Tranexamic Acid for Craniofacial Surgery

Phase 4

Terminated

Brief Summary: This is a randomized, blinded, prospective study that will investigate the potential benefit of tranexamic acid to reduce the intraoperative bleeding and blood transfusions in pediatric patients undergoing craniofacial surgeries.

Detailed Description: Surgical procedures for the correction of craniofacial deformities result in unavoidable and significant blood loss in small children and infants. Patients may experience blood losses that exceed one to two blood volumes. In an effort to reduce our transfusion requirements, we have introduced tranexamic acid into our practice. However, the benefit of tranexamic acid in pediatric craniofacial surgery has not yet been reported. We hypothesize that the intraoperative use of tranexamic acid in pediatric patients presenting for craniofacial reconstructions will reduce blood loss and allogeneic transfusion requirements.

This is a randomized, blinded, prospective study that will investigate the potential benefit of tranexamic acid to reduce the intraoperative bleeding and blood transfusions in pediatric patients undergoing craniofacial surgeries. An initial dose of 100 mg/kg tranexamic acid (Cyclokapron 100mg/ml) or an equal volume of a placebo will be administered over 15 minutes after the induction of anesthesia and before the skin incision. A maintenance infusion of 10 mg/kg/hr of tranexamic acid or equal volume of a placebo will be started upon completion of the initial dose and will be continued until skin closure. The primary outcome will include the reduction in the total volume of allogeneic erythrocytes.

Recruitment & Eligibility

Inclusion Criteria

The inclusion of the patients will depend on the following criteria:

All pediatric patients scheduled for primary or secondary repair of craniosynostosis with a frontal orbital advancement, or cranial vault reconstruction.
Patients will be between the ages of 6 months and 18 years old.
They will be > than 5 kg.
All subjects being evaluated in the Craniofacial Clinic for primary or secondary repair of craniosynostosis will potentially be included in the study. Prior to inclusion in the study potential participants will be screened by history and laboratory data. The laboratory data will include a complete blood count, PT, PTT, type and cross, factor V leiden, anticardiolipin antibody, and lupus anticoagulant. The history will be obtained from the parents or current care takers. The medical records may be reviewed if there is a need for clarification.

Exclusion Criteria

Patients that will be excluded from the study include the following:

Familial or personal coagulopathy risk-factor V leiden, anticardiolipin antibody, and lupus anticoagulant
Abnormal PT, PTT, Platelet count. or closing time. All patients presenting for craniofacial surgery have preoperative blood work performed which includes a type and screen, HCT, PLT, PT, PTT, and closing time. Patients who have abnormalities detected in their coagulation profile proceed on to a complete hematologic evaluation that includes an evaluation for Von Willebrand's Disease.
History of thrombotic episodes in the patient
Renal failure or hepatic failure.
Infants less than 5 kg
Age < 6 months or > 18 years old

Arm && Interventions

Group	Intervention	Description
Placebo	saline	Saline was administered intravenously
Tranexamic acid	Tranexamic acid	Tranexamic acid (100 mg/kg load, 10 mg/kg/hr) intravenous

Primary Outcome Measures

Name	Time	Method
Total Volume (ml/kg) of Allogeneic Blood Exposure.	intraoperative and postoperative (24 hr)	This is the blood administered during surgery. The blood comes form the blood bank. It is not cell salvage blood. The volume was normalized by weight.
Number of Patients That Remained Transfusion Free	24 hours

Secondary Outcome Measures

Name	Time	Method
Effect of Tranexamic Acid on Prothrombin Time (PT), Partial Thromboplastin Time (PTT) at Three Time Points (Baseline, After Osteotomies, and Immediately After Procedure).	(baseline, after osteotomies, and immediately after procedure)
Platelets	baseline, after osteotomies, immediately after surgery