and the total blood loss was greater. However, both groups demonstrated that the tranexamic acid groups received a lower mean volume of red cells. Dadure et al. also found that more children in the tranexamic acid group avoided transfusion altogether. There were no thrombotic complications observed in either study but the numbers are small.

Results from randomized trials may be difficult to generalize if they are performed in circumscribed homogeneous populations. It would therefore be very valuable to see the benefit of tranexamic acid demonstrated in two quite different settings.

Posted by Andrew Davidson, MBBS MD FANZCA
Andrew Davidson
About the Author

J. Lance Lichtor, M.D
J. Lance Lichtor, M.D. is a professor of anesthesiology and pediatrics at The University of Massachusetts Medical School. He is the web editor and an associate editor for Anesthesiology.

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