A Randomized Controlled Trial of Low-Dose Tranexamic Acid versus Placebo to Reduce Red Blood Cell Transfusion During Complex Multilevel Spine Fusion Surgery

Northwestern High Risk Spine Group

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Multilevel spine fusion surgery for adult deformity correction is associated with significant blood loss and coagulopathy. Tranexamic acid reduces blood loss in high-risk surgery, but the efficacy of a low-dose regimen is unknown. Methods: Sixty-one patients undergoing multilevel complex spinal fusion with and without osteotomies were randomly assigned to receive low-dose tranexamic acid (10 mg/kg loading dose, then 1 mg·kg−1·hr−1 throughout surgery) or placebo. The primary outcome was the total volume of red blood cells transfused intraoperatively. Results: Thirty-one patients received tranexamic acid, and 30 patients received placebo. Patient demographics, risk of major transfusion, preoperative hemoglobin, and surgical risk of the 2 groups were similar. There was a significant decrease in total volume of red blood cells transfused (placebo group median 1460 mL vs. tranexamic acid group 1140 mL; median difference 463 mL, 95% confidence interval 15 to 914 mL, P = 0.034), with a decrease in cell saver transfusion (placebo group median 490 mL vs. tranexamic acid group 256 mL; median difference 166 mL, 95% confidence interval 0 to 368 mL, P = 0.042). The decrease in packed red blood cell transfusion did not reach statistical significance (placebo group median 1050 mL vs. tranexamic acid group 600 mL; median difference 300 mL, 95% confidence interval 0 to 600 mL, P = 0.097). Conclusions: Our results support the use of low-dose tranexamic acid during complex multilevel spine fusion surgery to decrease total red blood cell transfusion.

Original languageEnglish (US)
Pages (from-to)e572-e579
JournalWorld Neurosurgery
Volume110
DOIs
StatePublished - Feb 1 2018

Fingerprint

Tranexamic Acid
Erythrocyte Transfusion
Spine
Randomized Controlled Trials
Placebos
Confidence Intervals
Erythrocytes
Spinal Fusion
Osteotomy
Hemoglobins
Demography

Keywords

  • Complex spine fusion
  • Tranexamic acid

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{bcff70b6c9de45d185e1d798034f7bda,
title = "A Randomized Controlled Trial of Low-Dose Tranexamic Acid versus Placebo to Reduce Red Blood Cell Transfusion During Complex Multilevel Spine Fusion Surgery",
abstract = "Background: Multilevel spine fusion surgery for adult deformity correction is associated with significant blood loss and coagulopathy. Tranexamic acid reduces blood loss in high-risk surgery, but the efficacy of a low-dose regimen is unknown. Methods: Sixty-one patients undergoing multilevel complex spinal fusion with and without osteotomies were randomly assigned to receive low-dose tranexamic acid (10 mg/kg loading dose, then 1 mg·kg−1·hr−1 throughout surgery) or placebo. The primary outcome was the total volume of red blood cells transfused intraoperatively. Results: Thirty-one patients received tranexamic acid, and 30 patients received placebo. Patient demographics, risk of major transfusion, preoperative hemoglobin, and surgical risk of the 2 groups were similar. There was a significant decrease in total volume of red blood cells transfused (placebo group median 1460 mL vs. tranexamic acid group 1140 mL; median difference 463 mL, 95{\%} confidence interval 15 to 914 mL, P = 0.034), with a decrease in cell saver transfusion (placebo group median 490 mL vs. tranexamic acid group 256 mL; median difference 166 mL, 95{\%} confidence interval 0 to 368 mL, P = 0.042). The decrease in packed red blood cell transfusion did not reach statistical significance (placebo group median 1050 mL vs. tranexamic acid group 600 mL; median difference 300 mL, 95{\%} confidence interval 0 to 600 mL, P = 0.097). Conclusions: Our results support the use of low-dose tranexamic acid during complex multilevel spine fusion surgery to decrease total red blood cell transfusion.",
keywords = "Complex spine fusion, Tranexamic acid",
author = "{Northwestern High Risk Spine Group} and Carabini, {Louanne Marie} and Moreland, {Natalie C.} and Vealey, {Ryan J.} and Bebawy, {John Patrick F} and Koski, {Tyler Robert} and Antoun Koht and Gupta, {Dhanesh K.} and Avram, {Michael J} and Carine Zeeni and Gould, {Robert W.} and Hemmer, {Laura B} and Sugrue, {Patrick A.} and Jamal McClendon",
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A Randomized Controlled Trial of Low-Dose Tranexamic Acid versus Placebo to Reduce Red Blood Cell Transfusion During Complex Multilevel Spine Fusion Surgery. / Northwestern High Risk Spine Group.

