Susan M. Goobie
The use of tranexamic acid compared with placebo in patients who underwent surgery for adolescent idiopathic scoliosis significantly decreased blood loss by 27%, according to recently published data.
"This prospective randomized controlled trial demonstrates that intravenous [tranexamic acid] TXA in children undergoing adolescent idiopathic spinal fusion surgery is effective in reducing blood loss and transfusion requirements,” Susan M. Goobie, MD, FRCPC, told Healio.com/Orthopedics. “A 27% reduction in blood loss with TXA is reported even when multimodal PBM strategies are employed. TXA decreases the rate of blood loss intra-operatively and the effect extends into the postoperative period with a significant reduction in drain output at 24 hours in the TXA group compared to the placebo.”
She added, “We know from further pharmacokinetic analysis of this data (unpublished) that a dose of 30 mg/kg loading dose and 10 mg/kg per hour maintains TXA plasma levels in the therapeutic range and therefore this is the current dose used at Boston Children's Hospital for [adolescent idiopathic scoliosis] AIS surgery."
Researchers identified 111 patients with AIS and randomly assigned them to either placebo or tranexamic acid. Power analysis showed that 50 patients per treatment group would offer power to detect a less than 20% difference in blood loss. Blood loss rates were compared with two-way analysis of variance with the group-by-time interaction F test.
Results showed the risk for clinically relevant blood loss in patients who received placebo was more than twice as high compared with patients who received TXA. Patients treated with TXA vs. patients who received placebo had a 27% decrease in intraoperative blood loss, significantly lower rate of intraoperative bleeding per hour and per fused spinal level, less intraoperative blood loss and less postoperative bleeding in the drain. There were six patients who received placebo that needed an allogenic blood transfusion compared with no patients who received TXA. Investigators noted there were no perioperative adverse events such as thromboembolic events or seizures.
According to researchers, TXA administration, duration of surgery and number of levels fused were among the independent factors predictive of blood loss. A predictive independent variable of a longer hospital stay was linked to greater intraoperative blood loss. – by Monica Jaramillo
Disclosures: Goobie reports she receives grants from Scoliosis Research Society and personal fees from Octaplast. Please see the full study for a list of all other authors’ relevant financial disclosures.