Abstract
Objective Craniosynostosis surgery in small children is very often associated with a high blood
loss. Tranexamic acid (TXA) reduces blood loss during this procedure, although the
potential underlying coagulopathy in these children is not known in detail. Objective
was to determine the nature of any coagulopathy found during and after craniosynostosis
surgery and to characterize the effect of TXA on fibrin clot formation, clot strength,
and fibrinolysis.
Materials and Methods Thirty children received either TXA (bolus dose of 10 mg/kg followed by 8 hours continuous
infusion of 3 mg/kg/h) or placebo. Dynamic whole blood clot formation assessed by
thromboelastometry, platelet count, dynamic thrombin generation/thrombin-antithrombin,
clot lysis assay, and fibrinogen/factor XIII (FXIII) levels were measured. Additionally,
clot structure was investigated by real-time live confocal microscopy and topical
data analysis.
Results Increased ability of thrombin generation was observed together with a tendency toward
shortened activated partial thromboplastin time and clotting time. Postoperative maximum
clot firmness was higher among children receiving TXA. FXIII decreased significantly
during surgery in both groups.
Resistance toward tissue plasminogen activator-induced fibrinolysis was higher in
children that received TXA, as evidenced by topical data analysis and by a significant
longer lysis time. Fibrinogen levels were higher in the TXA group at 24 hours.
Conclusion A significant coagulopathy mainly characterized by changes in clot stability and
not parameters of thrombin generation was reported. Tranexamic acid improved clot
strength and reduced fibrinolysis, thereby avoiding reduction in fibrinogen levels.
Keywords
antifibrinolytic agents - blood coagulation - craniosynostosis - fibrinolysis - hemorrhage
