Tranexamic Acid in Pediatric Scoliosis Surgery: A Prospective Randomized Trial Comparing High-dose and Low-dose Tranexamic Acid in Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion Surgery.

Abstract

STUDY DESIGN:

Prospective randomized double-blinded trial.

OBJECTIVE:

The objective of this study is to determine the efficacy of high-dose versus low-dose tranexamic acid (TXA) in adolescent idiopathic scoliosis (AIS) corrective surgery.

SUMMARY OF BACKGROUND DATA:

Corrective surgery for AIS is associated with significant blood loss. Evidence on the optimum TXA dose to reduce bleeding in pediatric population is scarce.

METHODS:

A total of 166 AIS patients aged between 10 and 21 years, of American Society of Anesthesiologists (ASA) physical status I and II, preoperative hemoglobin >10 g/dL, platelet count >150,000 cells/L and Cobb angle of >45° scheduled for elective single-stage posterior spinal fusion (PSF) surgery by two attending surgeons were included between March 2017 and November 2018. Patients were randomized into Group A (High Dose, 30 mg/kg TXA loading dose followed by 10 mg/kg/h infusion) and Group B (Low Dose, 10 mg/kg TXA loading dose followed by 1 mg/kg/h infusion). The primary outcome was total surgical blood loss between both groups. Secondary outcomes were transfusion requirement, perioperative changes in hemoglobin and coagulation profiles, adverse events, and factors that influence total blood loss.

RESULTS:

The mean total surgical blood loss between the two groups was not significant (Group A: 928.8 ± 406.1 mL [range: 348-1857 mL]; Group B: 918.1 ± 406.2 mL [range: 271-2000 mL], P = 0.865). The median duration of surgery was 120 minutes. One patient in each group received allogenic blood transfusion during the perioperative period. There were no significant changes in hemoglobin and coagulation profile at pre-operation, post-operation 0 hour and 48 hours. Sex, number of vertebral levels fused, and duration of surgery were independently associated with total surgical blood loss. No adverse events were observed perioperatively.

CONCLUSION:

Low-dose TXA was as efficacious as high-dose TXA in reducing blood loss and allogenic blood transfusion for AIS patients undergoing PSF surgery.Level of Evidence: 1.

• Authors: Mohd Shahnaz Hasan, Siti Nadzrah Yunus, Ching Choe Ng, Chris Yin Wei Chan, Chee Kidd Chiu, Mun Keong Kwan
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 46 Issue 22 Pg. E1170-E1177 (Nov 15 2021) ISSN: 1528-1159 [Electronic] United States
• PMID: 33882541 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Antifibrinolytic Agents
• Tranexamic Acid

Topics

• Adolescent
• Adult
• Antifibrinolytic Agents
• Blood Loss, Surgical (prevention & control)
• Child
• Humans
• Prospective Studies
• Scoliosis (surgery)
• Spinal Fusion (adverse effects)
• Tranexamic Acid
• Young Adult