High- versus low-dose tranexamic acid as part of a Patient Blood Management strategy for reducing blood loss in patients undergoing surgery for adolescent idiopathic scoliosis.

Abstract

PURPOSE\nThe administration of tranexamic acid (TXA) has been shown to be beneficial in reducing blood loss during surgery for adolescent idiopathic scoliosis (AIS), but optimal dosing has yet to be defined. This retrospective study compared high- versus low-dose TXA as part of a Patient Blood Management strategy for reducing blood loss in patients undergoing posterior spine fusion surgery.\n\n\nMETHODS\nClinical records were reviewed for 223 patients with AIS who underwent posterior spinal fusion of five or more levels during a 6-year time period. We compared normalized blood loss, total estimated blood loss (EBL), and the need for transfusion between patients receiving high-dose TXA (loading dose of\u2009≥\u200930\xa0mg/kg) versus low-dose TXA\xa0(loading dose\u2009<\u200930\xa0mg/kg). Both groups received maintenance TXA infusions of 10\xa0mg/kg/h until skin closure.\n\n\nRESULTS\nPatient demographics, curves, and surgical characteristics were similar in both groups. The high-dose TXA group had a 36% reduction in normalized blood loss (1.8\xa0cc/kg/level fused versus 2.8\xa0cc/kg/level fused, p\u2009<\u20090.001) and a 37.5% reduction in total EBL (1000\xa0cc versus 1600\xa0cc, p\u2009<\u20090.001). Patients in the high-dose group had a 48% reduction in PRBC transfusion, with only 19% receiving a transfusion of PRBC compared to 67% in the low-dose group (p\u2009<\u20090.001).\n\n\nCONCLUSION\nWhen combined with other proven Patient Blood Management strategies, the use of high-dose TXA compared to low-dose TXA may be beneficial in reducing blood loss for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion surgery.\n\n\nLEVEL OF EVIDENCE\nLevel III, retrospective cohort.