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.
Population Pharmacokinetics of Epsilon-Aminocaproic Acid in Infants Undergoing Craniofacial Reconstruction Surgery
