Tranexamic acid reduces blood loss in paediatric proximal femoral and/or pelvic osteotomies

Anne J Brouwer; Dagmar R J Kempink; Pieter Bas de Witte

doi:10.1302/1863-2548.15.200249

Tranexamic acid reduces blood loss in paediatric proximal femoral and/or pelvic osteotomies

J Child Orthop. 2021 Jun 1;15(3):241-247. doi: 10.1302/1863-2548.15.200249.

Authors

Anne J Brouwer^{1

2}, Dagmar R J Kempink^{2

3}, Pieter Bas de Witte^{2

3}

Affiliations

¹ Faculty of Medicine, Erasmus University Rotterdam, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
² Department of Pediatric Orthopaedics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands.
³ Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

Purpose: Proximal femoral and/or pelvic osteotomies (PFPO) are associated with significant blood loss, which can be harmful, especially in paediatric patients. Therefore, considering methods to reduce blood loss is important. The purpose of this study was to examine the efficacy of tranexamic acid (TXA) in reducing intraoperative estimated blood loss (EBL) in paediatric patients undergoing a PFPO.

Methods: Paediatric patients who had a PFPO between 2014 and 2019 were retrospectively reviewed. Outcome measures included patient demographics, TXA use (none, preoperative and/or intraoperative bolus, pump), EBL, transfusion rate and thromboembolic complications. Univariate and multivariate analyses were performed to assess associations between investigated outcome measures and EBL.

Results: A total of 340 PFPO (263 patients) were included. Mean age at surgery was 8.0 years (sd 4.3). In all, 269 patients received no TXA, 20 had a preoperative bolus, 43 had an intraoperative bolus and eight patients had other TXA regimes (preoperative and intraoperative bolus or pump). Overall, mean blood loss was 211 ml (sd 163). Multivariate analysis showed significant associations between higher EBL and higher age at surgery, male sex, higher body mass index and longer procedure time. There was a significant association between lower EBL and a preoperative TXA bolus: 66 ml (33%) less EBL compared with patients without TXA (95% confidence interval -129 to -4; p = 0.04). No thromboembolic complications were reported in any of the studied patients.

Conclusion: Preoperative TXA administration is associated with a decreased EBL in PFPO. No thromboembolic events were reported. Administering TXA preoperatively appears to be effective in paediatric patients undergoing a PFPO.

Level of evidence: Level III - retrospective comparative study.

Keywords: paediatric orthopaedics; pelvic osteotomy; proximal femoral osteotomy; surgical blood loss; tranexamic acid.