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Comparison of the Coagulation Profile of Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion With and Without Tranexamic Acid

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Abstract

Study Design

Prospective, observational cohort study.

Objective

To improve the understanding of coagulation and bleeding mechanisms during spinal deformity surgery.

Summary of Background Data

Fibrinolysis is the mechanism of bleeding for adolescent idiopathic scoliosis undergoing posterior spinal fusion. Antifibrinolytics have become popular; however, literature to support their use remains mixed. The mechanism of action has not been demonstrated.

Methods

The coagulation profile of 88 adolescent idiopathic scoliosis patients undergoing posterior spinal fusion was analyzed. Standard coagulation laboratory investigations and thromboelastograms were drawn hourly through the case. Fifty-eight patients received no antifibrinolytic, whereas 30 patients received tranexamic acid by standardized protocol. The coagulation parameters, estimated blood loss, and transfusion requirements were compared in the two groups.

Results

The two cohorts had no differences in demographic or surgical characteristics. Mean age was 13.6 years, 83% were female, a mean of 11.1 levels were fused, and the mean duration of surgery was 209 minutes. The tranexamic acid cohort did not demonstrate a decrease in blood loss. The transfusion rate, however, dropped from 47% in the non–tranexamic acid cohort to 23% in the tranexamic acid cohort (p = .03). Standard coagulation parameters did not differ between the groups. Fibrinolysis was diminished in the tranexamic acid cohort as measured by a Fibrinolysis score (mean maximum value 2.0 without tranexamic acid vs. 0.7 with tranexamic acid, p < .0001) and the lysis percent at 30 minutes by thromboelastogram (elevated to 3.9% without tranexamic acid vs. 1.2% with tranexamic acid at the 3-hour mark, p = .05).

Conclusions

This study provides confirmation of antifibrinolytic activity during posterior spinal fusion for adolescent idiopathic scoliosis. The presented data of fibrinolysis are proposed as standard measurements for future work on controlling blood loss during scoliosis surgery.

Level of Evidence

Level 2, prospective comparative study.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 4th Floor, Pittsburgh, PA, 15224, USA

    Patrick Bosch MD, Joanne A. Londino BSN, RN & Natalie E. Novak BS

  2. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Public Health Building, 130 De Soto St, Pittsburgh, PA, 15261, USA

    Tanya S. Kenkre PhD, MPH

  3. Department of Anesthesia, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 4th Floor, Pittsburgh, PA, 15224, USA

    Doreen Soliman MD

Authors
  1. Patrick Bosch MD
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  2. Tanya S. Kenkre PhD, MPH
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  3. Doreen Soliman MD
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  4. Joanne A. Londino BSN, RN
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  5. Natalie E. Novak BS
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Corresponding author

Correspondence to Patrick Bosch MD.

Additional information

Author disclosures: PB (grants from Pediatric Orthopaedic Society of North America [POSNA] and Scoliosis Research Society [SRS], during the conduct of the study), TSK (grants from POSNA and SRS, during the conduct of the study), DS (grants from POSNA and SRS, during the conduct of the study), JAL (grants from POSNA and SRS, during the conduct of the study), NEN (grants from POSNA and SRS, during the conduct of the study).

IRB approval: This research study was approved by the University of Pittsburgh Institutional Review Board, and informed consent was obtained and collected from all subjects.

Source of Funding: Pediatric Orthopaedic Society of North America, USA and Scoliosis Research Society, USA provided support for this work to Patrick Bosch, MD.

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Bosch, P., Kenkre, T.S., Soliman, D. et al. Comparison of the Coagulation Profile of Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion With and Without Tranexamic Acid. Spine Deform 7, 910–916 (2019). https://doi.org/10.1016/j.jspd.2019.04.005

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  • DOI: https://doi.org/10.1016/j.jspd.2019.04.005

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