In: World Neurosurgery, Vol. 110, 01.02.2018, p. e572-e579.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A Randomized Controlled Trial of Low-Dose Tranexamic Acid versus Placebo to Reduce Red Blood Cell Transfusion During Complex Multilevel Spine Fusion Surgery

AU - Northwestern High Risk Spine Group

AU - Carabini, Louanne Marie

AU - Moreland, Natalie C.

AU - Vealey, Ryan J.

AU - Bebawy, John Patrick F

AU - Koski, Tyler Robert

AU - Koht, Antoun

AU - Gupta, Dhanesh K.

AU - Avram, Michael J

AU - Zeeni, Carine

AU - Gould, Robert W.

AU - Hemmer, Laura B

AU - Sugrue, Patrick A.

AU - McClendon, Jamal

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background: Multilevel spine fusion surgery for adult deformity correction is associated with significant blood loss and coagulopathy. Tranexamic acid reduces blood loss in high-risk surgery, but the efficacy of a low-dose regimen is unknown. Methods: Sixty-one patients undergoing multilevel complex spinal fusion with and without osteotomies were randomly assigned to receive low-dose tranexamic acid (10 mg/kg loading dose, then 1 mg·kg−1·hr−1 throughout surgery) or placebo. The primary outcome was the total volume of red blood cells transfused intraoperatively. Results: Thirty-one patients received tranexamic acid, and 30 patients received placebo. Patient demographics, risk of major transfusion, preoperative hemoglobin, and surgical risk of the 2 groups were similar. There was a significant decrease in total volume of red blood cells transfused (placebo group median 1460 mL vs. tranexamic acid group 1140 mL; median difference 463 mL, 95% confidence interval 15 to 914 mL, P = 0.034), with a decrease in cell saver transfusion (placebo group median 490 mL vs. tranexamic acid group 256 mL; median difference 166 mL, 95% confidence interval 0 to 368 mL, P = 0.042). The decrease in packed red blood cell transfusion did not reach statistical significance (placebo group median 1050 mL vs. tranexamic acid group 600 mL; median difference 300 mL, 95% confidence interval 0 to 600 mL, P = 0.097). Conclusions: Our results support the use of low-dose tranexamic acid during complex multilevel spine fusion surgery to decrease total red blood cell transfusion.

AB - Background: Multilevel spine fusion surgery for adult deformity correction is associated with significant blood loss and coagulopathy. Tranexamic acid reduces blood loss in high-risk surgery, but the efficacy of a low-dose regimen is unknown. Methods: Sixty-one patients undergoing multilevel complex spinal fusion with and without osteotomies were randomly assigned to receive low-dose tranexamic acid (10 mg/kg loading dose, then 1 mg·kg−1·hr−1 throughout surgery) or placebo. The primary outcome was the total volume of red blood cells transfused intraoperatively. Results: Thirty-one patients received tranexamic acid, and 30 patients received placebo. Patient demographics, risk of major transfusion, preoperative hemoglobin, and surgical risk of the 2 groups were similar. There was a significant decrease in total volume of red blood cells transfused (placebo group median 1460 mL vs. tranexamic acid group 1140 mL; median difference 463 mL, 95% confidence interval 15 to 914 mL, P = 0.034), with a decrease in cell saver transfusion (placebo group median 490 mL vs. tranexamic acid group 256 mL; median difference 166 mL, 95% confidence interval 0 to 368 mL, P = 0.042). The decrease in packed red blood cell transfusion did not reach statistical significance (placebo group median 1050 mL vs. tranexamic acid group 600 mL; median difference 300 mL, 95% confidence interval 0 to 600 mL, P = 0.097). Conclusions: Our results support the use of low-dose tranexamic acid during complex multilevel spine fusion surgery to decrease total red blood cell transfusion.

KW - Complex spine fusion

KW - Tranexamic acid

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DO - 10.1016/j.wneu.2017.11.070

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SN - 1878-8750

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