Variation in prophylactic tranexamic acid administration among anesthesiologists and surgeons in orthopedic surgery: a retrospective cohort study

Houston, Brett L.; Fergusson, Dean; Falk, Jamie; Ariano, Robert E.; Houston, Donald S.; Krupka, Emily; Blankstein, Anna R.; Perelman, Iris; Breau, Rodney H.; McIsaac, Daniel I.; Rimmer, Emily; Garland, Allan; Tinmouth, Alan; Balshaw, Robert; Turgeon, Alexis F.; Jacobsohn, Eric; Bohm, Éric; Zarychanski, Ryan

doi:10.1007/s12630-021-01939-x

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…Still, controversy exists whether to use TXA as prophylaxis in spine surgery as benefits (reducing blood loss) and harmful side effects (i.e. venous thromboembolism) must be outweighed in these patients, especially in those with underlying risk factors [ 2 ]. Furthermore, application should be critically reviewed for commonly low-bleeding procedures such as dorsal one-level fusions, where hyperfibrinolysis is unlikely to occur.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, surgical procedures of the spine benefit from perioperative blood conservation strategies including autologous blood donation, the utility of intraoperative cell salvage (cell saver), reduction of central venous pressure and the use of synthetic antifibrinolytic medications [ 1 , 2 ]. Tranexamic acid (TXA) is the most frequently used antifibrinolytic agent and in the past 10 years, and numerous studies investigated the risks and benefits of such pharmacological blood conservation strategies [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Omission of tranexamic acid does not increase the amount of perioperative blood transfusions in patients undergoing one-level spinal fusion surgery: a retrospective propensity score-matched noninferiority study

Alfitian

Scheyerer

Rohde

et al. 2022

Arch Orthop Trauma Surg

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Introduction Application of tranexamic acid (TXA) in spine surgery is very frequent even without signs of hyperfibrinolysis, although its beneficial blood-saving effects are offset by harmful adverse events such as thromboembolic incidents. Thus, we investigated whether in relatively less invasive spinal procedures such as one-level posterior spinal fusion, omission of TXA affects the requirement for blood transfusions. Methods We conducted a retrospective propensity score-matched noninferiority study with 212 patients who underwent one-level posterior spine fusion and who were stratified according to whether they received TXA intraoperatively at our tertiary care center. The primary endpoint was the volume of transfused packed red cells. Testing for noninferiority or equivalence was performed by two one-sided testing procedure (TOST) with a priori defined noninferiority margins ($$\delta$$ δ ). Results After propensity score matching a total of five patients (11.6%) treated with TXA were transfused compared with five patients (11.6%) who did not receive TXA. The majority of patients (51.2%) had a risk-increasing condition. The risk difference (no TXA–TXA) of intraoperative transfusion was − 4.7% (CI 90% − 13.62 to 4.32%), and omitting TXA was noninferior ($$\delta$$ δ  = $$\pm$$ ±  10%). The mean intergroup difference in transfused volume (no TXA–TXA) was − 23.26 ml intraoperatively (CI 90% − 69.34 to 22.83 ml) and − 46.51 ml overall (CI 90% − 181.12 to 88.1 ml), respectively, suggesting equivalence of TXA omission ($$\delta$$ δ  = $$\pm$$ ± 300 ml). The hemoglobin decline between both groups was also equivalent (with $$\delta$$ δ  = $$\pm$$ ± 1 g/dl) both on the first postoperative day ($$\Delta \Delta$$ Δ Δ Hb = 0.02 g/dl, CI 90% − 0.53 to 0.56 g/dl) and at discharge ($$\Delta \Delta$$ Δ Δ Hb = − 0.29 g/dl, CI 90% − 0.89 to 0.31 g/dl). Conclusion We demonstrated that requirement of transfusion is rare among one-level fusion surgery and the omission of TXA is noninferior with regard to blood transfusion in high-risk patients undergoing this procedure. Therefore, the prophylactic use of TXA cannot be recommended here, suggesting to focus on alternative blood conservation strategies, if necessary.

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Section: Discussionmentioning

confidence: 99%