High-dose Versus Low-dose Tranexamic Acid to Reduce Transfusion Requirements in Pediatric Scoliosis Surgery

Johnson, Daniel J.; Johnson, Christine Cole; Goobie, Susan M.; Nami, Nina; Wetzler, Joshua A.; Sponseller, Paul D.; Frank, Steven M.

doi:10.1097/bpo.0000000000000820

Cited by 67 publications

(64 citation statements)

References 27 publications

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“…Over the past decades, multidisciplinary and multimodal strategies have been implemented to prevent and reduce intraoperative bleeding and improve perioperative blood management in patients undergoing surgical procedures associated with a high risk of bleeding . The development of Patient Blood Management (PBM) guidelines intended to promote blood conservation have helped guide surgical programs to identify risk factors for bleeding and transfusion, and develop surgery‐specific perioperative strategies to improve patient care and resource utilization.…”

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confidence: 99%

Preoperative anemia increases the risk of red blood cell transfusion and prolonged hospital length of stay in children undergoing spine arthrodesis surgery

et al. 2018

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BACKGROUND: Preoperative anemia is an important modifiable risk factor for red blood cell (RBC) transfusion in a variety of surgical populations. The primary objective of this study was to examine the association between preoperative anemia and i) transfusion of RBCs within 72 hours of surgery and ii) postoperative clinical outcomes in children undergoing spine arthrodesis surgery. STUDY DESIGN AND METHODS:We assembled a retrospective cohort of children included in the American College of Surgeons National Quality Improvement Program Pediatric database who underwent spine arthrodesis surgery from 2012 to 2016. Anemia was defined using age-and sex-specific hematocrit thresholds. Data collected included demographic and surgical characteristics, RBC transfusion within 72 hours, and 30-day postoperative outcomes (postoperative mechanical ventilation, infection, readmission, hospital length of stay, mortality). Multivariable logistic regression analyses were used to identify independent predictors of RBC transfusion and postoperative outcomes. RESULTS:We included 9,095 patients in the analysis.Preoperative anemia was present in 14% (n = 1,233) of the population and 67% (n = 6,135) of patients were transfused. Our multivariable logistic regression showed anemia, surgical time > 350 minutes, > 7 vertebral levels fused, neuromuscular disease, and cerebral palsy were all independent predictors of RBC transfusion. Preoperative anemia was also associated with prolonged hospital LOS (adjusted OR: 1.31, 95%CI: 1.11-1.54, p = 0.002). CONCLUSIONS:In this study of 9,095 children undergoing spine surgery, preoperative anemia was associated with an increased risk of RBC transfusion and prolonged LOS. Further studies are needed to determine if treatment of preoperative anemia can effectively reduce intraoperative RBC transfusion.

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confidence: 99%

Preoperative anemia increases the risk of red blood cell transfusion and prolonged hospital length of stay in children undergoing spine arthrodesis surgery

et al. 2018

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“…We are also unable to comment of safety and efficacy of higher dose regimens for TXA. This could be a topic of further study, since optimal dosage of this drug is still relatively unknown and varies widely, and there is evidence that higher doses may be more efficacious …”

Section: Discussionmentioning

confidence: 99%

The impact of patient blood management on blood utilization and clinical outcomes in complex spine surgery

et al. 2019

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BACKGROUND: Patient blood management (PBM) is especially applicable in major spine surgery, during which bleeding and transfusion are common. What remains unclear in this setting is the overall impact of bundled PBM measures on transfusion requirements and clinical outcomes. We compared these outcomes before and after implementing a PBM program. STUDY DESIGN AND METHODS:We conducted a retrospective review of 928 adult complex spine surgery patients performed by a single surgeon between January 2009 and June 2016. Although PBM measures were phased in over time, tranexamic acid (TXA) administration became standard protocol in July 2013, which defined our pre-and post-PBM periods. Transfusion rates for all blood components before and after PBM implementation were compared, as were morbid event rates and mortality. RESULTS:Baseline characteristics were similar before and after PBM. Before PBM, the mean number of units/ patient decreased for red blood cells (RBCs; by 19.5%; p = 0.0057) and plasma (by 33%; p = 0.0008), but not for platelets (p = 0.15). After risk adjustment by multivariable analyses, the composite outcome of morbidity or mortality showed a nonsignificant trend toward improvement after PBM (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.39-1.01; p = 0.055), and the risk of thrombotic events was unchanged (OR, 1.12; 95% CI, 0.42-2.58; p = 0.80). CONCLUSION:In complex spine surgery, a multifaceted PBM program that includes TXA can be advantageous by reducing transfusion requirements without changing clinical outcomes. ABBREVIATIONS: CCI = Charlson Comorbidity Index; DIC = disseminated intravascular coagulation; DVT = deep venous thrombosis; IQR = interquartile range; PBM = patient blood management; PE = pulmonary embolism; TXA = tranexamic acid. From the

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“…In high dose versus low dose study, the group of patients on a loading dose of 50mg/kg and a maintenance dose of 5mg/kg/h had a lower estimated blood loss than those who were on a loading dose of 10mg/kg and a maintenance dose of 1mg/kg/h by P=0.01 difference. 19 Nevertheless, high doses of drug raise great concern regarding toxicity, and to which extent of increase can the drug safely be administered. In a TXA study of different dose regimens, Jing-Ming Xie et al,.…”

Section: Discussion:-mentioning

confidence: 99%

Efficacy of Tranexamic Acid in Reducing Blood Loss and Blood Transfusion in Idiopathic Scoliosis; A Systematic Review and Meta-Analysis.

Ajmi¹,

Saeed²,

Faryan³

et al. 2017

IJAR

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High-dose Versus Low-dose Tranexamic Acid to Reduce Transfusion Requirements in Pediatric Scoliosis Surgery

Abstract: Level-III, retrospective cohort study.

Cited by 67 publications

References 27 publications

Preoperative anemia increases the risk of red blood cell transfusion and prolonged hospital length of stay in children undergoing spine arthrodesis surgery

Preoperative anemia increases the risk of red blood cell transfusion and prolonged hospital length of stay in children undergoing spine arthrodesis surgery

The impact of patient blood management on blood utilization and clinical outcomes in complex spine surgery

Efficacy of Tranexamic Acid in Reducing Blood Loss and Blood Transfusion in Idiopathic Scoliosis; A Systematic Review and Meta-Analysis.

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