Susan M Goobie1, David Faraoni2. 1. Department of Anesthesiology, Critical Care and Pain Medicine. Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 2. Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
PURPOSE OF REVIEW: Perioperative bleeding and blood product transfusion are associated with significant morbidity and mortality. Prevention and optimal management of bleeding decreases risk and lowers costs. Tranexamic acid (TXA) is an antifibrinolytic agent that reduces bleeding and transfusion in a broad number of adult and pediatric surgeries, as well as in trauma and obstetrics. This review highlights the current pediatric indications and contraindications of TXA. The efficacy and safety profile, given current and evolving research, will be covered. RECENT FINDINGS: Based on the published evidence, prophylactic or therapeutic TXA administration is a well-tolerated and effective strategy to reduce bleeding, decrease allogeneic blood product transfusion, and improve pediatric patients' outcomes. TXA is now recommended in recent guidelines as an important part of pediatric blood management protocols. SUMMARY: Based on TXA pharmacokinetics, the authors recommend a dosing regimen of between 10 to 30 mg/kg loading dose followed by 5 to 10 mg/kg/h maintenance infusion rate for pediatric trauma and surgery. Maximal efficacy and minimal side-effects with this dosage regime will have to be determined in larger prospective trials including high-risk groups. Furthermore, future research should focus on determining the ideal TXA plasma therapeutic concentration for maximum efficacy and minimal side-effects.
PURPOSE OF REVIEW: Perioperative bleeding and blood product transfusion are associated with significant morbidity and mortality. Prevention and optimal management of bleeding decreases risk and lowers costs. Tranexamic acid (TXA) is an antifibrinolytic agent that reduces bleeding and transfusion in a broad number of adult and pediatric surgeries, as well as in trauma and obstetrics. This review highlights the current pediatric indications and contraindications of TXA. The efficacy and safety profile, given current and evolving research, will be covered. RECENT FINDINGS: Based on the published evidence, prophylactic or therapeutic TXA administration is a well-tolerated and effective strategy to reduce bleeding, decrease allogeneic blood product transfusion, and improve pediatric patients' outcomes. TXA is now recommended in recent guidelines as an important part of pediatric blood management protocols. SUMMARY: Based on TXA pharmacokinetics, the authors recommend a dosing regimen of between 10 to 30 mg/kg loading dose followed by 5 to 10 mg/kg/h maintenance infusion rate for pediatric trauma and surgery. Maximal efficacy and minimal side-effects with this dosage regime will have to be determined in larger prospective trials including high-risk groups. Furthermore, future research should focus on determining the ideal TXA plasma therapeutic concentration for maximum efficacy and minimal side-effects.
Authors: John C F Clohisy; Lawrence G Lenke; Mostafa H El Dafrawy; Rachel C Wolfe; Elfaridah Frazier; Michael P Kelly Journal: Spine Deform Date: 2022-06-25
Authors: Ioannis Gkiatas; Aristeidis-Panagiotis Kontokostopoulos; Spyridon E Tsirigkakis; Ioannis Kostas-Agnantis; Ioannis Gelalis; Anastasios Korompilias; Emilios Pakos Journal: World J Orthop Date: 2022-06-18
Authors: Aryeh Shander; Susan M Goobie; Matthew A Warner; Matti Aapro; Elvira Bisbe; Angel A Perez-Calatayud; Jeannie Callum; Melissa M Cushing; Wayne B Dyer; Jochen Erhard; David Faraoni; Shannon Farmer; Tatyana Fedorova; Steven M Frank; Bernd Froessler; Hans Gombotz; Irwin Gross; Nicole R Guinn; Thorsten Haas; Jeffrey Hamdorf; James P Isbister; Mazyar Javidroozi; Hongwen Ji; Young-Woo Kim; Daryl J Kor; Johann Kurz; Sigismond Lasocki; Michael F Leahy; Cheuk-Kwong Lee; Jeong Jae Lee; Vernon Louw; Jens Meier; Anna Mezzacasa; Manuel Munoz; Sherri Ozawa; Marco Pavesi; Nina Shander; Donat R Spahn; Bruce D Spiess; Jackie Thomson; Kevin Trentino; Christoph Zenger; Axel Hofmann Journal: Anesth Analg Date: 2020-07 Impact factor: 5.108
Authors: D M Baron; M Franchini; S M Goobie; M Javidroozi; A A Klein; S Lasocki; G M Liumbruno; M Muñoz; A Shander; D R Spahn; K Zacharowski; P Meybohm Journal: Anaesthesia Date: 2020-05-06 Impact factor: 6.955