Evaluating Tranexamic Acid Administration in Cranial Vault Reconstruction: The Experience of an Academic Center in the Deep South

Background: In infants with craniosynostosis, cranial vault reconstruction is performed to prevent sequela of premature fusion of cranial sutures. Open correction puts patients at risk for complications of major blood loss. We evaluated the impact of tranexamic acid (TXA) in children undergoing open surgical repair of a variety of types of craniosynostosis. Methods: A retrospective review of 102 infants who underwent open cranial vault reconstruction between January 2015 and December 2020 at a tertiary referral hospital was performed. The patients were stratified into TXA or non-TXA based on usage. Outcome measures included volume of blood transfused, perioperative blood loss and any adverse effects were noted. Results: In this cohort 42% of patients were treated with TXA. There was no significant difference between the patient demographics of TXA and non-TXA cohorts with the majority classified as Sagittal Craniosynostosis ( P = .1062), an average weight of 8.89 ± 1.37 kg, and age of 9.02 ± 2.02 months at time of surgery. The non-TXA cohort had longer length of hospital stay ( P = .04). The TXA cohort had an average 100 ml decrease in surgical drain output over the course of their hospital stay ( P = .02). Overall surgical complication was 14% ( P = .18) and clinical outcomes were not significantly different between the cohorts. Conclusions: The receipt of TXA in the interoperative period in patients with craniosynostosis undergoing cranial vault remodeling was associated with a decreased surgical drain output and length of stay.