Abstract
Intraoperative blood loss in scoliosis surgery often requires transfusions. Autogenous blood decreases but does not eliminate risks typically associated with allogenic blood transfusion. Costs associated with transfusions are significant. Tranexamic acid (TXA) has been shown to decrease blood loss in cardiac and joint surgery. Few studies have examined its use in pediatric spine surgery, and the results are inconsistent. The aim of this study was to determine whether TXA decreases intraoperative blood loss and transfusion requirements in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by a single surgeon. The medical records and operative reports of surgically treated patients with adolescent idiopathic scoliosis between 2000 and 2009 were retrospectively reviewed. The inclusion criteria were: (1) patients who underwent instrumented posterior spinal fusion, (2) had complete medical records, and (3) were treated by the same surgeon. Forty-nine patients who met the inclusion criteria were divided into two groups: Group A (25 patients) received TXA, while Group B (24 patients) did not receive TXA. After controlling for age at the time of surgery, gender, and number of vertebral levels fused, the mean intraoperative blood loss was significantly lower in Group A (537ml) than in Group B (1,245ml) (p=0.027). The mean volume of blood transfused intraoperatively was 426 and 740ml for Group A and Group B, respectively. The difference was not statistically significant after controlling for age, gender, and number of levels fused (p=0.078). TXA significantly decreased intraoperative blood loss in posterior spinal fusions performed for adolescent idiopathic scoliosis.
Highlights
Posterior spinal fusion surgery for adolescent idiopathic scoliosis is often associated with significant blood loss requiring transfusion due to prolonged operative times, extensive soft tissue dissection, and significant bone bleeding during instrumentation and decortications [1,2,3,4]
Tranexamic acid (TXA) is a synthetic lysine analog similar to e-aminocaproic acid that acts as an antifibrinolytic agent by competitively blocking the lysine binding site of plasminogen and plasmin, stabilizing fibrin clots [16, 30]
TXA is approximately 6–10 times more potent than e-aminocaproic acid [31, 32], there are no studies that directly compare the effectiveness of these two drugs on pediatric scoliosis surgery
Summary
Posterior spinal fusion surgery for adolescent idiopathic scoliosis is often associated with significant blood loss requiring transfusion due to prolonged operative times, extensive soft tissue dissection, and significant bone bleeding during instrumentation and decortications [1,2,3,4]. Homologous blood, when available, decreases but does not eliminate the risks associated with transfusion [1, 6,7,8,9]. Postoperative infections have been associated with the immunomodulatory effects of homologous transfusions [10,11,12,13,14]. The costs associated with transfusions are significant [15]. Tranexamic acid [TXA, 4-(aminomethyl)cyclohexanecarboxylic acid], a synthetic lysine analog, acts as an antifibrolytic agent by binding reversibly to plasminogen and plasmin and completely blocking the interaction of plasminogen and plasmin with lysine on the surface of fibrin [16]. TXA inhibits fibrinolysis by preventing the proteolytic action of plasmin on fibrin at the surgical
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