40. The Benefits of Antifibrinolytic Administration in Minimally Invasive Craniosynostosis Repair

PURPOSE: The use of antifibrinolytics (AF) in minimally invasive craniosynostosis repair (MICR) is a topic of ongoing debate. This study aimed to assess the impact of AF on intraoperative blood loss, blood transfusion frequency and volume, complication rates, and length of hospital stay in children undergoing MICR. METHODS: A single institution retrospective chart review was conducted on children who underwent MICR from 2007 to 2023. Patients were divided into two groups based on their AF administration status. Calculated blood loss (CBL) was derived from estimated blood volume (EBV) and hematocrit values to determine estimated red cell mass (ERCM) at various points. Intraoperative transfusion management was also evaluated, considering transfusion volumes appropriate within 15% of preoperative ERCM. RESULTS: 85 patients were included, with 40 receiving AF therapy and 45 not. No significant differences were found in demographics, operative time, complications, or transfusion volume. However, the mean weight-adjusted CBL (38.93 mL/kg vs. 62.89 mL/kg, p = 0.001), length of hospital stay (1.5 days vs. 2.2 days, p < 0.0001) and percentage of patients requiring transfusions were all significantly lower in the AF group (42.5% vs. 95.6%, p < 0.0001). Surprisingly, patients in the AF group were under-transfused at discharge at significantly higher rates (62.5% vs 26.7%, p = 0.0009). CONCLUSION: The findings support the safety and efficacy of AF in MICR. AF administration reduced blood loss and length of stay, suggesting these agents should be standard practice in MICR, with a focus on matching transfusion to blood volume loss.