Results show tranexamic acid may help reduce significant blood loss in AIS surgery

Tranexamic acid may be used alone or combined with epsilon-aminocaproic acid to reduce blood loss.

Intraoperative administration of tranexamic acid during adolescent idiopathic scoliosis surgery reduced total blood loss and the need for cell saver transfusions compared with intraoperative administration of Amicar (epsilon-aminocaproic acid, Xanodyne Pharmeceuticals), according to results of a prospective, multicenter database registry study.

Tranexamic acid (TXA) led to reduced estimated blood loss (EBL) and EBL as a percentage of blood volume and to significantly less cell saver transfusions at final follow-up after adolescent idiopathic scoliosis (AIS) surgery, according to Baron S. Lonner, MD, who presented the findings.

“We found TXA performed the best in all of these parameters, including percent of blood volume loss and cell saver, as well,” Lonner said.

TXA vs aminocaproic acid

Lonner showed a schematic during his presentation that depicted how TXA outperformed epsilon-aminocaproic acid. For example, there were greater amounts of blood loss associated with epsilon-aminocaproic acid than with a non-antifibrinolytic group of patients included in the study.

Baron S. Lonner

“When we standardized by levels fused and degree of Cobb angle magnitude, the same findings hold. The TXA performs better and Amicar showed no benefit, although it is possible there were confounding variables accounting for this. There was, however, a clear benefit of TXA over no antifibrinolytic therapy for these operations,” Lonner said.

For the study, Lonner and colleagues mined prospectively collected data from an AIS registry study and compared results for 525 patients who received TXA intraoperatively during AIS surgery to 117 patients who received of epsilon-aminocaproic acid during AIS surgery compared to patients who did not receive antifibrinolytics. They focused on the effect the two drugs had on blood loss, EBL and cell saver transfusion.

Impact on blood loss parameters

The investigators compared these groups to a control group of 1,127 patients who received no antifibrinolytic during the same type of surgery. They assessed blood loss, blood loss adjusted for total blood volume, and standardized blood loss by levels fused and curve magnitude.

Lonner and colleagues also performed a multivariate analysis to control for surgeon variation, total operative time and osteotomies.

Based on the findings, EBL, EBL as a percentage of blood volume and cell saver transfusions were significantly lower in the TXA cohort compared with the epsilon-aminocaproic acid and control groups.

Combined results analyzed

When investigators combined results for the epsilon-aminocaproic acid and TXA groups, the EBL was 865 mL in the combined group and 1,010 mL in the control group. The combined group experienced 24% EBL compared to 31% EBL in the control group. In addition, the combined group required significantly less cell saver transfusion than the control group at 242.4 mL and 276.6 mL, respectively.

“A multivariate analysis controlling for surgeon operative time and osteotomy performed showed TXA outperformed the control and Amicar when we did the per-level analysis. There were no differences in surgical site infections and no thromboembolic complications in this group,” Lonner said.

TXA should be used for AIS procedures in which significant blood loss is expected, he concluded. – by Robert Linnehan

Reference:
Lonner BS, et al. Paper #18. Presented at: Scoliosis Research Society Annual Meeting; Sept. 30-Oct. 3, 2015; Minneapolis.

For more information:

Baron S. Lonner, MD, can be reached at Scoliosis and Spine Associates, 820 2nd Ave Suite 7A, New York, NY 10017; email: blonner@nyc.rr.com.

Disclosure: Lonner reports he receives royalties from DePuy Spine, owns stock in Spine Search and Paradigm Spine, is a consultant to DePuy Spine, has speaking and/or teaching arrangements with DePuy Spine and K2M, is on the board of directors of Spine Search, is on the scientific advisory board of DePuy Spine and receives grants from DePuy Spine, AOSpine, John and Marcella Fox Fund and OREF.