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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Safety of antifibrinolytics in 6583 pediatric patients having craniosynostosis surgery: A decade of data reported from the multicenter Pediatric Craniofacial Collaborative Group
Paediatric Anaesthesia, Volume 32, No. 12, Year 2022
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Description
Background: Antifibrinolytics such as tranexamic acid and epsilon-aminocaproic acid are effective at reducing blood loss and transfusion in pediatric patients having craniofacial surgery. The Pediatric Craniofacial Collaborative Group has previously reported low rates of seizures and thromboembolic events (equal to no antifibrinolytic given) in open craniofacial surgery. Aims: To query the Pediatric Craniofacial Collaborative Group database to provide an updated antifibrinolytic safety profile in children given that antifibrinolytics have become recommended standard of care in this surgical population. Additionally, we include the population of younger infants having minimally invasive procedures. Methods: Patients in the Pediatric Craniofacial Collaborative Group registry between June 2012 and March 2021 having open craniofacial surgery (fronto-orbital advancement, mid and posterior vault, total cranial vault remodeling, intracranial LeFort III monobloc), endoscopic cranial suture release, and spring mediated cranioplasty were included. The primary outcome is the rate of postoperative complications possibly attributable to antifibrinolytic use (seizures, seizure-like activity, and thromboembolic events) in infants and children undergoing craniosynostosis surgery who did or did not receive antifibrinolytics. Results: Forty-five institutions reporting 6583 patients were included. The overall seizure rate was 0.24% (95% CI: 0.14, 0.39%), with 0.20% in the no Antifibrinolytic group and 0.26% in the combined Antifibrinolytic group, with no statistically reported difference. Comparing seizure rates between tranexamic acid (0.22%) and epsilon-aminocaproic acid (0.44%), there was no statistically significant difference (odds ratio = 2.0; 95% CI: 0.6, 6.7; p =.257). Seizure rate was higher in patients greater than 6 months (0.30% vs. 0.18%; p =.327), patients undergoing open procedures (0.30% vs. 0.06%; p =.141), and syndromic patients (0.70% vs. 0.19%; p =.009). Conclusions: This multicenter international experience of pediatric craniofacial surgery reports no increase in seizures or thromboembolic events in those that received antifibrinolytics (tranexamic acid and epsilon-aminocaproic acid) versus those that did not. This report provides further evidence of antifibrinolytic safety. We recommend following pharmacokinetic-based dosing guidelines for administration. © 2022 John Wiley & Sons Ltd.
Authors & Co-Authors
Staffa, Steven J.
United States, Boston
Boston Children's Hospital
Stricker, Paul A.
United States, Philadelphia
University of Pennsylvania
Pérez-Pradilla, Carolina
Colombia, Bogota
Fundacion Santa fe de Bogota
Goobie, Susan M.
United States, Boston
Boston Children's Hospital
Barker, Nigel H.
Unknown Affiliation
Bradley, James P.
Unknown Affiliation
de Castro, Alexa
Unknown Affiliation
Echeverry Marín, Piedad Cecilia
Unknown Affiliation
Enicker, Basil Claude
Unknown Affiliation
Gosman, Amanda A.
Unknown Affiliation
Grivoyannis, Anastasia D.
Unknown Affiliation
Haas, Thorsten
Unknown Affiliation
Madaree, Anil
Unknown Affiliation
Muhly, Wallis Taylor
Unknown Affiliation
Taylor, Jenna Leigh
Unknown Affiliation
Whyte, Simon David
Unknown Affiliation
Statistics
Citations: 9
Authors: 16
Affiliations: 4
Identifiers
Doi:
10.1111/pan.14540
ISSN:
11555645
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cross Sectional Study
Case-Control Study