Tranexamic acid decreases transfusion requirements during the modified pi-plasty procedure for sagittal craniosynostosis

Sagittal craniosynostosis is the most common of the isolated craniosynostoses. At our center, the preferred procedure for children older than 3 months is modified pi-plasty. The amount of blood loss is a major concern in extensive cranioplasties. Therefore, the aim of our study was to evaluate the effectiveness of intraoperative tranexamic acid (TXA) administration in decreasing transfusion needs in patients undergoing modified pi-plasty. Our retrospective study was performed using a population of 59 patients who underwent modified pi-plasty, wherein patients who received TXA during surgery (study group, n = 26) were compared with patients who did not receive TXA (control group, n = 33). The primary study endpoints were intraoperative red blood cell substitution (%), postoperative red blood cell substitution (%), total red blood cell substitution (%), and hematocrit variation. Perioperative administration of TXA significantly decreased the total red blood cell substitution (62.90% vs 86.70%; p = 0.002) and resulted in a higher postoperative hematocrit (29.47% vs 27.53%; p = 0.060). In conclusion, perioperative administration of TXA significantly decreased blood transfusion requirements in our patients with sagittal craniosynostosis undergoing modified pi-plasty.