Tranexamic Acid Is Efficacious at Decreasing the Rate of Blood Loss in Adolescent Scoliosis Surgery

• DOI: 10.2106/jbjs.18.00314
• Publication Date: 2018-12-05T19:14:36Z
• Authors: Susan M. Goobie; David Zurakowski; Michael P. Glotzb...; Mary E. McCann; Daniel Hedequist; Robert M. Brustowicz; Navil F. Sethna; Lawerence I. Karlin; John B. Emans; M. Timothy Hresko
• Keywords: Antifibrinolytic; Idiopathic scoliosis

Background: Tranexamic acid (TXA) is an antifibrinolytic drug that reduces surgical blood loss. Evidence supporting its efficacy in surgery for adolescent idiopathic scoliosis not robust. This trial was designed to validate the clinical of TXA scoliosis. Methods: institutional review board-approved prospective double-blinded involved 111 patients with who were randomized receive either a placebo or (50-mg/kg loading dose and 10-mg/kg/h infusion). Power analysis indicated 50 per group would provide power detect >20% difference Two-way variance (ANOVA) applied compare loss rates (slopes) using group-by-time interaction F test. Results: The risk clinically relevant (>20 mL/kg) more than twice as high (44% versus 21%, relative = 2.1, 95% confidence interval 1.2 3.7). Compared group, had 27% reduction intraoperative loss, significantly lower rate bleeding hour (mean standard deviation, 190 ± 73 230 80 mL, p 0.01; 9.77, < 0.001) fused spinal level (82 32 110 40 0.001), less (836 373 1,031 484 0.02), postoperative (in drain) (498 228 645 318 0.009). Six received no patient required allogenic transfusion. No perioperative adverse events, including thromboembolic events seizures, observed. Three independent factors predictive loss: administration, duration surgery, number levels fused. Greater only variable longer hospital stay. Conclusions: Use undergoing reduced by 27%, compared group. amount More placebo-treated blood. Patients greater spent time hospital. Level Evidence: Therapeutic I . See Instructions Authors complete description evidence.