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Topical tranexemic acid reduces intra-operative blood loss and transfusion requirements in spinal deformity correction in patients with adolescent idiopathic scoliosis

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Abstract

Purpose

To evaluate the effectiveness of the use of topical tranexamic acid (tTXA) in spinal deformity correction in AIS patients

Methods

Sixty consecutive operative AIS patients were reviewed from a single institution and divided into two groups with similar demographics. Standardized peri-operative blood salvage techniques were utilized in all 60 patients. In the latter 30 patients, tTXA soaked sponges (1 g mixed in 500 ml Normal Saline) was utilised for wound packing during the entire surgical procedure compared to dry sponges as used in the former 30 patients. Both the groups were compared for the magnitude of deformity corrected, EBL per level fused, total EBL, blood transfused, drain output and peri-operative events.

Results

Sixty AIS patients (mean age 14.4 yrs, 43 females, mean BMI 21.5, mean levels 10.7) were included. Both groups achieved similar change in Coronal Cobb correction. The EBVL (Estimated blood volume loss) % lost in the topical TXA group was 38% less than the control group (11.2 vs. 18.3%, p = 0.006). Similarly, the EBL/level was significantly lower in the topical TXA group (41 ± 30 ml vs. 57 ± 26 ml, p = 0.03). Three of 30 patients in the control group required at least 1 unit of blood transfusion, whereas only 1 patient in the topical TXA group required transfusion (10 vs. 3.3%, p = 0.001). No differences were noted in post-operative drain output, change in hemoglobin levels, and peri-operative complication rates.

Conclusion

When used as an adjunct to the conventional blood salvage techniques in spinal deformity correction procedures, the use of tTXA resulted in reduced operative blood loss, and blood transfusion requirements.

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References

  1. Shapiro F, Sethna N (2004) Blood loss in pediatric spine surgery. Eur Spine J 13(Suppl 1):S6-17

    Article  PubMed  PubMed Central  Google Scholar 

  2. Joseph SA Jr, Berekashvili K, Mariller MM et al (2008) Blood conservation techniques in spinal deformity surgery: a retrospective review of patients refusing blood transfusion. Spine (Phila Pa 1976) 33(21):2310–2315

    Article  Google Scholar 

  3. Blanchette CM, Wang PF, Joshi AV, Asmussen M, Saunders W, Kruse P (2007) Cost and utilization of blood transfusion associated with spinal surgeries in the United States. Eur Spine J 16(3):353–363

    Article  PubMed  Google Scholar 

  4. Lavoie J (2011) Blood transfusion risks and alternative strategies in pediatric patients. PaediatrAnaesth 21(1):14–24

    Google Scholar 

  5. Ponnusamy KE, Kim TJ, Khanuja HS (2014) Perioperative blood transfusions in orthopaedic surgery. J Bone Joint Surg Am 96(21):1836–1844

    Article  PubMed  Google Scholar 

  6. Bartley CE, Bastrom TP, Newton PO (2014) Blood loss reduction during surgical correction of adolescent idiopathic scoliosis utilizing an ultrasonic bone scalpel. Spine Deform 2(4):285–290

    Article  PubMed  Google Scholar 

  7. Bible JE, Mirza M, Knaub MA (2018) Blood-loss management in spine surgery. J Am AcadOrthopSurg 26(2):35–44

    Google Scholar 

  8. Koerner JD, Patel A, Zhao C et al (2014) Blood loss during posterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 39(18):1479–1487

    Article  Google Scholar 

  9. Oetgen ME, Litrenta J (2017) Perioperative blood management in pediatric spine surgery. J Am AcadOrthopSurg 25(7):480–488

    Google Scholar 

  10. Wahlquist S, Nelson S, Glivar P (2019) Effect of the ultrasonic bone scalpel on blood loss during pediatric spinal deformity correction surgery. Spine Deform 7(4):582–587

    Article  PubMed  Google Scholar 

  11. McCormack PL (2012) Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs 72(5):585–617

    Article  CAS  PubMed  Google Scholar 

  12. Ker K, Edwards P, Perel P, Shakur H, Roberts I (2012) Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 344:e3054

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Ker K, Prieto-Merino D, Roberts I (2013) Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. Br J Surg 100(10):1271–1279

