Antifibrinolytics reduce blood loss in adult spinal deformity surgery: a prospective, randomized controlled trial.

Abstract

STUDY DESIGN:

This is a prospective, randomized, double-blinded comparison of tranexamic acid (TXA), epsilon aminocaproic acid (EACA), and placebo used intraoperatively in patients with adult spinal deformity.

OBJECTIVE:

The purpose of this study was to provide high-quality evidence regarding the comparative efficacies of TXA, EACA, and placebo in reducing blood loss and transfusion requirements in patients undergoing posterior spinal fusion surgery.

SUMMARY OF BACKGROUND DATA:

Spine deformity surgery usually involves substantial blood loss. The antifibrinolytics TXA and EACA have been shown to improve hemostasis in large blood loss surgical procedures.

METHODS:

Fifty-one patients undergoing posterior spinal fusion of at least 5 levels for correction of adult spinal deformity were randomized to 1 of 3 treatment groups. Primary outcome measures included intraoperative estimated blood loss, total loss, (estimated blood loss + postoperative blood loss), and transfusion rates.

RESULTS:

Patients received TXA (n = 19), EACA (n = 19), or placebo (n = 13) in the operating room (mean ages: 60, 47, and 43 yr, respectively); TXA patients were significantly older and had larger estimated blood volumes than both other groups. Total losses were significantly reduced for EACA versus control, and there was a demonstrable but nonsignificant trend toward reduced intraoperative blood loss in both antifibrinolytic arms versus control. EACA had significant reductions in postoperative blood transfusions versus TXA.

CONCLUSION:

The findings in this study support the use of antifibrinolytics to reduce blood loss in posterior adult spinal deformity surgery.

LEVEL OF EVIDENCE:

1.

• Authors: Austin Peters, Kushagra Verma, Kseniya Slobodyanyuk, Thomas Cheriyan, Christian Hoelscher, Frank Schwab, Baron Lonner, Tessa Huncke, Virginie Lafage, Thomas Errico
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 40 Issue 8 Pg. E443-9 (Apr 15 2015) ISSN: 1528-1159 [Electronic] United States
• PMID: 25868100 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Antifibrinolytic Agents
• Tranexamic Acid
• Aminocaproic Acid

Topics

• Adult
• Aminocaproic Acid (therapeutic use)
• Antifibrinolytic Agents (therapeutic use)
• Blood Loss, Surgical (prevention & control)
• Blood Transfusion
• Blood Volume
• Double-Blind Method
• Female
• Hematocrit
• Humans
• Intraoperative Care
• Male
• Middle Aged
• Prospective Studies
• Spinal Fusion
• Spine (abnormalities, surgery)
• Tranexamic Acid (therapeutic use)