Intravenous Tranexamic Acid Reduces Blood Loss and Transfusion Volume in Scoliosis Surgery for Spinal Muscular Atrophy: Results of a 20-Year Retrospective Analysis.

Shih-Hsiang Chou,Chia-Lung Shih,Sung-Yen Lin,Meng-Huang Wu,Wen-Chen Liang,Cheng-Chang Lu,Yuh-Jyh Jong,Yen-Mou Lu,Yin-Chun Tien

doi:10.3390/ijerph18199959

Abstract

Intravenous tranexamic acid (TXA) has been administered to reduce intraoperative blood loss in scoliosis surgery. However, the therapeutic effect of TXA on spinal muscular atrophy (SMA) scoliosis surgery is not well demonstrated. Therefore, this study aimed to assess the efficacy of intravenous TXA in SMA scoliosis surgery. From December 1993 to August 2020, 30 SMA patients who underwent scoliosis surgery (posterior fusion with fusion level of thoracic second or third to pelvis) were retrospectively enrolled and divided into the TXA group and non-TXA (control) group, with 15 patients in each group. Survey parameters were the amount of blood loss, blood transfusion, crystalloid transfusion volume, intubation time, and associated pulmonary complications (including pneumonia, pulmonary edema, and pulmonary atelectasis). The TXA group had significantly lesser blood loss than the control group (p = 0.011). Compared with the control group, the TXA group had significantly lower blood transfusion (p < 0.001), crystalloid volume (p = 0.041), and total transfusion volume (p = 0.005). In addition, the TXA group had fewer postoperative pulmonary complications, and patients with pulmonary complications were associated with a higher relative crystalloid volume and relative total transfusion volume (p = 0.003 and 0.022, respectively). In conclusion, TXA can be effective in reducing intraoperative blood loss and crystalloid fluid transfusions during scoliosis surgery in SMA patients, which may aid in reducing postoperative pulmonary complications.

Highlights

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder characterized by spinal motor neuron degeneration resulting in generalized muscle atrophy and weakness [1]
The 30 spinal muscular atrophy (SMA) patients were distributed to the tranexamic acid (TXA) group (n = 15) and control group (n = 15)
This study assessed the effect of intravenous TXA administration on SMA scoliosis This study assessed the effect of intravenous TXA administration on SMA scoliosis surgery with regard to estimated blood loss, intraoperative transfusion, and postoperative surgery with regard estimated blood loss, intraoperative transfusion, postoperative complications

Summary

Introduction

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder characterized by spinal motor neuron degeneration resulting in generalized muscle atrophy and weakness [1]. SMA scoliosis would affect the patient’s sitting ability, distorting spinal balance, and further impairing pulmonary function [3]. Surgical interventions aim to correct spinal deformity and halt scoliosis curve progression and pulmonary function decline [5]. Patients undergoing spinal surgery for neuromuscular scoliosis have an increased risk of perioperative bleeding [3,4,6,7,8,9], with the risk of losing >50% of the total blood volume [10], and are strongly associated with an increased requirement for intraoperative fluid and blood transfusion and subsequent pulmonary complication rates [11,12]. How to decrease the perioperative blood loss and the need for blood and fluid transfusion in SMA patients undergoing scoliosis surgery is a critical concern

Objectives

Methods

Results

Conclusion