The Role of Tranexamic Acid in Craniosynostosis Surgery: Efficacy, Safety, and Practical Use. A Review

Abstract

Craniosynostosis is a congenital condition in which premature fusion of the cranial sutures results in abnormalities of the shape of the skull and can lead to increased intracranial pressure and associated neurological problems. The main treatment for this condition is surgery, but interventions are often accompanied by significant blood loss, which may require blood transfusions and increase the risk of complications.

Tranexamic acid (TXA) is an antifibrinolytic agent used to reduce bleeding by inhibiting fibrin degradation. In craniosynostosis surgery, TXA is administered to minimize intraoperative and postoperative blood loss and reduce the need for transfusions. Clinical studies have shown that TXA significantly reduces blood loss without a significant increase in adverse events, including thromboembolic complications. However, safety and dosing in pediatric patients require careful management. Future studies will help determine optimal dosing regimens and further elucidate the long-term safety of this drug.

This review article outlines several benefits of using TXA in infants. First, it significantly reduces perioperative blood loss in surgeries such as cardiac or neurosurgical procedures. By stabilizing the clotting process, TXA can prevent hemorrhagic complications, which are often harder to manage in infants due to their smaller blood volumes and delicate hemodynamic status. Furthermore, TXA has been shown to reduce the need for donor blood transfusions, which is crucial in minimizing the risks associated with blood transfusions, such as infections or immune reactions.

This review also notes that TXA is generally well-tolerated by infants when administered in appropriate doses, with limited side effects observed in the studies reviewed. This makes it a promising and relatively safe option for managing bleeding in this high-risk population.