The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: A single-surgeon experience

Abstract

Purpose Intraoperative blood loss in scoliosis surgery often requires transfusions. Autogenous blood decreases but does not eliminate risks typically associated with allogenic blood transfusion. Costs associated with transfusions are significant. Tranexamic acid (TXA) has been shown to decrease blood loss in cardiac and joint surgery. Few studies have examined its use in pediatric spine surgery, and the results are inconsistent. The aim of this study was to determine whether TXA decreases intraoperative blood loss and transfusion requirements in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by a single surgeon. Methods The medical records and operative reports of surgically treated patients with adolescent idiopathic scoliosis between 2000 and 2009 were retrospectively reviewed. The inclusion criteria were: (1) patients who underwent instrumented posterior spinal fusion, (2) had complete medical records, and (3) were treated by the same surgeon. Forty-nine patients who met the inclusion criteria were divided into two groups: Group A (25 patients) received TXA, while Group B (24 patients) did not receive TXA.Results After controlling for age at the time of surgery, gender, and number of vertebral levels fused, the mean intraoperative blood loss was significantly lower in Group A (537 ml) than in Group B (1,245 ml) (p = 0.027). The mean volume of blood transfused intraoperatively was 426 and 740 ml for Group A and Group B, respectively. The difference was not statistically significant after controlling for age, gender, and number of levels fused (p = 0.078). Conclusion TXA significantly decreased intraoperative blood loss in posterior spinal fusions performed for adolescent idiopathic scoliosis.

Complication rate during multilevel lumbar fusion in patients above 60 years

“…Injection tranexamic acid 1 g intravenous was given routinely preoperatively, immediately before skin incision in all cases. Literature describes that a single dose of tranexamic acid 15 mg/kg can effectively reduce blood loss without increasing the risk of deep vein thrombosis 15. The other technique employed in our surgeries was simultaneous exposure and instrumentation on either side by two trained spine surgeons [Figure 2].…”

Patient Factors Are Associated With Poor Short-term Outcomes After Posterior Fusion for Adolescent Idiopathic Scoliosis

“…There may be a benefit to reducing operative blood loss in order to reduce postoperative LOS. Several methods of reducing intraoperative blood loss show promise, including, tranexamic acid [26,47,53], use of a bipolar sealer [15,28], and intrathecal morphine [23]. While minimally invasive procedures have been reported to reduce postoperative LOS and blood loss in patients treated with other spinal procedures [10,36,40,48], minimally invasive surgery for AIS has not yet shown the same benefits [39].…”

Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery

“…The administration of TXA in orthopedic surgery has been studied in various dosing regimens, including fixed 32,40,64 or weighted 9, 24,26,28,44 IV doses, a single IV dose 9, 26,28,40,44 or multiple IV doses, 9,28,37 continuous IV infusion, 22,26,43,53,54,58,65 and topical (ie, intra-articular) application by direct wash or injection, with or without drain clamping. 6,7, 23,25,[29][30][31]33,36,41,42,57,61 Although agreement has not been reached on the standards for TXA administration, suggestions have been made depending on the type and site of the surgery.…”