Combined Application of Tranexamic Acid and Thrombelastography in Pediatric Epilepsy Surgery

Abstract

Background: Pediatric patients undergoing epilepsy surgeries are under high risks of bleeding, hemodynamic instability and complications related to transfusions. This study aimed to investigate whether combined application of tranexamic acid (TXA) and thrombelastography (TEG) in pediatric epilepsy surgery can decrease blood loss, transfusion requirements and post-operation complications.Methods: Thirty-two pediatric patients undergoing elective epilepsy surgery were randomized into two groups. Group T (Group T=Group Treatment, n=16) was given a loading dose of 10 mg/kg TXA in 15 minutes and then maintained at the speed of 5 mg/kg/h, while Group C (Group C=Group Control, n=16) was given the same dosage of normal saline. TEG tests were performed at the beginning of surgery (T1), opening the dura mater (T2), closing the dura mater (T3) and the end of surgery (T4) in both groups. In Group T, transfusion decision was made according to TEG results; while in Group C, it was made by anesthetist's experience without knowing the TEG results. The volume of blood loss, blood transfusion, post-operative drainage and complications were recorded.Results: In Group T, intraoperative bleeding volume was significantly lower than Group C ([8.23±4.10] ml/kg vs [12.86±5.30] ml/kg, P=0.010]), and subsequently the ratio of transfusion of red blood cells (RBC) (18.75% vs 56.25%, P=0.026), fresh frozen plasma (FFP) (32.15% vs 43.75%, P=0.465) were significantly reduced. Maximal amplitude (MA) value of TEG at T3 (Group T=[61.11±4.58] mm vs Group C=[56.09±8.03] mm, P=0.038) and T4 (Group T=[60.31±6.23] mm vs Group C=[54.08±7.28] mm, P=0.014) in Group T were significantly higher than those in Group C. A significant difference existed between two groups in postoperative drainage volume in the first 24 hours (Group T=[4.19±1.55] ml/kg vs Group C=[5.83±2.07] ml/kg, P=0.017). Postoperative hospital stay was significantly shortened in Group T, compared to Group C ([7.9±2.1] days vs [10.8±3.8] days, P=0.014). No transfusion related complications occurred in both groups.Conclusions: Combined application of TXA and TEG in pediatric epilepsy surgery may decrease blood loss, reduce transfusion requirements. The risk of thromboembolism may not be increased. Citation: Qing-Fang Duan, Wen-Ya Fu, Wei Xiao, Jia-Jian Qi, Guo-Guang Zhao, Yong-Zhi Shan, et al. Combined application of tranexamic acid and thrombelastography in pediatric epilepsy surgery. J Anesth Perioper Med 2017; 4: 213-9. doi: 10.24015/JAPM.2017.0007This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.