title: Antifibrinolytics reduce blood loss in adult spinal deformity surgery: a prospective, randomized controlled trial.
abstract: METHODS
  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.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  The findings in this study support the use of antifibrinolytics to reduce blood loss in posterior adult spinal deformity surgery.
  
  
  METHODS
  1.
authors: *Spine Center, Department of Orthopaedics, Hospital for Joint Diseases, New York University, New York, NY †Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR; and ‡Department of Orthopaedics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
authors: Austin
authors: A
authors: Peters
authors: Kushagra
authors: K
authors: Verma
authors: Kseniya
authors: K
authors: Slobodyanyuk
authors: Thomas
authors: T
authors: Cheriyan
authors: Christian
authors: C
authors: Hoelscher
authors: Frank
authors: F
authors: Schwab
authors: Baron
authors: B
authors: Lonner
authors: Tessa
authors: T
authors: Huncke
authors: Virginie
authors: V
authors: Lafage
authors: Thomas
authors: T
authors: Errico
mesh_terms: D000328:Adult; D015119:Aminocaproic Acid / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001810:Blood Volume; D004311:Double-Blind Method; D005260:Female; D006400:Hematocrit; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013123:Spinal Fusion; D013131:Spine / Q000002:abnormalities / Q000601:surgery*; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D015119:Aminocaproic Acid