TY - JOUR
T1 - Analysis of tranexamic acid usage in adult spinal deformity patients with relative contraindications
T2 - does it increase the risk of complications?
AU - On behalf of The International Spine Study Group
AU - Mullin, Jeffrey P.
AU - Soliman, Mohamed A.R.
AU - Smith, Justin S.
AU - Kelly, Michael P.
AU - Buell, Thomas J.
AU - Diebo, Bassel
AU - Scheer, Justin K.
AU - Line, Breton
AU - Lafage, Virginie
AU - Lafage, Renaud
AU - Klineberg, Eric
AU - Kim, Han Jo
AU - Passias, Peter G.
AU - Gum, Jeffrey L.
AU - Kebaish, Khaled
AU - Eastlack, Robert K.
AU - Daniels, Alan H.
AU - Soroceanu, Alex
AU - Mundis, Gregory
AU - Hostin, Richard
AU - Protopsaltis, Themistocles S.
AU - Hamilton, D. Kojo
AU - Gupta, Munish C.
AU - Lewis, Stephen J.
AU - Schwab, Frank J.
AU - Lenke, Lawrence G.
AU - Shaffrey, Christopher I.
AU - Bess, Shay
AU - Ames, Christopher P.
AU - Burton, Douglas
N1 - Publisher Copyright:
©AANS 2024, except where prohibited by US copyright law.
PY - 2024/6
Y1 - 2024/6
N2 - OBJECTIVE Complex spinal deformity surgeries may involve significant blood loss. The use of antifibrinolytic agents such as tranexamic acid (TXA) has been proven to reduce perioperative blood loss. However, for patients with a history of thromboembolic events, there is concern of increased risk when TXA is used during these surgeries. This study aimed to assess whether TXA use in patients undergoing complex spinal deformity correction surgeries increases the risk of thromboembolic complications based on preexisting thromboembolic risk factors. METHODS Data were analyzed for adult patients who received TXA during surgical correction for spinal deformity at 21 North American centers between August 2018 and October 2022. Patients with preexisting thromboembolic events and other risk factors (history of deep venous thrombosis [DVT], pulmonary embolism [PE], myocardial infarction [MI], stroke, peripheral vascular disease, or cancer) were identified. Thromboembolic complication rates were assessed during the postoperative 90 days. Univariate and multivariate analyses were performed to assess thromboembolic outcomes in high-risk and low-risk patients who received intravenous TXA. RESULTS Among 411 consecutive patients who underwent complex spinal deformity surgery and received TXA in-traoperatively, 130 (31.6%) were considered high-risk patients. There was no significant difference in thromboembolic complications between patients with and those without preexisting thromboembolic risk factors in univariate analysis (high-risk group vs low-risk group: 8.5% vs 2.8%, p = 0.45). Specifically, there were no significant differences between groups regarding the 90-day postoperative rates of DVT (high-risk group vs low-risk group: 1.5% vs 1.4%, p = 0.98), PE (2.3% vs 1.8%, p = 0.71), acute MI (1.5% vs 0%, p = 0.19), or stroke (0.8% vs 1.1%, p > 0.99). On multivariate analysis, high-risk status was not a significant independent predictor for any of the thromboembolic complications. CONCLUSIONS Administration of intravenous TXA during the correction procedure did not change rates of thromboembolic events, acute MI, or stroke in this cohort of adult spinal deformity surgery patients.
AB - OBJECTIVE Complex spinal deformity surgeries may involve significant blood loss. The use of antifibrinolytic agents such as tranexamic acid (TXA) has been proven to reduce perioperative blood loss. However, for patients with a history of thromboembolic events, there is concern of increased risk when TXA is used during these surgeries. This study aimed to assess whether TXA use in patients undergoing complex spinal deformity correction surgeries increases the risk of thromboembolic complications based on preexisting thromboembolic risk factors. METHODS Data were analyzed for adult patients who received TXA during surgical correction for spinal deformity at 21 North American centers between August 2018 and October 2022. Patients with preexisting thromboembolic events and other risk factors (history of deep venous thrombosis [DVT], pulmonary embolism [PE], myocardial infarction [MI], stroke, peripheral vascular disease, or cancer) were identified. Thromboembolic complication rates were assessed during the postoperative 90 days. Univariate and multivariate analyses were performed to assess thromboembolic outcomes in high-risk and low-risk patients who received intravenous TXA. RESULTS Among 411 consecutive patients who underwent complex spinal deformity surgery and received TXA in-traoperatively, 130 (31.6%) were considered high-risk patients. There was no significant difference in thromboembolic complications between patients with and those without preexisting thromboembolic risk factors in univariate analysis (high-risk group vs low-risk group: 8.5% vs 2.8%, p = 0.45). Specifically, there were no significant differences between groups regarding the 90-day postoperative rates of DVT (high-risk group vs low-risk group: 1.5% vs 1.4%, p = 0.98), PE (2.3% vs 1.8%, p = 0.71), acute MI (1.5% vs 0%, p = 0.19), or stroke (0.8% vs 1.1%, p > 0.99). On multivariate analysis, high-risk status was not a significant independent predictor for any of the thromboembolic complications. CONCLUSIONS Administration of intravenous TXA during the correction procedure did not change rates of thromboembolic events, acute MI, or stroke in this cohort of adult spinal deformity surgery patients.
KW - adult spinal deformity surgery
KW - antifibrinolytic therapy
KW - high-risk
KW - thromboembolic complications
KW - tranexamic acid
UR - http://www.scopus.com/inward/record.url?scp=85195227441&partnerID=8YFLogxK
U2 - 10.3171/2024.1.SPINE231098
DO - 10.3171/2024.1.SPINE231098
M3 - Article
C2 - 38457792
AN - SCOPUS:85195227441
SN - 1547-5654
VL - 40
SP - 684
EP - 691
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 6
ER -