328 - Efficacy Antifibrinolytics on Surgical Bleeding in Spine Surgery: A Me...

#328 Efficacy Antifibrinolytics on Surgical Bleeding in Spine Surgery: A Meta-analysis

Biologic Therapies

Poster Presented by: T. Cheriyan


T. Cheriyan (1)
S.P. Maier (2)
K.M. Bianco (1)
K. Slobodyanyuk (1)
V. Lafage (2)
F. Schwab (1)
B.S. Lonner (1)
T.J. Errico (1)

(1) New York University School of Medicine, New York, NY, United States
(2) NYU Hospital for Joint Diseases, Orthopaedic Surgery, New York, NY, United States


Summary: A randomized, double-blinded, placebo controlled comparison of tranexamic acid (TXA) and aminocaproic acid (EACA) in reducing blood loss in spine surgery. TXA and EACA were found to reduce blood loss relative to placebo, with no difference between the medications.

Introduction: Adult spinal deformity (AD) surgery usually involves substantial blood loss The antifibrinolytics TXA and EACA have been shown to improve hemostasis in large blood loss surgeries. This study aimed to provide high-quality evidence regarding the relative effectiveness of TXA, EACA and placebo in reducing blood loss and transfusions in spine surgery.

Methods: A prospective, randomized, double-blinded comparison of TXA, EACA and placebo used intra-operatively in patients with AD. Fifty two patients (ages 18-80) undergoing posterior spinal fusion of at least five levels for correction of AD were randomized to one of three treatment groups. Primary outcome measures included intraoperative and total blood loss (TBL) and transfusions. Secondary outcomes included change in hematocrit (Hct) and complications.

Results: For patients ≥50 of age, intraoperative blood loss in both TXA (1297±190 mL) and EACA groups (1278±223 mL) were less than control (2954±1116 mL, p=0.02) . Similarly, TBL was reduced in TXA or EACA compared to saline in patients age ≥50 (TXA 3085±1261 mL; EACA 2857±854 mL; control 5468±2881 mL; p=0.01).

For patients age < 50, there was no significant difference between the groups in terms of intraoperative and TBL.

Postoperative transfusion rates were statistically different between EACA (10%) and placebo (29%) (p=0.03), However there was no difference in intraoperative or postoperative transfusion rates between other groups.

No differences were noted in postoperative blood loss and change in Hct. One patient in each treatment arm was diagnosed with pulmonary embolism and one patient in the TXA group expired postoperatively; no thromboembolic events were reported for placebo.

Conclusion: TXA and EACA antifibrinolytics reduce blood loss in posterior adult deformity surgery in patients older than 50 years.