Efficacy of topical versus intravenous tranexamic acid in spinal deformity
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ORIGINAL ARTICLE
Efficacy of topical versus intravenous tranexamic acid in spinal deformity Karen A. Weissmann1,2 · Virginie Lafage3 · Carlos Barrios Pitaque1 · Renaud Lafage4 · Francoise M. Descazeaux5 Received: 18 February 2020 / Revised: 13 August 2020 / Accepted: 16 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To compare topical tranexamic acid versus intravenous tranexamic acid in reducing intra- and postoperative blood loss and transfusion rate in deformity patients. Materials and method We performed a retrospective cohort study with posterior fusion deformity patients, between 2009 and 2016. Patients were categorized in 4 groups: “No TXA” (n = 35) if the wound was packed with saline soaked sponges, “IV TXA” (n = 37) the patient received 20 mg/kg bolus at the beginning of the surgery followed by continuous infusion of 1 mg/kg/hr until closure, “Topical TXA” (n = 23) the wound was packed with sponges soaked in 6 g of TXA diluted in a 3 L saline solution, or “Combined TXA” (n = 86) the patient received both IV and topical TXA. The primary outcomes were total, intra- and postoperative blood loss, surgical time, postoperative Ht/Hb, transfusion rates, and duration of drain insertion. Results A total of 181 patients were analyzed (78.6% F, 15.08 yo). No differences were found in total and intraoperative blood loss, surgical time, postoperative Ht/Ht, and transfusion rates. “Combined TXA” group had significantly less postoperative bleeding than “no TXA” group (p = 0.022). IV TXA patients (with o/without topical TXA) removed drains one day earlier than the no TXA group (p = 0.002). There were no complications related to the use of tranexamic acid. Conclusion There is significant decrease in postoperative bleeding in pediatric deformity patients with combined topical and IV tranexamic acid. Keywords Tranexamic acid · Scoliosis · Topical
Introduction Despite all the recent advances in deformity surgery, blood management remains a major issue. Excessive blood loss increases complications, hospital stays, and costs [1]. Excessive bleeding affects patients intraoperatively [2] and impacts the recovery process, it can lead to an extended * Karen A. Weissmann [email protected]; [email protected] 1
Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
2
Departamento de Ortopedia y Traumatología, Area Sur., Universidad de Chile, Gran Avenida Jose Miguel Carrera 3100, San Miguel, Santiago, Chile
3
Department of Surgery, Hospital for Special Surgery, New York, NY, US
4
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, US
5
Hospital Exequiel Gonzalez Cortés, Santiago, Chile
length of stay, nausea, and unnecessary allogeneic transfusions with increased risk of infection [3], and it also involves extra strain for the family in procuring blood and increased costs. On a very high level, there are two ways to mitigate the issue of blood loss [4]: replace or save blood. Replacing blood in
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