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01-11-2012 | Review Article

A systematic review of the use of antifibrinolytic agents in pediatric surgery and implications for craniofacial use

Authors: Marten N. Basta, Paul A. Stricker, Jesse A. Taylor

Published in: Pediatric Surgery International | Issue 11/2012

Abstract

A systematic review aimed to evaluate the efficacy and safety of aprotinin, epsilon-aminocaproic acid (EACA), and tranexamic acid (TXA) in reducing perioperative blood loss, risk for transfusion, and total perioperative transfusion volume in major pediatric surgery. Medline, Embase, and Cochrane Reviews were searched for relevant articles published from January 1990 to January 2012. Additional studies were identified by cross-referencing citations and extracting data from recent published reviews. Data were recorded and analyzed using Cochrane’s RevMan5.1 software. Thirty-four studies were included in this review of which 21 provided level 1b evidence, 11 were level 2b, and two were level 3b. As compared to control groups, antifibrinolytics reduced perioperative blood loss by standardized mean difference (SMD) of −0.70 (−0.89, −0.50; p < 0.00001), total transfusion volume by SMD of −0.78 (−0.95, −0.61; p < 0.00001), and Odds Ratio (OR) for transfusion was 0.39 (0.23, 0.64; p = 0.002). The OR for adverse events attributable to treatment was not statistically significant across groups (OR = 0.96; p = 0.58). Antifibrinolytics are effective in reducing blood loss and transfusion requirements in major pediatric surgery. TXA and EACA also appear to have reasonable side-effect profiles. Application to craniofacial surgery is promising, though further investigation is necessary.

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Title: A systematic review of the use of antifibrinolytic agents in pediatric surgery and implications for craniofacial use
Authors: Marten N. Basta
Paul A. Stricker
Jesse A. Taylor
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 11/2012
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-012-3167-6

At a glance: The STEP trials

Springer Medicine

A systematic review of the use of antifibrinolytic agents in pediatric surgery and implications for craniofacial use

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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