TY - JOUR
T1 - High-Dose TXA Is Associated with Less Blood Loss Than Low-Dose TXA without Increased Complications in Patients with Complex Adult Spinal Deformity
AU - International Spine Study Group
AU - Kim, Andrew H.
AU - Mo, Kevin C.
AU - Harris, Andrew B.
AU - Lafage, Renaud
AU - Neuman, Brian J.
AU - Hostin, Richard A.
AU - Soroceanu, Alexandra
AU - Kim, Han Jo
AU - Klineberg, Eric O.
AU - Gum, Jeffrey L.
AU - Gupta, Munish C.
AU - Hamilton, D. Kojo
AU - Schwab, Frank
AU - Burton, Doug
AU - Daniels, Alan
AU - Passias, Peter G.
AU - Hart, Robert A.
AU - Line, Breton G.
AU - Ames, Christopher
AU - Lafage, Virginie
AU - Shaffrey, Christopher I.
AU - Smith, Justin S.
AU - Bess, Shay
AU - Lenke, Lawrence
AU - Kebaish, Khaled M.
AU - Akbarnia, Behrooz
AU - Anand, Neel
AU - Boachie-Adjei, Oheneba
AU - Bridwell, Keith
AU - Burton, Douglas
AU - Chou, Dean
AU - Cunningham, Matthew E.
AU - Deviren, Vedat
AU - Eastlack, Robert
AU - Fessler, Richard
AU - Glassman, Steven
AU - Gum, Jeffrey
AU - Gupta, Munish
AU - Hart, Robert
AU - Hosogane, Naobumi
AU - Hostin, Richard
AU - Javidan, Yashar
AU - Fu, Kai Ming
AU - Kanter, Adam
AU - Kebaish, Khaled
AU - Kelly, Michael
AU - Klineberg, Eric
AU - Line, Breton
AU - Mummaneni, Praveen
AU - Mundis, Gregory
AU - Neuman, Brian
AU - Nunley, Pierce
AU - Okonkwo, David
AU - Park, Paul
AU - Passias, Peter
AU - Protopsaltis, Themistocles
AU - Scheer, Justin
AU - Sciubba, Daniel
AU - Shaffrey, Christopher
AU - Ailon, Tamir
AU - Than, Khoi
AU - Uribe, Juan
AU - Wang, Michael
AU - Yagi, Mitsuru
AU - Yeramaneni, Samrat
N1 - Publisher Copyright:
© 2024 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.
PY - 2024/12/4
Y1 - 2024/12/4
N2 - Background:Tranexamic acid (TXA) is commonly utilized to reduce blood loss in adult spinal deformity (ASD) surgery. Despite its widespread use, there is a lack of consensus regarding the optimal dosing regimen. The aim of this study was to assess differences in blood loss and complications between high, medium, and low-dose TXA regimens among patients undergoing surgery for complex ASD.Methods:A multicenter database was retrospectively analyzed to identify 265 patients with complex ASD. Patients were separated into 3 groups by TXA regimen: (1) low dose (<20-mg/kg loading dose with ≤2-mg/kg/hr maintenance dose), (2) medium dose (20 to 50-mg/kg loading dose with 2 to 5-mg/kg/hr maintenance dose), and (3) high dose (>50-mg/kg loading dose with ≥5-mg/kg/hr maintenance dose). The measured outcomes included blood loss, complications, and red blood cell (RBC) units transfused intraoperatively and perioperatively. The multivariable analysis controlled for TXA dosing regimen, levels fused, operating room time, preoperative hemoglobin, 3-column osteotomy, and posterior interbody fusion.Results:The cohort was predominantly White (91.3%) and female (69.1%) and had a mean age of 61.6 years. Of the 265 patients, 54 (20.4%) received low-dose, 131 (49.4%) received medium-dose, and 80 (30.2%) received high-dose TXA. The median blood loss was 1,200 mL (interquartile range [IQR], 750 to 2,000). The median RBC units transfused intraoperatively was 1.0 (IQR, 0.0 to 2.0), and the median RBC units transfused perioperatively was 2.0 (IQR, 1.0 to 4.0). Compared with the high-dose group, the low-dose group had increased blood loss (by 513.0 mL; p = 0.022) as well as increased RBC units transfused intraoperatively (by 0.6 units; p < 0.001) and perioperatively (by 0.3 units; p = 0.024). The medium-dose group had increased blood loss (by 491.8 mL; p = 0.006) as well as increased RBC units transfused intraoperatively (by 0.7 units; p < 0.001) and perioperatively (by 0.5 units; p < 0.001) compared with the high-dose group.Conclusions:Patients with ASD who received high-dose intraoperative TXA had fewer RBC transfusions intraoperatively, fewer RBC transfusions perioperatively, and less blood loss than those who received low or medium-dose TXA, with no differences in the rates of seizure or thromboembolic complications.
AB - Background:Tranexamic acid (TXA) is commonly utilized to reduce blood loss in adult spinal deformity (ASD) surgery. Despite its widespread use, there is a lack of consensus regarding the optimal dosing regimen. The aim of this study was to assess differences in blood loss and complications between high, medium, and low-dose TXA regimens among patients undergoing surgery for complex ASD.Methods:A multicenter database was retrospectively analyzed to identify 265 patients with complex ASD. Patients were separated into 3 groups by TXA regimen: (1) low dose (<20-mg/kg loading dose with ≤2-mg/kg/hr maintenance dose), (2) medium dose (20 to 50-mg/kg loading dose with 2 to 5-mg/kg/hr maintenance dose), and (3) high dose (>50-mg/kg loading dose with ≥5-mg/kg/hr maintenance dose). The measured outcomes included blood loss, complications, and red blood cell (RBC) units transfused intraoperatively and perioperatively. The multivariable analysis controlled for TXA dosing regimen, levels fused, operating room time, preoperative hemoglobin, 3-column osteotomy, and posterior interbody fusion.Results:The cohort was predominantly White (91.3%) and female (69.1%) and had a mean age of 61.6 years. Of the 265 patients, 54 (20.4%) received low-dose, 131 (49.4%) received medium-dose, and 80 (30.2%) received high-dose TXA. The median blood loss was 1,200 mL (interquartile range [IQR], 750 to 2,000). The median RBC units transfused intraoperatively was 1.0 (IQR, 0.0 to 2.0), and the median RBC units transfused perioperatively was 2.0 (IQR, 1.0 to 4.0). Compared with the high-dose group, the low-dose group had increased blood loss (by 513.0 mL; p = 0.022) as well as increased RBC units transfused intraoperatively (by 0.6 units; p < 0.001) and perioperatively (by 0.3 units; p = 0.024). The medium-dose group had increased blood loss (by 491.8 mL; p = 0.006) as well as increased RBC units transfused intraoperatively (by 0.7 units; p < 0.001) and perioperatively (by 0.5 units; p < 0.001) compared with the high-dose group.Conclusions:Patients with ASD who received high-dose intraoperative TXA had fewer RBC transfusions intraoperatively, fewer RBC transfusions perioperatively, and less blood loss than those who received low or medium-dose TXA, with no differences in the rates of seizure or thromboembolic complications.
UR - http://www.scopus.com/inward/record.url?scp=85206803073&partnerID=8YFLogxK
U2 - 10.2106/JBJS.23.01323
DO - 10.2106/JBJS.23.01323
M3 - Article
C2 - 39361771
AN - SCOPUS:85206803073
SN - 0021-9355
VL - 106
SP - 2205
EP - 2214
JO - Journal of Bone and Joint Surgery
JF - Journal of Bone and Joint Surgery
IS - 23
ER -