Safety of antifibrinolytics in cranial vault reconstructive surgery: a report from the pediatric craniofacial collaborative group. Issue 3 (17th February 2017)

• Record Type: Journal Article
• Authors: Goobie, Susan M.; Cladis, Franklyn P.; Glover, Chris D.; Huang, Henry; Reddy, Srijaya K.; Fernandez, Allison M.; Zurakowski, David; Stricker, Paul A.
• Editors: Anderson, Brian
• Other Names: Fiadjoe John investigator.; Soneru Codruta investigator.; Falcon Ricardo investigator.; Petersen Timothy investigator.; Kowalczyk‐Derderian Courtney investigator.; Dalesio Nicholas investigator.; Budac Stefan investigator.; Groenewald Neels investigator.; Rubens Daniel investigator.; Thompson Douglas investigator.; Watts Rheana investigator.; Gentry Katherine investigator.; Ivanova Iskra investigator.; Hetmaniuk Mali investigator.; Hsieh Vincent investigator.; Collins Michael investigator.; Wong Karen investigator.; Binstock Wendy investigator.; Reid Russell investigator.; Poteet‐Schwartz Kim investigator.; Gries Heike investigator.; Hall Rebecca investigator.; Koh Jeffrey investigator.; Colpitts Kelsey investigator.; Scott Lauren investigator.; Bannister Carolyn investigator.; Sung Wai investigator.; Jain Ranu investigator.; Chaudhry Rabail investigator.; Tuite Gerald F. investigator.; Ruas Ernesto investigator.; Drozhinin Oleg investigator.; Tetreault Lisa investigator.; Muldowney Bridget investigator.; Ricketts Karene investigator.; Fernandez Patrick investigator.; Sohn Lisa investigator.; Hajduk John investigator.; Taicher Brad investigator.; Burkhart Jessica investigator.; Wright Allison investigator.; Kugler Jane investigator.; Barajas‐DeLoa Lea investigator.; Gangadharan Meera investigator.; Busso Veronica investigator.; Stallworth Kayla investigator.; Staudt Susan investigator.; Labovsky Kristen investigator.; Glover Chris investigator.; Karlberg‐Hippard Helena investigator.; Capehart Samantha investigator.; Streckfus Cynthia investigator.; Nguyen Kim‐Phuong investigator.; Manyang Peter investigator.; Martinez Jose Luis investigator.; Hansen Jennifer investigator.; Mitzel Heather investigator.; Brzenski Alyssa investigator.; Chiao Franklin investigator.; Ingelmo Pablo investigator.; Mujallid Razaz investigator.; Bosenberg Adrian investigator.;
• Is Part Of: Paediatric anaesthesia. Volume 27:Issue 3(2017:Mar.)
• Page Start: 271
• Page End: 281
• Publication Date: 2017-02-17
• Subjects: antifibrinolytics -- tranexamic acid -- aminocaproic acid -- craniofacial surgery -- craniosynostosis -- safety; Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.13076
• Languages: English
• ISSNs: 1155-5645

Abstract

Summary: Background: Antifibrinolytic therapy significantly decreases blood loss and transfusion in pediatric cranial vault reconstructive surgery; however, concern regarding the side effects profile limits clinical use. Aims: The aim was to utilize the Pediatric Craniofacial Surgery Perioperative Registry database to identify the safety profile of antifibrinolytic therapy for cranial vault reconstructive surgery by reporting the incidence of adverse events as they relate to exposure to tranexamic acid and aminocaproic acid compared to no exposure to antifibrinolytics. Methods: The database was queried for cases of open cranial vault reconstructive surgery. Less invasive procedures such as neuro‐endoscopic and spring‐mediated cranioplasties were excluded. The outcomes evaluated included any perioperative neurological adverse event including seizures or seizure‐like movements and thromboembolic events. Results: Thirty‐one institutions reported a total of 1638 cases from 2010 to 2015. Total antifibrinolytic administration accounted for 59.5% (tranexamic acid, 36.1% and aminocaproic acid, 23.4%), with 40.5% not receiving any antifibrinolytic. The overall incidence of postoperative seizures or seizure‐like movements was 0.6%. No significant difference was detected in the incidence of postoperative seizures between patients receiving tranexamic acid and those receiving aminocaproic acid [the odds ratio for seizures being 0.34 (95% confidence interval: 0.07–1.85) controlling for American Society of Anesthesia (ASA) physical class] nor in patients receiving antifibrinolytics compared to those not administered antifibrinolytics (the odds ratio for seizures being 1.02 (confidence interval 0.29–3.63) controlling for ASA physical class). One complicated patient in the antifibrinolytic group with a femoral venous catheter had a postoperative deep venous thrombosis. Conclusions: This is the first report of an incidence of postoperative seizures of 0.6% in pediatric cranial vault reconstructive surgery. There was no significant difference in postoperative seizures or seizure‐like events in those patients who received the tranexamic acid or aminocaproic acid vs those that did not. This report provides evidence of the safety profile of antifibrinolytic in children having noncardiac major surgery. Caution should prevail however in using antifibrinolytic in high‐risk patients. Antifibrinolytic dosage regimes should be based on pharmacokinetic data avoiding high doses. Abstract :