130. Tranexamic acid use is associated with reduced intraoperative blood loss during spine surgery in Marfan syndrome

Abstract

<h3>BACKGROUND CONTEXT</h3> Sixty percent of patients with Marfan syndrome (MFS) have scoliosis, of which up to 50% will typically require surgical intervention. Chief among surgical concerns in MFS patients undergoing scoliosis correction is the increased risk for intraoperative bleeding due to hemostatic deviations secondary to aortic dilatation, rheological disturbances, endothelial injury, and abnormal levels of clotting factors. Tranexamic acid (TXA) is an anti-fibrinolytic agent that has been demonstrated to reduce blood loss secondary to traumatic injury or surgical intervention, and the subsequent need for transfusion. However, the efficacy of TXA in connective tissue disorders, like MFS, is controversial given the interaction between the clotting cascade and the endothelium of the vasculature. To our knowledge, no other study has previously reported on the utility of TXA in the surgical management of MFS-associated scoliosis. <h3>PURPOSE</h3> The objective of this study was to assess the effect of TXA on intraoperative blood requirements in MFS patients undergoing spinal fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective review, single institution. <h3>PATIENT SAMPLE</h3> Administrative databases were queried for patients with MFS who underwent spinal fusion for scoliosis between 2000 and 2020 by one surgeon. We excluded operations spanning <3 vertebral levels, along with those related to growing rods (insertion or distraction) or postoperative infection. Sixty-one patients with MFS met inclusion criteria, of whom 23 were treated with TXA and 38 were not. <h3>OUTCOME MEASURES</h3> The following outcomes were assessed and compared between MFS patients treated with and without TXA during spinal fusion: estimated intraoperative blood loss and allogenic blood transfusion requirements. <h3>Methods</h3> The individual charts (including operative and anesthesia notes) of all patients were personally reviewed by study team members to identify MFS patients who received TXA during spinal fusion and their surgical outcomes. Statistical analysis was performed to compare demographic variables and surgical outcomes – using chi-square or t tests, as appropriate. A p-value of < 0.05 was considered significant. <h3>Results</h3> There was no significant difference in patient age, gender, curvature severity, or number of levels fused between the groups. Patients with MFS who were treated with TXA experienced significantly less intraoperative blood loss (625 ± 229 ml, p = 0.008) compared to those who were not. Likewise, we detected a significant difference in total quantity of transfused allogeneic blood products (1.3 ± 0.5, p = 0.013), though there was no difference in transfusion rates between each group (p = 0.317). <h3>Conclusions</h3> We demonstrate the efficacy of TXA in hemostasis during surgical treatment of MFS-associated scoliosis. Our study suggests that the vascular effects secondary to connective tissue deficiency in MFS does not interfere with TXA mechanism of action. <h3>FDA DEVICE/DRUG STATUS</h3> Unavailable from authors at time of publication. Tranexamic acid: not approved for this indication.