Antifibrinolytics reduce blood loss in adult spinal deformity surgery: a prospective, randomized controlled trial.

Authors

• Austin Peters
• Kushagra Verma
• Kseniya Slobodyanyuk
• Thomas Cheriyan
• Christian Hoelscher
• Frank Schwab
• Baron Lonner
• Tessa Huncke
• Virginie Lafage
• Thomas Errico

Publication/Presentation Date

4-15-2015

Abstract

STUDY DESIGN: 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.

OBJECTIVE: 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.

SUMMARY OF BACKGROUND DATA: 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.

METHODS: 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.

RESULTS: 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 versus control, and there was a demonstrable but nonsignificant trend toward reduced intraoperative blood loss in both antifibrinolytic arms versus control. EACA had significant reductions in postoperative blood transfusions versus TXA.

CONCLUSION: The findings in this study support the use of antifibrinolytics to reduce blood loss in posterior adult spinal deformity surgery.

LEVEL OF EVIDENCE: 1.

Volume

40

Issue

8

First Page

443

Last Page

449

ISSN

1528-1159

Published In/Presented At

Peters, A., Verma, K., Slobodyanyuk, K., Cheriyan, T., Hoelscher, C., Schwab, F., Lonner, B., Huncke, T., Lafage, V., & Errico, T. (2015). Antifibrinolytics reduce blood loss in adult spinal deformity surgery: a prospective, randomized controlled trial. Spine, 40(8), E443–E449. https://doi.org/10.1097/BRS.0000000000000799

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

25868100

Department(s)

Administration and Leadership

Document Type

Article