The Impact of Tranexamic Acid Usage on Craniosynostosis Surgery Outcomes: A Single-Center Review

Alexander E Velazquez; Anna G Boydstun; John M Sullivan; Colton J Fernstrum; Emily E Hecox; John B Phillips; Clarice A Swift; Haven M Howell; Rebekah B Aultman; Katherine E Baker; Clay Thames; Gidarell C Bryant; Michael S Lebhar; Laura S Humphries; Ian C Hoppe

doi:10.1097/SCS.0000000000011492

The Impact of Tranexamic Acid Usage on Craniosynostosis Surgery Outcomes: A Single-Center Review

J Craniofac Surg. 2025 May 12. doi: 10.1097/SCS.0000000000011492. Online ahead of print.

Authors

Affiliations

¹ University of Mississippi School of Medicine.
² Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS.

PMID: 40358527
DOI: 10.1097/SCS.0000000000011492

Abstract

Purpose: Tranexamic acid (TXA) has become an increasingly common adjunct to mitigate blood loss in both elective and traumatic surgery. By inhibiting the activation of plasmin and thereby preventing fibrinolysis, TXA is thought to reduce intraoperative blood loss. This study examines a single institution's use of TXA in cranial vault remodeling surgery and its correlation with intraoperative blood loss and postoperative recovery.

Methods: A retrospective chart analysis of 168 patients who underwent craniosynostosis surgery between 2012 and 2023 was performed. A total of 149 patients received TXA, though dosing protocols were inconsistent across the study period. Standardized weight-based dosing (10 mg/kg loading and 5 mg/kg/h maintenance) was only adopted in recent years. Outcomes recorded included TXA loading and running dose, estimated blood loss, blood replaced, length of hospital stay, and morphine equivalents needed.

Results: Despite variability in TXA dosing, patients who received TXA demonstrated a trend toward decreased total blood loss (199 vs. 280 mL, P=0.091) and a lower percentage loss of circulating blood volume (23% vs. 29%, P=0.434), though these findings did not reach statistical significance. However, patients in the TXA group required significantly fewer total postoperative morphine equivalents (7.34 vs. 14.59, P=0.043). No significant difference in transfusion requirements or hospital length of stay was observed.

Conclusion: TXA administration in craniosynostosis surgery was associated with a clinically meaningful but statistically nonsignificant reduction in intraoperative blood loss and a significant reduction in postoperative opioid consumption. While these findings highlight potential benefits of TXA, further prospective studies with standardized dosing protocols are needed to confirm its impact on perioperative outcomes.

Keywords: Antifibrinolytics; blood loss; cranial vault remodelling; craniosynostosis; opioid consumption; pediatric surgery; postoperative pain; tranexamic acid.