Tranexamic acid for reducing blood loss, transfusion requirements, and dosage in pediatric craniosynostosis surgery: a systematic review and meta-analysis

Background: Craniosynostosis surgery is a high risk of substantial blood loss, frequently requiring transfusion. This study evaluates the efficacy of tranexamic acid (TXA) in reducing blood loss and transfusion requirements and examines the administered TXA dosages. Methods: A systematic literature search was performed across databases including PubMed, EBSCO, ScienceDirect, ProQuest, EMBASE, and others, to evaluate the effects of TXA in craniosynostosis surgery. Pooled weighted mean differences (WMDs) were calculated to evaluate reductions in blood loss, transfusion requirements, and duration of Intensive Care Unit (ICU) and hospital stays. The meta-analysis was conducted using Review Manager 5.4 software. This study is registered with PROSPERO. Results: Four randomized controlled trials and 10 retrospective cohort studies, with 2,180 patients, were included. The pooled analysis revealed a significant reduction in blood loss during craniosynostosis surgery, with a WMD of -18.54 (95% CI: -27.15 to -9.93, p < 0.0001; I2 = 90%). Additionally, there was a significant decrease in transfusion requirements, with a WMD of -5.08 (95% CI: -8.86 to -1.30, p = 0.009; I2 = 92%). Furthermore, the analysis revealed a significant reduction in the length of hospital stay, with a WMD of -0.48 (95% CI: -0.94 to -0.02, p = 0.04; I2 = 76%). The dosage of TXA ranged from a 10-50 mg/kg loading dose to a maintenance dose of 3-10 mg/kg/h. No significant reduction was noted in ICU stay duration. Conclusions: TXA administration during craniosynostosis surgery significantly reduced blood loss and transfusion requirements, contributing to shorter hospital stays. These findings support minimizing transfusion and optimizing TXA dosing in surgical protocols, although no effect was seen on ICU stay duration.