OBJECTIVE: To compare the effects of different dosage regimens of tranexamic acid on blood loss

blood transfusion

clinical prognosis

and incidence of postoperative epilepsy complications in children undergoing skull remodeling surgery. METHODS: Totally 352 children undergoing skull remodeling surgery in neurosurgery department of Chongqing Changshou People’s Hospital from 2018 to 2020 were extracted to be divided into the lowdose group（ n = 176） and the high-dose group（ n = 176） via the random number table. Twenty minutes before skin incision

children in the high-dose group received intravenous infusion of tranexamic acid sodium chloride injection with the loading dose of 50 mg/kg

followed by continuous intravenous infusion of maintenance dose of 5 mg/（ kg·h）until the end of surgery. Children in the low-dose group received tranexamic acid sodium chloride injection at the loading dose of 10 mg/kg

followed by continuous intravenous infusion of maintenance dose of 5 mg/（ kg·h） until the end of surgery. Perioperative blood loss

blood transfusion volume

inflammation indicators and postoperative epilepsy complications were collected and compared between two groups. RESULTS: Intraoperative blood loss（ t = 1. 562

P =0. 119）

postoperative blood loss（ t = 0. 671

P = 0. 502）

total blood loss（ t = 0. 221

P = 0. 826）

intraoperative red blood cell（ RBC） transfusion volume（ t = 0. 712

P = 0. 477）

the amount of postoperative RBC blood transfusion（ t =1. 882

P =0. 061） and the total amount of RBC blood transfusion（ t =0. 837

P =0. 403） were not statistically significant between the low-dose group and the high-dose group. After operation

there were no significant differences in the levels of interleukin 6

interleukin 10

tissue plasminogen activator

plasminogen activator inhibitor-1

D-dimer and plasminogen between two groups（ P > 0. 05）. There were no significant differences in Glasgow prognostic grade（ χ2= 0. 321

P = 0. 570）

length of stay in ICU（ t = 1. 489

P = 0. 137） and total length of stay（ t = 0. 933

P =0. 351） between the low-dose group and the high-dose group. However

the incidence of epilepsy complications in the low-dose group decreased significantly in the high-dose group [0%（ 0/176） vs. 2. 8%（ 5/176）

χ2= 5. 072

P =0. 024]

and the difference was statistically significant. CONCLUSIONS: The low-dose regimen of tranexamic acid is similar to the high-dose regimen in reducing blood loss and blood transfusion during the perioperative period of skull remodeling surgery

yet the low-dose regimen can significantly reduce the incidence of postoperative epilepsy complications in children.