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A Comparison of Two Different Dosing Protocols for Tranexamic Acid in Posterior Spinal Fusion for Spinal Deformity: A Prospective, Randomized Trial

Kushagra Verma, MD, MS,1 Eitan Kohan, MD,2 Christopher P. Ames, MD,1 Dana L. Cruz, BS,3 Vedat Deviren, MD,1 Sigurd Berven, MD,1 Thomas J. Errico, MD3

1University of California - San Francisco, San Francisco, CA, 2Washington University in St. Louis, St. Louis, MO, 3NYU Hospital for Joint Disease, New York City, NY

Abstract

Background

Multilevel spinal fusions have typically been associated with significant blood loss. Previous studies have shown a reduction in blood loss with antifibrinolytics in both adolescent and adult spinal deformity patients. While this has been mirrored in other subspecialties as well, the dosing of TXA remains highly variable. To date, there remains a paucity of data guiding dosing for TXA in spine surgery and orthopedic surgery as a whole.

Methods/Design

One hundred and fifty patients from 3 institutions (50 each site) will be consecutively enrolled and randomized to either a high dose of TXA (50mg/kg loading followed by 20mg/kg hourly) or a lose dose (10mg/kg, then 1mg/kg hourly). Both surgeons and patients will be blinded to the treatment group. Primary outcomes will be perioperative blood loss, drain output, and transfusion rate. Secondary outcomes will be length of stay, complications, and overall cost.

Discussion

The primary goal of this study is to provide level-1 comparative data for two TXA dosing regimens in adult spinal deformity surgery. Management of blood loss remains a critical factor in reducing complications during spinal deformity surgery. The null hypothesis is that there is no difference between high- and low-dose TXA with respect to any of the primary or secondary outcomes.

keywords: 
tranexamic acid, TXA, antifibrinolytic, blood loss, dosing, spine, spinal fusion, Deformity
Volume 9 Article 65
doi: 
10.14444/2065