73. Tranexamic acid in patients undergoing adult spinal deformity surgery

Abstract

BACKGROUND CONTEXT Antifibrinolytic agents are used during ASD surgery to minimize blood loss and transfusion requirements. Tranexamic acid (TXA) reduces the risk of blood loss and transfusion after ASD surgery, but there persists concern for prothrombotic effects, myocardial infarction, stroke, and postoperative neurologic events including seizures. PURPOSE To investigate perioperative blood loss and transfusion after TXA for ASD surgery. STUDY DESIGN/SETTING Retrospective review of prospectively collected single center database. PATIENT SAMPLE 469 patients who received TXA, and 354 patients who did not receive TXA. OUTCOME MEASURES Perioperative blood loss and blood product transfusion rate, and complications. METHODS Using a single-institution multi-surgeon database, we performed a retrospective review of patients undergoing ASD surgery from 2011-2018. We identified 469 patients who received TXA, and 354 patients who did not receive TXA. We investigated perioperative blood loss and blood product transfusion rate, and complications occurring after surgery. RESULTS There was no significant difference in age, BMI, or frailty between the TXA (age: 45 ± 23, BMI: 25 ± 6) and non-TXA group (age: 47 ± 24, BMI: 26 ± 7). The prevalence of coronary artery disease, chronic kidney disease, and history of pulmonary embolism was higher in the non-TXA group, presumably due to surgeon preoperative screening, with no difference in other medical comorbidities. There were more revision surgeries and pelvic fixation procedures in the TXA group, with no other differences in surgical complexity. The group that received TXA had significantly lower EBL (1693 ± 1343 mL vs 2009 ± 1892 mL, p=0.019), and were transfused less platelets intraoperatively (.07 ± .3 U vs 0.25 ± 0.86 U, p=0.012). There was no difference in rates of perioperative pRBC transfusion between the groups. The most common complications in both groups were ileus and urinary retention. There was no difference in rate of thrombotic, cardiac, or renal complications, or seizures between the two groups. There was no significant difference in 90-day complication, readmission, or revision rates. CONCLUSIONS Among patients undergoing ASD surgery, TXA was associated with a lower estimated blood loss, without a higher risk for any morbid event. To our knowledge, this is the largest study to date to evaluate the safety of TXA for ASD surgery. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.