P103. Complex ASD patients receiving high dose TXA have significantly lower blood loss compared to low dose TXA without increased thromboembolic complications

Abstract

<h3>BACKGROUND CONTEXT</h3> Tranexamic acid (TXA) is commonly used to lower blood loss in ASD surgery. Despite widespread use of TXA in ASD surgery, there is a lack of consensus regarding the optimal dosing intraoperatively. <h3>PURPOSE</h3> This study aims to assess differences in blood loss and complications between high-dose, medium-dose, and low-dose TXA regimens. Complex ASD patients who receive high-dose TXA will have decreased blood loss compared to those who receive low-dose TXA. <h3>STUDY DESIGN/SETTING</h3> Retrospective Review. <h3>PATIENT SAMPLE</h3> A total of 265 ASD patients in a multi-center prospective study were retrospectively analyzed. <h3>OUTCOME MEASURES</h3> Blood loss (ml), Major Blood Loss (>90th percentile ml), units transfused intraoperatively, units transfused perioperatively. <h3>METHODS</h3> Patients were separated into three cohorts by TXA regimen: 1) low-dose patients had=20mg/kg loading dose with=2mg/kg/hr maintenance dose 2) medium-dose patients had 20-50 mg/kg loading dose with 2-5 mg/kg/hr maintenance dose. 3) high-dose patients had=50mg/kg loading dose with=5mg/kg/hr maintenance dose. Major or minor blood loss was defined as above or below the 90th percentile of our cohort respectively. Multivariable analysis controlled for levels fused, BMI, platelets, Hgb, OR time, 3CO, and radiographic alignment. <h3>RESULTS</h3> Fifty-four (20%) patients received low-dose regimen, 133 (50%) received medium-dose and 80 (30%) received high dose. Mean blood loss was 1,551±1,295 ml, intraoperative units RBCs 1.52±2, and perioperative units RBCs 2.3±2.3. Mean major blood loss was 4,566±1,516ml and minor blood loss 1,236±755ml. Compared to the low-dose group, patients in the high-dose group had 77.8% decreased odds of major blood loss (OR 0.222; P=0.007), decreased blood loss (Coef. -540.92ml; P=0.019), units transfused intraoperatively (Coef. -.739 units; P < 0.001), and units transfused perioperatively (Coef. -0.328 units; P=0.025). Compared to medium-dose group, the high-dose group had less units transfused intraoperatively (Coef. -.59 units; P < 0.001) and perioperatively (Coef. -.42 units; P < 0.001) with no difference in blood loss. There was no difference between the medium and low dose groups in blood loss or units transfused. There was no association between high-dose TXA regimen and increased rates of DVT, PE, or any medical complication before six weeks. No patients had a seizure. <h3>CONCLUSIONS</h3> In this multicenter prospectively collected database, ASD patients receiving high-dose intraoperative TXA have decreased odds of major blood loss, less RBC transfusions intraoperatively and 540ml less blood loss compared to low dose TXA, without additional risk of seizure or thromboembolic complications. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.