Bleeding management in adolescent idiopathic scoliosis: the role of low-dose tranexamic acid

Abstract

Background

Despite advances in surgical and blood management techniques, it continues to carry risks of excessive blood loss and transfusion. Tranexamic Acid (TXA), an antifibrinolytic agent, has shown efficacy in reducing these risks across various surgeries. This retrospective cohort study evaluated factors influencing intraoperative blood loss in Adolescent Idiopathic Scoliosis (AIS) surgery, focusing on low-dose TXA administration.

Methods

This retrospective cohort study included 187 AIS patients undergoing posterior spinal fusion with or without intraoperative TXA. Patients were grouped into non-TXA (116 patients) and TXA (71 patients) cohorts. The TXA group received a 10 mg.kg^-1 intravenous loading dose over 15 minutes, followed by a continuous infusion of 1 mg.kg^-1.h^-1 until skin closure. Outcomes included estimated blood loss, transfusion needs, length of stay, and thromboembolic or neurologic complications. Multivariate regression adjusted intraoperative blood volume loss for potential covariates.

Results

Baseline demographic characteristics were similar between groups. However, differences in surgical complexity cannot be excluded and are acknowledged. TXA use was associated with a 39% reduction in estimated intraoperative blood volume loss compared with the non-TXA group. Blood loss correlated significantly with TXA use, sex, ASA status, number of fused levels, curve type, and surgery duration.

Conclusion

Low-dose TXA significantly reduced intraoperative blood loss and transfusion requirements during AIS surgery. Greater blood loss was linked to longer procedures and more fused levels, whereas lumbar curve type appeared protective. This study provides insights into AIS outcomes and their associations with predictive factors and TXA use.

Level of evidence

Level III – retrospective cohort study.