Use of tranexamic acid in corrective surgery for adolescent idiopathic scoliosis: effectiveness and safety

English Keywords:Adolescent idiopathic scoliosis  Blood loss  Tranexamic acid  Perioperative period

English Abstract:

  【Abstract】 Objectives： To assess the efficacy and safety of intravenous use of tranexamic acid(TXA) in reducing blood loss during correction surgery for patients with adolescent idiopathic scoliosis(AIS). Methods： The clinical data of 759 AIS patients who underwent posterior corrective fusion surgery at Nanjing Drum Tower Hospital between November 2016 and May 2022 were reviewed retrospectively. There were 544 females and 215 males, with an average age of 14.7±2.1 years. Among the patients, 369 patients receiving intravenous use of TXA during surgery were included in the TXA group, while the other 390 patients receiving the same volume of saline but not TXA were included in the control group. The baseline data(age, gender ratio, Cobb angle, and scoliosis type), pre- and postoperative blood laboratory parameters[hemoglobin(Hb), hematocrit(Hct), platelet count(PLT), prothrombin time(PT), D-dimer, activated partial thromboplastin time(APTT), and fibrinogen(FIB)], blood management indicators(intraoperative blood loss, intraoperative blood transfusion, postoperative drainage volume and removal time of drainage tube), and correction-related indicators(pre- and postoperative scoliosis degree, correction rate) and postoperative complications were compared between the two groups． Results: There were no significant differences in baseline data and preoperative blood laboratory parameters between the groups(P>0.05). In TXA group, the intraoperative blood loss(551.7±130.3mL), intraoperative blood transfusion volume(551.3±96.3mL), postoperative drainage volume(468.3±162.5mL), and postoperative drainage time(2.8±0.4d) were all significantly lower than those in the control group(666.7±166.8mL, 650.0±138.3mL, 550.0±135.1mL, 3.1±0.8d, P<0.05). Postoperative D-dimer and PLT in the TXA group were significantly lower than those in the control group(P<0.05), while other blood laboratory parameters showed no significant differences between the two groups(P>0.05). There were no statistically significant differences in scoliosis correction rates, postoperative complication rates between the two groups(P>0.05). Conclusions: The use of TXA in surgery can reduce the perioperative blood loss and transfusion, and improve coagulation status in AIS patients, without increasing the incidence rates of complications.