    Article  CAS  PubMed  Google Scholar 

  14. Elwatidy S, Jamjoom Z, Elgamal E, Zakaria A, Turkistani A, El-Dawlatly A (2008) Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebo-controlled study. Spine (Phila Pa 1976) 33(24):2577–2580

    Article  Google Scholar 

  15. Lykissas MG, Crawford AH, Chan G, Aronson LA, Al-Sayyad MJ (2013) The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: a single-surgeon experience. J Child Orthop 7(3):245–249

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sethna NF, Zurakowski D, Brustowicz RM, Bacsik J, Sullivan LJ, Shapiro F (2005) Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology 102(4):727–732

    Article  CAS  PubMed  Google Scholar 

  17. Shapiro F, Zurakowski D, Sethna NF (2007) Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis. Spine (Phila Pa 1976) 32(20):2278–2283

    Article  Google Scholar 

  18. Verma K, Errico T, Diefenbach C et al (2014) The relative efficacy of antifibrinolytics in adolescent idiopathic scoliosis: a prospective randomized trial. J Bone Joint Surg Am 96(10):e80

    Article  PubMed  Google Scholar 

  19. Yagi M, Hasegawa J, Nagoshi N et al (2012) Does the intraoperative tranexamic acid decrease operative blood loss during posterior spinal fusion for treatment of adolescent idiopathic scoliosis? Spine (Phila Pa 1976) 37(21):E1336-1342

    Article  Google Scholar 

  20. Zhong J, Cao K, Wang B, Zhou X, Lin N, Lu H (2019) The perioperative efficacy and safety of tranexamic acid in adolescent idiopathic scoliosis. World neurosurgery 129:e726–e732

    Article  PubMed  Google Scholar 

  21. Ker K, Roberts I (2014) Tranexamic acid for surgical bleeding. BMJ 349:g4934

    Article  PubMed  CAS  Google Scholar 

  22. Lin ZX, Woolf SK (2016) Safety, efficacy, and cost-effectiveness of tranexamic acid in orthopedic surgery. Orthopedics 39(2):119–130

    Article  PubMed  Google Scholar 

  23. Cheriyan T, Maier SP 2nd, Bianco K et al (2015) Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis. Spine J 15(4):752–761

    Article  PubMed  Google Scholar 

  24. Franchini M, Mengoli C, Marietta M et al (2018) Safety of intravenous tranexamic acid in patients undergoing majororthopaedic surgery: a meta-analysis of randomised controlled trials. Blood Transfus 16(1):36–43

    PubMed  PubMed Central  Google Scholar 

  25. Mikhail C, Pennington Z, Arnold PM et al (2020) Minimizing blood loss in spine surgery. Global Spine J 10(1 Suppl):71S-83S

    Article  PubMed  PubMed Central  Google Scholar 

  26. Poeran J, Rasul R, Suzuki S et al (2014) Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ 349:g4829

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Sun Q, Li J, Chen J, Zheng C, Liu C, Jia Y (2019) Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials. BMJ Open 9(1):e024350

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ipema HJ, Tanzi MG (2012) Use of topical tranexamic acid or aminocaproic acid to prevent bleeding after major surgical procedures. Ann Pharmacother 46(1):97–107

    Article  CAS  PubMed  Google Scholar 

  29. Ker K, Beecher D, Roberts I (2013) Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database Syst Rev 23(7):CD010562

    Google Scholar 

  30. Montroy J, Hutton B, Moodley P et al (2018) The efficacy and safety of topical tranexamic acid: a systematic review and meta-analysis. Transfus Med Rev S0887–7963:30151

    Google Scholar 

  31. Chen S, Wu K, Kong G, Feng W, Deng Z, Wang H (2016) The efficacy of topical tranexamic acid in total hip arthroplasty: a meta-analysis. BMC MusculoskeletDisord 17:81

    Article  CAS  Google Scholar 

  32. Yerneni K, Burke JF, Tuchman A et al (2019) Topical tranexamic acid in spinal surgery: a systematic review and meta-analysis. J ClinNeurosci 61:114–119

