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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

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Abstract

Purpose

The 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.

Methods

Clinical 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 ≥ 30 mg/kg) versus low-dose TXA (loading dose < 30 mg/kg). Both groups received maintenance TXA infusions of 10 mg/kg/h until skin closure.

Results

Patient 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 cc/kg/level fused versus 2.8 cc/kg/level fused, p < 0.001) and a 37.5% reduction in total EBL (1000 cc versus 1600 cc, p < 0.001). 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 < 0.001).

Conclusion

When 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.

Level of evidence

Level III, retrospective cohort

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

We would like to thank Rich Vogel, Ph.D from NuVasive Clinical Services for helping us with access to neuromonitoring data.

Funding

This project was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860.

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Authors and Affiliations

  1. Department of Anesthesiology, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA, USA

    Sundeep Tumber, Casey Stondell, Sampaguita Tafoya, Yashar Javidan, Eric Klineberg & Rolando Roberto

  2. University of California, Davis, Sacramento, CA, USA

    Adam Bacon

  3. Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA, USA

    Sandra L. Taylor

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  1. Sundeep Tumber
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Contributions

Conception and design: ST, AB, CS, SLT, and RR. Acquisition of data: ST, AB, and RR. Analysis and/or interpretation of data: ST, AB, CS, ST, SLT, YJ, EK, and RR. Drafting the manuscript: ST, AB, CS, ST, SLT, and RR. Revising the manuscript for important intellectual content: ST, AB, CS, ST, SLT, YJ, EK, and RR. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Sundeep Tumber.

Ethics declarations

Ethics approval

The Western Institutional Review Board granted approval for this retrospective review (NCA 2015R, 9/21/2020).

Informed consent

This retrospective chart review involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Western Institutional Review Board granted approval for this retrospective review (NCA 2015R, 9/21/2020).

Consent to participate

N/A—retrospective without patient identifiers or images.

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N/A—retrospective without patient identifiers or images.

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Tumber, S., Bacon, A., Stondell, C. et al. 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. Spine Deform 10, 107–113 (2022). https://doi.org/10.1007/s43390-021-00387-3

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