Antifibrinolytics Reduce Blood Loss in Adult Spinal Deformity Surgery. Issue 8 (15th April 2015)

• Record Type: Journal Article
• Authors: Peters, Austin; Verma, Kushagra; Slobodyanyuk, Kseniya; Cheriyan, Thomas; Hoelscher, Christian; Schwab, Frank; Lonner, Baron; Huncke, Tessa; Lafage, Virginie; Errico, Thomas
• Is Part Of: Spine. Volume 40:Issue 8(2015)
• Publication Date: 2015-04-15
• Subjects: Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000000799
• Languages: English
• ISSNs: 0362-2436

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Study Design.</title> <p>This is a prospective, randomized, double-blinded comparison of tranexamic acid (TXA), epsilon aminocaproic acid (EACA), and placebo used intraoperatively in patients with adult spinal deformity.</p> </sec> <sec> <title>Objective.</title> <p>The purpose of this study was to provide high-quality evidence regarding the comparative efficacies of TXA, EACA, and placebo in reducing blood loss and transfusion requirements in patients undergoing posterior spinal fusion surgery.</p> </sec> <sec> <title>Summary of Background Data.</title> <p>Spine deformity surgery usually involves substantial blood loss. The antifibrinolytics TXA and EACA have been shown to improve hemostasis in large blood loss surgical procedures.</p> </sec> <sec> <title>Methods.</title> <p>Fifty-one patients undergoing posterior spinal fusion of at least 5 levels for correction of adult spinal deformity were randomized to 1 of 3 treatment groups. Primary outcome measures included intraoperative estimated blood loss, total loss, (estimated blood loss + postoperative blood loss), and transfusion rates.</p> </sec> <sec> <title>Results.</title> <p>Patients received TXA (n = 19), EACA (n = 19), or placebo (n = 13) in the operating room (mean ages: 60, 47, and 43 yr, respectively); TXA patients were significantly older and had larger estimated blood volumes than both other groups. Total losses were significantly reduced for EACA <italic>versus</italic> control, and there was a demonstrable but nonsignificant trend toward reduced intraoperative blood loss in both antifibrinolytic arms <italic>versus</italic> control. EACA had significant reductions in postoperative blood transfusions <italic>versus</italic> TXA.</p> </sec> <sec> <title>Conclusion.</title> <p>The findings in this study support the use of antifibrinolytics to reduce blood loss in posterior adult spinal deformity surgery.</p> <p> <bold>Level of Evidence:</bold> 1</p> </sec> </abstract>