Optimal dose of tranexamic acid to prevent bleeding and to decrease transfusion demand in adolescent idiopathic scoliosis patients undergoing operative treatment
Keywords:High dose, low dose, tranexamic acid, blood loss, blood transfusion
Tranexamic Acid is an anti-fibrinolytic agent that has been studied previously to show the effect inreducing blood loss in major surgery. However, the dosage of the tranexamic acid has not been established.
This is a prospective single-center double blind randomized study and was performed in the UKM Medical Centre. Total of thirty-six patients with Adolescence Idiopathic Scoliosis was consented and eligible to join the study. The patients were divided into two groups of eighteen patients and each group was given different doses of tranexamic acid. Blood investigation of hemoglobin, hematocrit, platelets, fibrinogen and D-dimer was conductedfor analysis, and blood loss perioperatively and blood transfusion provided were recorded and compared.
There was significant difference in blood loss and blood transfusion between the two groups. The group with high dose of tranexamic acid (50mg/kg) has less blood loss (20%) compared to the group with low dose (25mg/kg). The high dose group also showed reduced risk of blood transfusion (66%) compared to the low dose group. There was no significant difference between the two groups on the level of hemoglobin, hematocrit and platelets post-operatively. There was also no significant effect of tranexamic acid on fibrinogen and D-dimer that were assessedpre-operatively and postoperatively. No signs of reducing level of fibrin degradation products after bolus administration of tranexamic acid.
High dose administration of tranexamic acid showed lower blood loss, hence lowering the demand of blood
transfusion compared to the low dose.
Gill JB, Chin Y, Levin A, Feng D. The use of antifibrinolytic agents in spine surgery: A meta-analysis. J Bone Jt Surg - Ser A. 2008;90(11):2399–407.
Elwatidy S, Jamjoom Z, Elgamal E, Zakaria a, Turkistani a, El-Dawlatly a. Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebo-controlled study. Spine (Phila Pa 1976) [Internet]. 2008;33(24):2577– 80. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/19011538
Grant J a, Howard J, Luntley J, Harder J, Aleissa S, Parsons D. Perioperative blood transfusion requirements in pediatric scoliosis surgery: the efficacy of tranexamic acid. J Pediatr Orthop [Internet]. 2009;29(3):300–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19305284
Neilipovitz DT, Murto K, Hall L, Barrowman NJ, Splinter WM. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg. 2001;93(1):82–7.
Sethna NF, Zurakowski D, Brustowicz RM, Bacsik J, Sullivan LJ, Shapiro F. Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology. 2005;102(4):727–32.
Ozier Y,Bellamy L. Pharmacological agents: antifibrinolytics and desmopressin. Best Practice & Research Clinical Anaesthesiology 24 (2010) 107-119.