Cohort Demographics and Intraoperative Management
We identified 95 patients (5 to 35 months of age) who underwent CCVR at
MCJCHV between September 2015 and December 2019. All of the patients
were cared for by the same pediatric plastic surgeon and pediatric
neurosurgeon. Overall, 47 patients received EACA and 48 received TXA.
Dosing regimen was largely equivalent for patients in each
antifibrinolytic group, although a few patients received slightly
different dosing regimen based on the anesthesiologist’s preference.
These minor dosing variations were equal between groups. There were no
major differences in demographics between the two cohorts, except that
there were slightly more syndromic patients in the EACA group (Table 1).
There was no difference in operative time or ICU length of stay, but the
total hospital length of stay was slightly longer in the TXA group.
There were more intraoperative complications in the EACA group and more
postoperative complications in the TXA group, but neither reached
statistical significance (Table 1). Intraoperative complications
included hypotension and possible venous air embolism. Postoperative
complications included two patients with new-onset seizure activity, one
minor local allergic reaction, three patients requiring repeat operation
(two for infectious complications, one for proptosis), one transfusion
reaction, and two postoperative thromboembolic events (Table 2). Both
postoperative thromboembolic events were associated with arterial lines
placed for the procedure. One did not require any intervention. The
other was treated with anticoagulation for ~2.5 months
with complete resolution.