Tranexamic acid may reduce perioperative blood loss for pediatric limb-salvage surgery
Key takeaways:
- Compared with placebo, tranexamic acid was linked with reduced perioperative blood loss and transfusions for pediatric limb-salvage surgery.
- No effect was seen for intraoperative blood loss or transfusion.
Compared with placebo, a preoperative and intraoperative infusion of tranexamic acid was associated with significant reductions in perioperative blood loss and transfusions during pediatric limb-salvage surgery for bone cancer.
However, results of the study showed tranexamic acid (TXA) was not associated with reductions in intraoperative blood loss (IBL) or intraoperative blood transfusion (IBT) requirements.
“We found that TXA is safe to use in children and adolescents under the age of 18 years who are undergoing limb-salvage surgery due to bone cancer,” Ahmed Mohamed El Ghoneimy, MD, and colleagues at the Children Cancer Hospital in Cairo, Egypt, wrote in the study. “Although TXA use was not associated with a significant reduction in IBL and IBT, we still recommend its use to reduce [perioperative blood loss] PBL and [perioperative blood transfusion] PBT.”
El Ghoneimy and colleagues performed a randomized, double-blind, placebo-controlled trial of 48 Egyptian pediatric patients (mean age, 12.5 years) who were diagnosed with a malignant bone tumor of the femur and underwent surgical resection and reconstruction with a megaprosthesis. El Ghoneimy and colleagues randomly assigned 24 patients to receive a preoperative loading dose infusion of 10 mg/kg of TXA and a continuous infusion of 5 mg/kg of TXA every hour until the end of surgery. They also randomly assigned 24 patients to a saline solution infusion (placebo) of the same dosages.
El Ghoneimy and colleagues used the hemoglobin balance method to calculate blood loss and blood transfusion requirements in the intraoperative and perioperative periods.
Overall, no significant differences were observed in intraoperative blood loss or intraoperative transfusion requirements between the groups. For the TXA group, median intraoperative blood loss was 279 mL and median intraoperative blood transfusion requirement was 143 mL. For the placebo group, median intraoperative blood loss was 535 mL and median intraoperative blood transfusion requirement was 0 mL.
In addition, operative time, time until drain removal and length of stay were similar between the groups.
However, El Ghoneimy and colleagues found the TXA group had significantly reduced perioperative blood loss at postoperative day 1 (435 mL vs. 800 mL) and at discharge (634 mL vs. 979 mL), as well as significantly reduced perioperative blood transfusion requirements (242.5 mL vs. 444 mL) compared with the placebo group.
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