Perioperative blood transfusion requirements in pediatric scoliosis surgery: the efficacy of tranexamic acid.
BACKGROUND
Previous studies have noted that the use of antifibrinolytic medications can help reduce blood loss and transfusion requirements during cardiac, total joint arthroplasty, and spine surgery. Tranexamic acid (TXA) has been investigated in these patient groups but consensus with respect to the dosing regimen has not been achieved, especially in the pediatric scoliosis literature. The purpose of this study was to compare the effects of 2 TXA dosing regimens on reducing transfusion requirements.


METHODS
A retrospective chart review was performed on all idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion from 2005 to 2006 to determine total perioperative transfusion requirements. Transfusion requirements for those patients receiving either a low (10 mg/kg loading, 1 mg/kg/h infusion) or high (20 mg/kg loading, 10 mg/kg/h infusion) dose of TXA were compared.


RESULTS
High-dose TXA (n = 11) showed a trend toward a reduction in transfusion requirements compared with the low dose (n = 15) for idiopathic scoliosis patients undergoing posterior only instrumentation and fusion (687.9 +/- 778.1 mL vs 1372.6 +/- 1077.3 mL; P = 0.07; 95% confidence interval for the mean difference, -66.3 mL to 1435.7 mL). Although substantial, this difference was underpowered to show a difference.


CONCLUSIONS
The use of the higher dose of TXA resulted in a 50% reduction in transfusion requirements for idiopathic scoliosis patients. Given previous studies, there appears to be a dose-response effect. A prospective dose-ranging study is now required to determine the optimal dose for pediatric patients with idiopathic scoliosis.


METHODS
III, retrospective cohort study.
Grant
John A
JA
Division of Orthopaedics, Department of Surgery, Faculty of Medicine, University of Calgary & Alberta Children's Hospital, Calgary, Alberta, Canada. grantja@ucalgary.ca
Howard
Jason
J
Luntley
Jeremy
J
Harder
James
J
Aleissa
Sami
S
Parsons
David
D
D000293:Adolescent; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D019990:Perioperative Care; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid