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Do Intra‐Operative Antifibrinolytics Reduce Blood Loss in Adolescent Idiopathic Scoliosis? A Prospective Randomized Comparison: *Paper #13

Verma, Kushagra MS; Errico, Thomas MD; Bharucha, Neil; Diefenbach, Christopher BS; Dean, Laura E. BA; Xavier, Shaun MD; Dryer, Joseph; Huncke, Tessa MD; Boenigk, Kirsten MD, PhD; Lonner, Baron S. MD

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Summary: The benefit of using antifibrinolytics during spinal fusion surgery for AIS is controversial. We found a significant reduction in blood loss but not transfusion rate with antifibrinolytics compared with placebo. TXA may be more effective than EACA in reducing post‐operative drain output.

Introduction: Antifibrinolytics are known to reduce blood loss. However, the benefit of using these medications for patients with Adolescent Idiopathic Scoliosis (AIS) is unclear. No study has compared tranexamic acid (TXA), epsilon aminocaproic acid (EACA), and placebo to assess blood loss, transfusion rate, and post‐operative drain output in a prospective randomized study.

Methods: This is a prospective, randomized, double blinded comparison of TXA, EACA and placebo used intra‐operatively in patients with AIS. 60 patients with AIS were randomly assigned to one of the treatment arms or the placebo group. The physicians, patients, and researchers were blinded to this assignment. TXA was administered at 10mg/kg for a loading dose followed by 1 mg/kg‐hr, while EACA was given at a 10‐fold higher dose. Estimated blood loss (EBL), pre and post‐operative hematocrit, blood product usage, and post‐operative drain output were recorded. An ANOVA with Tukey's post hoc analysis was used to compare groups. No pharmaceutical funding was received for this study.

Results: AIS patients received TXA (n=14), EACA (n=18), or saline (n=28) in the operating room (46F, 14M, mean age 15, range 11‐21). Average blood loss with either TXA (794 ± 544ml) or EACA (754 ± 484ml) was less than placebo (1074±738ml) (p<0.05). Total drain output was decreased with TXA (633± 427ml) compared to EACA (1332±585ml) (p<0.05), but not placebo (1080 ±558ml). There was no difference in the number of units transfused or the change in hematocrit during surgery comparing either medication against placebo. There were no thromboembolic, renal, or wound complications.

Conclusion: We report that intra‐operative antifibrinolytics reduce blood loss but not transfusion rate in AIS. Total drain output was reduced with TXA compared to EACA, but both treatment options were equivalent in terms of operative blood loss.

Significance: Our study provides level‐one evidence comparing TXA, EACA, and placebo in terms of blood loss, transfusion rate, and post‐operative drain output.

© 2010 Lippincott Williams & Wilkins, Inc.

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