Abstract
INTRODUCTION: Children undergoing complex cranial vault
reconstruction (CCVR) for craniosynostosis experience high rates of
bleeding and transfusion, increasing risk for perioperative
complications. ε-Aminocaproic acid (EACA) and tranexamic acid (TXA) are
antifibrinolytic agents that have been shown to reduce intraoperative
hemorrhage and transfusion requirements during CCVR. However, the
relative efficacy of these two agents has not yet been evaluated. The
aim of this study was to compare perioperative blood loss and
transfusion rates in children receiving EACA vs. TXA.
METHODS: All patients who underwent CCVR from September 2015 to
December 2019 at a single center were retrospectively evaluated. Primary
outcome measures included intraoperative estimated blood loss,
postoperative drain output, transfusion volumes, and calculated blood
loss. Secondary outcome measures included hematologic and coagulation
parameters.
RESULTS: 95 patients were included, with 47 patients in the
EACA cohort and 48 patients in the TXA cohort. There were no significant
differences in demographics, surgical outcomes, blood loss, transfusion
requirement, or perioperative hematologic and coagulation laboratory
values between the two cohorts. Adverse events were similar between the
groups, but did include two seizure events and two thromboembolic events
related to vascular access devices.
DISCUSSION: We found no significant difference in blood loss,
transfusion requirements, hematologic parameters, or outcomes between
pediatric CCVR patients who received EACA vs. TXA. Further research is
needed to define optimal antifibrinolytic dosing and duration of
therapy. While standard laboratory parameters were similar between
groups, future studies investigating coagulation-based and inflammatory
assays may be useful in defining surgical-induced coagulopathy.