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Low dose tranexamic acid reduces blood loss, transfusions in AIS surgery
Intraoperative and postoperative blood loss amounts were improved with low dose tranexamic acid.
SAN DIEGO, U.S.A. — Low dose of tranexamic acid administered for adolescent idiopathic scoliosis surgery was superior to a lack of antifibrinolytic controls in reducing intraoperative blood loss, transfusion and cell saver requirements, according to a single-center study presented here.
Lukas P. Zebala, MD, shared his group’s findings at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
Postoperative estimated blood loss amounts and total transfusion requirements were lower for patients who received low dose tranexamic acid, the study found, and no catastrophic complications attributable to tranexamic acid occurred.
“Outcome studies of tranexamic acid use in idiopathic scoliosis are scarce, with studies being limited by heterogeneous patient populations, small numbers of idiopathic scoliosis patients, and variable tranexamic dose administration,” Zebala said. “The purpose of this study was to assess the outcomes of low dose tranexamic acid on perioperative blood loss and transfusion in idiopathic scoliosis.”
Study methods
Zebala and his team studied 48 consecutive adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusions at one institution between January 2007 and September 2009 and received low-dose tranexamic acid during surgery. The researchers also studied a control group of 44 consecutive AIS posterior spinal fusion patients between January 2000 and December 2002 who did not receive antifibrinolytics during surgery. Demographic, operative and perioperative data was collected.
Thirty-four control patients — and none of the tranexamic acid patients — had an iliac crest bone graft for their fusion.
Findings and limitations
Zebala reported that between the two groups — which shared similar preoperative age, body mass index, posterior spinal fusion levels, gender, and major Cobb curve measurements — length of surgery was shorter in the low-dose tranexamic acid group than in the control group. Furthermore, the low-dose tranexamic acid patients experienced less average intraoperative estimated blood loss (415 mL as opposed to 689 mL), lower average transfusion amounts (0.4 units as opposed to 0.8 units), and fewer average cell saver requirements (22 mL as opposed to 195 mL).
The tranexamic acid group also experienced less postoperative drain output than the control group (925 mL vs. 1508 mL, respectively). As such, Zebala said, the cumulative total of estimated blood loss for the tranexamic acid group was lower than that found in the control group. Total blood transfusions were also lower in the tranexamic acid group.
Zebala said one tranexamic acid patient developed a deep vein thrombosis of the jugular vein 6 weeks after surgery, requiring anticoagulation. There were no reported cases of seizure, stroke or pulmonary embolism.
Limitations of the study, Zebala said, included the inherent limitations of a retrospective study, as well as historical controls. Surgeon technique and experience during the two different time periods potentially varied, and iliac crest graft was used significantly more often in earlier controls. Still, he said, the results of the study showed tranexamic acid assisted in lowering overall blood loss.
“Low-dose tranexamic acid appears to reduce perioperative blood loss and blood transfusion in idiopathic scoliosis surgery with no major perioperative complications at our institution,” Zebala said. — by Robert Press
Reference:
- Zebala LP, Lenke LG, Bridwell KH, et al. Low dose tranexamic acid reduces blood loss and blood transfusions in AIS surgery. Paper #446. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego, USA.
- Lukas P. Zebala, MD, can be reached at Washington University School of Medicine Department of Orthopedic Surgery, 660 South Euclid Ave., Campus Box 8233, St. Louis, MO USA 63110; email: zebalallu@wudosis.wustl.edu.
- Disclosure: Zebala has no relevant financial disclosures.
