Prohemostatic treatment has repeatedly been shown to be effective in reducing perioperative blood loss and transfusion requirements and in reducing clinically relevant outcome parameters such as reoperation, perioperative complications and mortality. Tranexamic acid is an antifibrinolytic prohemostatic intervention and is not only effective in cardiac surgery, trauma with excessive blood loss and other surgical situations that are associated with major hemorrhage but is also relatively safe.

Two randomized controlled trials investigating the effect of tranexamic acid on perioperative blood losses and transfusion requirements in children undergoing craniosynostosis surgery (a procedure known to be associated with major blood loss) showed the efficacy and safety of tranexamic acid in this clinical setting [1,2]. Both trials demonstrated that administration of tranexamic acid resulted in less perioperative blood loss, less transfusion and, importantly, less children exposed to allogeneic blood products.

Interestingly, both studies add to our knowledge on the safety of tranexamic acid, now in children. The authors of both studies are to be commended for performing these important trials, as there are not so many randomized controlled trials on prohemostatic interventions in children. Tranexamic acid is a relatively cheap, easy-to-use and apparently safe drug that turns out to be a universal prohemostatic intervention, applicable to virtually all operations that are associated with major blood losses and transfusions.

– Marcel Levi


1. Dadure C, Sauter M, Bringuier S, et al. Intraoperative tranexamic acid reduces blood transfusion in children undergoing craniosynostosis surgery: a randomized double-blind study. Anesthesiology 2011;114:856-61.

2. Goobie SM, Meier PM, Pereira LM, et al. Efficacy of tranexamic acid in pediatric craniosynostosis surgery: a double-blind, placebo-controlled trial. Anesthesiology 2011;114:862-71.