Effect of antifibrinolytic therapy on complications, thromboembolic events, blood product utilization, and fusion in adult spinal deformity surgery

Study Design. A multicenter, prospective, consecutive database of surgical patients with adult spinal deformity (ASD). Objective. This study investigated the use of antifibrinolytic (AF) therapy in ASD surgery. Summary of Background Data. AF therapy has been shown to be effective in preventing blood loss in some settings. Its effect on major and minor perioperative complications, blood product utilization, vascular events, and postoperative fusion in patients undergoing ASD surgery remains unclear. Methods. All patients with data on AF use were included. Parameters of blood utilization included transfusion rates and units of packed red blood cells and fresh frozen plasma transfused. Thromboembolic events included stroke, deep vein thrombosis, and pulmonary embolus. Multivariate regression was used, accounting for confounders. Results. Four hundred three patients were included. One hundred thirty-seven patients received aminocaproic acid (EACA), 81 received tranexamic acid (TXA), and 185 received no AFs. The use of AF was associated with a decrease in transfusion (EACA: odds ratio [OR]=0.38, P=0.043; TXA: OR=0.31, P=0.047), a decrease in the number of units of packed red blood cells transfused (EACA: incidence risk ratio [IRR]=0.45, P=0.0005; TXA: IRR=0.7, P=0.0005), and a decrease in the number of fresh frozen plasma transfused (EACA: IRR=0.65, P=0.003; TXA: IRR=0.67, P=0.006). AF use was associated with an increase in minor intraoperative complications (EACA: IRR=2.15, P=0.008; TXA: IRR=2.12, P=0.011). TXA use (but not EACA) was associated with a decrease in the incidence of major perioperative complications compared with no AF (IRR=0.37, P=0.019). There was no difference in the incidence of thromboembolic events. Conclusion. TXA or EACA use was associated with increased minor intraoperative complications. TXA was associated with decreased major perioperative complications. AF was associated with decreased utilization of blood products without an increased rate of thromboembolic events. Given the nature of this study, transfusion threshold was not standardized. Future studies with rigid criteria for transfusion should be prospectively performed to better evaluate the impact of AF during ASD surgery.