Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr 1;13(2):190-195.
doi: 10.1302/1863-2548.13.180143.

Impact of tranexamic acid use on blood loss and transfusion rates following femoral varus derotational osteotomy in children with cerebral palsy

A Nazareth  1   2 , S J Shymon  3 , L Andras  1   4 , R Y Goldstein  1   2 , R M Kay  1   2
Affiliations

Impact of tranexamic acid use on blood loss and transfusion rates following femoral varus derotational osteotomy in children with cerebral palsy

A Nazareth et al. J Child Orthop. .

Abstract

Purpose: Previous studies have established the safety and efficacy of tranexamic acid (TXA) in reducing blood loss after total joint arthroplasty and spinal fusion surgery; however, literature regarding the effectiveness of intraoperative TXA in children with cerebral palsy (CP) is limited. The aim of this study was to investigate the safety and efficacy of intraoperative TXA in reducing blood loss and transfusion requirements for children with CP undergoing a proximal femoral varus derotational osteotomy (VDRO).

Methods: This is a retrospective review of 258 children with CP who underwent VDRO performed at the author's institution between 2004 and 2017. In all, 36 subjects underwent VDRO surgery with administration of intravenous TXA and 222 subjects underwent VDRO without administration of TXA. Outcome measures including blood loss, transfusion requirements and venous thromboembolic events were compared between groups using t-tests and chi-squared tests.

Results: No significant differences were seen in the rates of transfusion between groups for the entire hospitalization (TXA group: 11.1% versus No TXA group: 19.8%), intraoperatively (TXA: 2.8% versus No TXA: 9.0%) or postoperatively (TXA: 8.3% versus No TXA: 14.4%). Intraoperative estimated blood loss (TXA: 144.4 mL versus No TXA: 159.0 mL) and percentage blood loss (TXA: 8.9% versus No TXA: 9.2%) were similar between groups. No major thromboembolic complications events occurred in either group.

Conclusion: The use of TXA was not associated with thromboembolic complications in this series of children with CP undergoing VDRO surgery. Though there was a trend toward lower rates of intraoperative and postoperative blood transfusion with TXA use in these patients, the differences were not significant, possibly due to low estimated blood loss in both groups and sample size.

Level of evidence: III- retrospective comparative study.

Keywords: cerebral palsy; proximal femoral varus derotational osteotomy; tranexamic acid.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Box-and-whiskers plots of intraoperative estimated blood loss in children with cerebral palsy undergoing proximal femoral varus derotational osteotomy (VDRO) surgery with and without transexamic acid (TXA). Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles.
Fig. 2
Fig. 2
Box-and-whiskers plots of intraoperative estimated blood loss percentage based on weight in children with cerebral palsy undergoing proximal femoral varus derotational osteotomy (VDRO) surgery with and without transexamic acid (TXA). Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles.
See this image and copyright information in PMC

References

    1. Rosenbaum P, Paneth N, Leviton A, et al. . A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007;109:8-14. - PubMed
    1. Arneson CL, Durkin MS, Benedict RE, et al. . Prevalence of cerebral palsy: Autism and Developmental Disabilities Monitoring Network, three sites, United States, 2004. Disabil Health J 2009;2:45-48. - PubMed
    1. Debnath UK, Guha AR Karlakki S, Varghese J, Evans GA. Combined femoral and Chiari osteotomies for reconstruction of the painful subluxation or dislocation of the hip in cerebral palsy. A long-term outcome study. J Bone Joint Surg [Br] 2006;88-B:1373-1378. - PubMed
    1. Nazareth A, Rethlefsen S, Sousa TC, et al. . Percutaneous hamstring lengthening surgery is as effective as open lengthening in children with cerebral palsy. J Pediatr Orthop 22 December 2016. (Epub ahead of print) - PubMed
    1. Alassaf N, Saran N, Benaroch T, Hamdy RC. Combined pelvic and femoral reconstruction in children with cerebral palsy. J Int Med Res 2018;46:475-484. - PMC - PubMed