    Google Scholar 

  33. Yue C, Pei F, Yang P, Xie J, Kang P (2015) Effect of topical tranexamic acid in reducing bleeding and transfusions in TKA. Orthopedics 38(5):315–324

    Article  PubMed  Google Scholar 

  34. Liang J, Liu H, Huang X et al (2016) Using tranexamic acid soaked absorbable gelatin sponge following complex posterior lumbar spine surgery: a randomized control trial. ClinNeurolNeurosurg 147:110–114

    Google Scholar 

  35. Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM (2014) A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J 96(8):1005–1015

    Article  PubMed  Google Scholar 

  36. Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232

    PubMed  Google Scholar 

  37. Fatima N, Barra ME, Roberts RJ et al (2020) Advances in surgical hemostasis: a comprehensive review and meta-analysis on topical tranexamic acid in spinal deformity surgery. Neurosurg Rev 44:163

    Article  PubMed  Google Scholar 

  38. Krohn CD, Sorensen R, Lange JE, Riise R, Bjornsen S, Brosstad F (2003) Tranexamic acid given into the wound reduces postoperative blood loss by half in major orthopaedic surgery. Eur J SurgSuppl 588:57–61

    Google Scholar 

  39. Ren Z, Li S, Sheng L et al (2017) Topical use of tranexamic acid can effectively decrease hidden blood loss during posterior lumbar spinal fusion surgery: a retrospective study. Medicine (Baltimore) 96(42):e8233

    Article  CAS  Google Scholar 

  40. Sudprasert W, Tanaviriyachai T, Choovongkomol K, Jongkittanakul S, Piyapromdee U (2019) A randomized controlled trial of topical application of tranexamic acid in patients with thoracolumbar spine trauma undergoing long-segment instrumented posterior spinal fusion. Asian Spine Journal 13(1):146–154

    Article  PubMed  Google Scholar 

  41. El-Sharkawi M, Sayed S, Gad W, El-Meshtawy M (2016) Effect of topical versus parentraltranexamic acid on blood loss in spinal deformity surgery. A prospective randomized controlled trial. Global Spine J 6(1_suppl):s-0036-1582659

    Google Scholar 

  42. Luo W, Sun RX, Jiang H, Ma XL (2018) The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis. J OrthopSurg Res 13(1):96

    Google Scholar 

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Funding

No funding was available for the study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Center for Spinal Disorders, Nicklaus Children’s Hospital, Miami, FL, 33155, USA

    Stephen George, Subaraman Ramchandran, Ali Mansour & Thomas Errico

  2. Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

    Alexander Mihas & Kevin George

Authors
  1. Stephen George
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  2. Subaraman Ramchandran
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  3. Alexander Mihas
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  4. Kevin George
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  5. Ali Mansour
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  6. Thomas Errico
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Contributions

SG, AM: Provided significant contributions to data acquisition and analysis, data interpretation, critical revision of manuscript, approval of version to be published and accountable to the data and results. SR: Provided significant contributions to study design, data acquisition and analysis, data interpretation, drafting of manuscript, approval of version to be published and accountable to the data and results. AM: Provided significant contributions to study design, data acquisition and analysis, data interpretation, approval of version to be published and accountable to the data and results. KG: Provided significant contributions to data acquisition and analysis, data interpretation, drafting of manuscript, approval of version to be published and accountable to the data and results. TE: Provided significant contributions to study design, data acquisition and analysis, data interpretation, critical revision of manuscript, approval of version to be published and accountable to the data and results.

Corresponding author

Correspondence to Subaraman Ramchandran.

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Conflict of interest

Dr. Subaraman Ramchandran, Mr. Alexander Mihas, Mr. Kevin George and Dr. Ali Mansour have nothing to disclose. Dr. Stephen George is a consultant with Globus Medical and Dr. Thomas Errico is a consultant with K2M/Stryker.

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IRB was obtained prior to initiation of the study.

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George, S., Ramchandran, S., Mihas, A. et al. Topical tranexemic acid reduces intra-operative blood loss and transfusion requirements in spinal deformity correction in patients with adolescent idiopathic scoliosis. Spine Deform 9, 1387–1393 (2021). https://doi.org/10.1007/s43390-021-00337-z

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  • DOI: https://doi.org/10.1007/s43390-021-00337-z

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