Louanne M Carabini1, Natalie C Moreland2, Ryan J Vealey3, John F Bebawy4, Tyler R Koski5, Antoun Koht6, Dhanesh K Gupta7, Michael J Avram8. 1. Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: l-carabini@northwestern.edu. 2. Department of Anesthesiology, University of California at Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA. 3. Department of Neuroanesthesia, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 4. Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 5. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 6. Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 7. Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA. 8. Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Abstract
BACKGROUND:Multilevel spine fusion surgery for adult deformity correction is associated with significant blood loss and coagulopathy. Tranexamic acid reduces blood loss in high-risk surgery, but the efficacy of a low-dose regimen is unknown. METHODS:Sixty-one patients undergoing multilevel complex spinal fusion with and without osteotomies were randomly assigned to receive low-dose tranexamic acid (10 mg/kg loading dose, then 1 mg·kg-1·hr-1 throughout surgery) or placebo. The primary outcome was the total volume of red blood cells transfused intraoperatively. RESULTS: Thirty-one patients received tranexamic acid, and 30 patients received placebo. Patient demographics, risk of major transfusion, preoperative hemoglobin, and surgical risk of the 2 groups were similar. There was a significant decrease in total volume of red blood cells transfused (placebo group median 1460 mL vs. tranexamic acid group 1140 mL; median difference 463 mL, 95% confidence interval 15 to 914 mL, P = 0.034), with a decrease in cell saver transfusion (placebo group median 490 mL vs. tranexamic acid group 256 mL; median difference 166 mL, 95% confidence interval 0 to 368 mL, P = 0.042). The decrease in packed red blood cell transfusion did not reach statistical significance (placebo group median 1050 mL vs. tranexamic acid group 600 mL; median difference 300 mL, 95% confidence interval 0 to 600 mL, P = 0.097). CONCLUSIONS: Our results support the use of low-dose tranexamic acid during complex multilevel spine fusion surgery to decrease total red blood cell transfusion.
RCT Entities:
BACKGROUND: Multilevel spine fusion surgery for adult deformity correction is associated with significant blood loss and coagulopathy. Tranexamic acid reduces blood loss in high-risk surgery, but the efficacy of a low-dose regimen is unknown. METHODS: Sixty-one patients undergoing multilevel complex spinal fusion with and without osteotomies were randomly assigned to receive low-dose tranexamic acid (10 mg/kg loading dose, then 1 mg·kg-1·hr-1 throughout surgery) or placebo. The primary outcome was the total volume of red blood cells transfused intraoperatively. RESULTS: Thirty-one patients received tranexamic acid, and 30 patients received placebo. Patient demographics, risk of major transfusion, preoperative hemoglobin, and surgical risk of the 2 groups were similar. There was a significant decrease in total volume of red blood cells transfused (placebo group median 1460 mL vs. tranexamic acid group 1140 mL; median difference 463 mL, 95% confidence interval 15 to 914 mL, P = 0.034), with a decrease in cell saver transfusion (placebo group median 490 mL vs. tranexamic acid group 256 mL; median difference 166 mL, 95% confidence interval 0 to 368 mL, P = 0.042). The decrease in packed red blood cell transfusion did not reach statistical significance (placebo group median 1050 mL vs. tranexamic acid group 600 mL; median difference 300 mL, 95% confidence interval 0 to 600 mL, P = 0.097). CONCLUSIONS: Our results support the use of low-dose tranexamic acid during complex multilevel spine fusion surgery to decrease total red blood cell transfusion.
Authors: José Luiz de Faria; Josué da Silva Brito; Louise Teixeira Costa E Silva; Christiano Tadeu Sanches Mattos Kilesse; Nicolli Bellotti de Souza; Carlos Umberto Pereira; Eberval Gadelha Figueiredo; Nícollas Nunes Rabelo Journal: Neurosurg Rev Date: 2020-06-17 Impact factor: 3.042
Authors: Dhwani Hariharan; Marco Mammi; Kelicia Daniels; Nayan Lamba; Kerilyn Petrucci; Christian D Cerecedo-Lopez; Joanne Doucette; Alexander F C Hulsbergen; Stefania Papatheodorou; Linda S Aglio; Timothy R Smith; Rania A Mekary; Hasan Zaidi Journal: Drugs Date: 2019-10 Impact factor: 9.546