Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis
Objective This was a retrospective, cohort study investigating the efficacy and safety of continuous low-dose postoperative tranexamic acid (PTXA) on drain output and transfusion requirements following adult spinal deformity surgery. Methods One hundred forty-seven patients undergoing posterior inst...
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Korean Spinal Neurosurgery Society
2020-12-01
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Online Access: | http://www.e-neurospine.org/upload/pdf/ns-2040114-057.pdf |
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doaj-676e4be859ef4f7f98ce0200ee81030c2021-01-06T06:59:53ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912020-12-0117488889510.14245/ns.2040114.0571085Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort AnalysisLauren K. Dunn0Ching-Jen Chen1Davis G. Taylor2Kamilla Esfahani3Brian Brenner4Charles Luo5Thomas J. Buell6Sarah N. Spangler7Avery L. Buchholz8Justin S. Smith9Christopher I. Shaffrey10Edward C. Nemergut11Marcel E. Durieux12Bhiken I. Naik13 Department of Anesthesiology, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Anesthesiology, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Anesthesiology, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Anesthesiology, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Anesthesiology, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA Departments of Neurosurgery and Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA Department of Anesthesiology, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Anesthesiology, University of Virginia Health Science Center, Charlottesville, VA, USA Department of Anesthesiology, University of Virginia Health Science Center, Charlottesville, VA, USAObjective This was a retrospective, cohort study investigating the efficacy and safety of continuous low-dose postoperative tranexamic acid (PTXA) on drain output and transfusion requirements following adult spinal deformity surgery. Methods One hundred forty-seven patients undergoing posterior instrumented thoracolumbar fusion of ≥ 3 vertebral levels at a single institution who received low-dose PTXA infusion (0.5–1 mg/kg/hr) for 24 hours were compared to 292 control patients who did not receive PTXA. The cohorts were propensity matched based on age, sex, American Society of Anesthesiologist physical status classification, body mass index, number of surgical levels, revision surgery, operative duration, and total intraoperative TXA dose (n = 106 in each group). Primary outcome was 72-hour postoperative drain output. Secondary outcomes were number of allogeneic blood transfusions. Results There was no significant difference in postoperative drain output in the PTXA group compared to control (660 ±420 mL vs. 710 ±490 mL, p = 0.46). The PTXA group received significantly more crystalloid (6,100 ±3,100 mL vs. 4,600 ±2,400 mL, p < 0.001) and red blood cell transfusions postoperatively (median [interquartile range]: 1 [0–2] units vs. 0 [0–1] units; incidence rate ratio [95% confidence interval], 1.6 [1.2–2.2]; p = 0.001). Rates of adverse events were comparable between groups. Conclusion Continuous low-dose PTXA infusion was not associated with reduced drain output after spinal deformity surgery. No difference in thromboembolic incidence was observed. A prospective dose escalation study is warranted to investigate the efficacy of higher dose PTXA.http://www.e-neurospine.org/upload/pdf/ns-2040114-057.pdftranexamic acidfibrinolysisantifibrinolytic agentsblood loss |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lauren K. Dunn Ching-Jen Chen Davis G. Taylor Kamilla Esfahani Brian Brenner Charles Luo Thomas J. Buell Sarah N. Spangler Avery L. Buchholz Justin S. Smith Christopher I. Shaffrey Edward C. Nemergut Marcel E. Durieux Bhiken I. Naik |
spellingShingle |
Lauren K. Dunn Ching-Jen Chen Davis G. Taylor Kamilla Esfahani Brian Brenner Charles Luo Thomas J. Buell Sarah N. Spangler Avery L. Buchholz Justin S. Smith Christopher I. Shaffrey Edward C. Nemergut Marcel E. Durieux Bhiken I. Naik Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis Neurospine tranexamic acid fibrinolysis antifibrinolytic agents blood loss |
author_facet |
Lauren K. Dunn Ching-Jen Chen Davis G. Taylor Kamilla Esfahani Brian Brenner Charles Luo Thomas J. Buell Sarah N. Spangler Avery L. Buchholz Justin S. Smith Christopher I. Shaffrey Edward C. Nemergut Marcel E. Durieux Bhiken I. Naik |
author_sort |
Lauren K. Dunn |
title |
Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis |
title_short |
Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis |
title_full |
Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis |
title_fullStr |
Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis |
title_full_unstemmed |
Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis |
title_sort |
postoperative low-dose tranexamic acid after major spine surgery: a matched cohort analysis |
publisher |
Korean Spinal Neurosurgery Society |
series |
Neurospine |
issn |
2586-6583 2586-6591 |
publishDate |
2020-12-01 |
description |
Objective This was a retrospective, cohort study investigating the efficacy and safety of continuous low-dose postoperative tranexamic acid (PTXA) on drain output and transfusion requirements following adult spinal deformity surgery. Methods One hundred forty-seven patients undergoing posterior instrumented thoracolumbar fusion of ≥ 3 vertebral levels at a single institution who received low-dose PTXA infusion (0.5–1 mg/kg/hr) for 24 hours were compared to 292 control patients who did not receive PTXA. The cohorts were propensity matched based on age, sex, American Society of Anesthesiologist physical status classification, body mass index, number of surgical levels, revision surgery, operative duration, and total intraoperative TXA dose (n = 106 in each group). Primary outcome was 72-hour postoperative drain output. Secondary outcomes were number of allogeneic blood transfusions. Results There was no significant difference in postoperative drain output in the PTXA group compared to control (660 ±420 mL vs. 710 ±490 mL, p = 0.46). The PTXA group received significantly more crystalloid (6,100 ±3,100 mL vs. 4,600 ±2,400 mL, p < 0.001) and red blood cell transfusions postoperatively (median [interquartile range]: 1 [0–2] units vs. 0 [0–1] units; incidence rate ratio [95% confidence interval], 1.6 [1.2–2.2]; p = 0.001). Rates of adverse events were comparable between groups. Conclusion Continuous low-dose PTXA infusion was not associated with reduced drain output after spinal deformity surgery. No difference in thromboembolic incidence was observed. A prospective dose escalation study is warranted to investigate the efficacy of higher dose PTXA. |
topic |
tranexamic acid fibrinolysis antifibrinolytic agents blood loss |
url |
http://www.e-neurospine.org/upload/pdf/ns-2040114-057.pdf |
work_keys_str_mv |
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