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Antifibrinolytics as a Patient Blood Management Modality in Craniosynostosis Surgery: Current Concepts and a View to the Future

  • Pediatric Anesthesia (R Agarwal, Section Editor)
  • Published:
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Abstract

Purpose of Review

The use of antifibrinolytics to reduce blood loss and blood transfusion in craniosynostosis surgery has become a standard of care for pediatric anesthesia. The purpose of this review is to summarize contemporary aspects of surgical and anesthesia care and to review current blood management evidence and best practices with a focus on antifibrinolytics.

Recent Findings

The literature was reviewed to assess the evolving role of antifibrinolytics in perioperative hemostatic management. The paper focuses on current concepts regarding the safety, efficacy, and appropriate dosing regimen of tranexamic acid (TXA).

Summary

The use of antifibrinolytics has emerged as a safe and effective prophylactic method of minimizing perioperative blood loss and transfusion requirements in pediatric patients undergoing craniosynostosis surgery. Recent head-to-head trials have shown that a low-dose TXA regime is equally effective and safe. Based on pharmacokinetic studies, a TXA dose between 10–30 mg/kg loading dose and 5–10 mg/kg/h is recommended.

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Authors and Affiliations

  1. Department of Plastic & Oral Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Alistair D. Varidel & John G. Meara

  2. Department of Neurosurgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Mark R. Proctor

  3. Department Anesthesiology, Critical Care & Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Susan M. Goobie

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Varidel, A.D., Meara, J.G., Proctor, M.R. et al. Antifibrinolytics as a Patient Blood Management Modality in Craniosynostosis Surgery: Current Concepts and a View to the Future. Curr Anesthesiol Rep 13, 148–158 (2023). https://doi.org/10.1007/s40140-023-00567-z

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