A new study published in the International Journal of Environmental Research and Public Health reported that perioperative IV tranexamic acid (TXA), a fibrinolysis inhibitor, can decrease intraoperative blood loss and crystalloid fluid volume overload during posterior spinal fusion surgery for scoliosis in patients with spinal muscular atrophy (SMA).
These changes may allow earlier postoperative extubation and help reduce postoperative pulmonary complications.
Surgical interventions in patients with SMA who require scoliosis surgery aim to correct spinal deformity and halt scoliosis curve progression and pulmonary function decline. This study is important because it represents the first report to establish the beneficial effect of TXA administration on SMA scoliosis surgery.
Although TXA benefits have been studied in other types of orthopedic surgery, this condition has been difficult to study because it exhibits considerable diagnostic heterogeneity and because there are very few patients.
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The study provides results from a retrospective review of 30 SMA patients who underwent corrective surgery for scoliosis between December 1993 and August 2020. There were 15 patients in the TXA group and 15 patients in the control group. Patients in the TXA group received an IV loading dose of 100 mg/kg, followed by a TXA maintenance dose of 10 mg/kg/h until skin closure.
TXA administration decreased the average percentage of total blood volume lost by 51% from 106.7 ± + 95.0 in the control group to 52.1 + 17.8 in the TXA group (P =0.011). Intraoperative blood transfusion volume was reduced by 60% from 1250.0 +± 1052.2 mL in the control arm to 498.7 ± + 158.4 mL in the TXA arm (P <0.001). The study also demonstrated that TXA admission can significantly reduce intraoperative crystalloid volume and total transfusion volume.
Additional benefits were observed postoperatively. Intubation time was shorter in the TXA group, declining from 52.8 +± 58.5 hours to 19.1 +± 12.9 hours and the rate of pulmonary complications was lower—33.3% in the TXA group compared with 53.3% in the control group.
Strategies such as perioperative TXA to prevent massive bleeding during surgery, the need for transfusions, and associated complications may help reduce morbidity from surgery. Additional benefits of TXA administration were noted by the study authors: “the transfusion of blood products adds to healthcare costs and increases the risk of complications, such as dilutional coagulopathy, pulmonary edema, and surgical site infection.”.
Further prospective studies with a larger sample population or multiple center studies need to be conducted to confirm the findings of this small retrospective study.
Chou S-H, Lin S-Y, Wu M-H, et al. Intravenous tranexamic acid reduces blood loss and transfusion volume in scoliosis surgery for spinal muscular atrophy: results of a 20-year retrospective analysis. Int J Environ Res Public Health. 2021;18(19):9959. doi.org/10.3390/ijerph18199959