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Safety and Efficacy of Aprotinin Versus Tranexamic Acid for Reducing Absolute Blood Loss and Transfusion in Pediatric Patients Undergoing Craniosynostosis Surgery: A Randomized, Double-Blind, Three-Arm Controlled Trial Publisher Pubmed



Soltani ZE1 ; Hanaei S1 ; Ohadi MAD1 ; Maroufi SF1 ; Meybodi KT1 ; Khademi S2 ; Yaghmaei B3 ; Soltani AE2 ; Nejat F1 ; Habibi Z1
Authors
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Authors Affiliations
  1. 1. Department of Pediatric Neurosurgery, Children’s Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Pediatric Anesthesiology, Children’s Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Pediatric Intensive Care Medicine, Children’s Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Neurosurgery: Pediatrics Published:2022


Abstract

OBJECTIVE Craniosynostosis surgery is associated with considerable blood loss and need for transfusion. Considering the lower estimated blood volume (EBV) of children compared to adults, excessive blood loss may quickly lead to hypovolemic shock. Therefore, reducing blood loss is important in craniosynostosis surgery. This study was conducted to evaluate the efficacy of aprotinin or tranexamic acid (TXA) in blood loss reduction in these patients. METHODS In the current randomized controlled trial, 90 eligible pediatric patients with craniosynostosis were randomly divided into three groups to receive either aprotinin, TXA, or no intervention. The absolute blood loss and transfusion amount were assessed for all patients both intraoperatively and 2 and 8 hours postoperatively. RESULTS Although crude values of estimated blood loss were not significantly different between groups (p = 0.162), when adjusted to the patient’s weight or EBV, the values reached the significance level (p = 0.018), particularly when the aprotinin group was compared to the control group (p = 0.0154). The EBV losses 2 hours and 8 hours postoperatively significantly dropped in the TXA and aprotinin groups compared to the control group (p = 0.001 and p < 0.001, respectively). Rates of postoperative blood transfusion were significantly higher in the control group (p = 0.024). Hemoglobin and hematocrit 8 hours postoperatively were lower in the control group than in the TXA or aprotinin treatment groups (p < 0.002 and p < 0.001, respectively). There were no serious adverse events associated with the interventions in this study. CONCLUSIONS Aprotinin and TXA can reduce blood loss and blood transfusion without serious complications and adverse events in pediatric patients undergoing craniosynostosis surgery. © AANS 2022