27. Efficacy of topical vs intravenous tranexamic acid in pediatric spinal deformity

Abstract

BACKGROUND CONTEXT Increased blood loss during pediatric deformity surgery has been associated with increased complications. While intravenous tranexamic acid (IV TXA) had positive results in controlling intraoperative bleeding, little is known regarding the effectiveness of topical tranexamic in spine surgery—a technique used in dental, cardiac and intra-articular surgical procedures with good results. PURPOSE This study aimed to compare the efficacy of topical vs IV in reducing intra and postoperative blood loss and need for transfusion in pediatric deformity patients. STUDY DESIGN/SETTING Single center retrospective cohort study of pediatric deformity patients who underwent a posterior-only fusion between 2009 and 2016. PATIENT SAMPLE A total of 181 pediatric spinal deformity patients. OUTCOME MEASURES Total, intra and postoperative blood loss, surgical time, postoperative Ht/Hb, intra and postoperative transfusion rates, and duration of drain insertion in days. METHODS A total of 181 patients were included (78.6% F, 15.08 years old) and categorized in one of the following 4 groups: “No TXA” (n=35) if the wound was packed with sponges soaked in saline, “IV TXA” (n=37) if the patient received a 20 mg/kg bolus at the beginning of the surgery followed by a continuous infusion of 1mg/kg/hr until skin closure, “Topical TXA” (n=23) if the wound was packed with sponges soaked in 1g of diluted in a 500ml saline solution, or “Combined TXA” (n=86) if the patient received both IV and topical TXA. The primary outcomes of interest were compared across the 4 treatment groups. RESULTS differences were found in the four groups in total blood loss, intraoperative blood loss, surgical time, postoperative Ht/Hb, intraoperative and postoperative transfusion rates, when comparing by group, sex or age. The “Combined TXA” group had significantly less postoperative bleeding than the control “no TXA” group (295.13±321.18mL, vs 480.58±447.61mL, p=0.05). Patients who received IV (with or without Topical TXA) had their drains removed one day earlier than the No TXA group (p=0.048). There were no complications related to the use of in this series. CONCLUSIONS There is a significant decrease in postoperative bleeding in pediatric deformity patients with the combined use of topical and IV TXA, without TXA-related complications. This combined modality positively impacts postoperative bleeding. FDA DEVICE/DRUG STATUS Not approved.