Tranexamic Acid Reduces PRBC Transfusion after Posterior Spine Surgeryfor Idiopathic Scoliosis from the Operating Room to Post-Operative DayFour

Background: Tranexamic acid (TXA), an antifibrinolytic, has been shown to reduce blood loss and packed red blood cell (PRBC) transfusion during surgery for patients with idiopathic scoliosis undergoing posterior spine fusion. Our goal was to determine if intra-operative TXA administration is also associated with reduced PRBC transfusion after the completion of surgery through post-operative day (POD) four in this patient population. Methods: A retrospective review of 230 patients undergoing single stage PSF for idiopathic scoliosis at a freestanding children’s hospital was undertaken. Subjects were grouped according to intra-operative administration of TXA (n=70) or no TXA (n=160). The primary outcome was PRBC transfusion following surgery to post-operative day (POD) four. Secondary outcomes included estimated blood loss, intra-operative PRBC transfusion, postoperative hematocrit, and hematocrit prior to PRBC transfusion. Results: The age, gender, number of spinal levels fused, surgical time, and number of cases by each surgeon were not significantly different between the groups. Following surgery to POD four, 16% of the TXA group received PRBC transfusion, compared to 39% in the non TXA group (p<0.001). The estimated blood loss was lower in the TXA group (median 437 ml TXA group vs. 550 ml Non TXA group, p=0.01). The percentage of patients receiving intra-operative PRBC transfusion was not significantly different between the two groups but the volume of PRBC transfused was lower in the TXA group. There were no significant differences between groups with regards to first hematocrit following surgery or hematocrit prior to transfusion. The lowest hematocrit in patients not receiving PRBC transfusion was higher in the TXA group (27.7%) vs. the Non TXA group (25.6%) (p<0.001). Conclusion: Tranexamic acid significantly reduced the percentage of patients with idiopathic scoliosis receiving PRBC transfusion following posterior spine fusion following surgery to POD four. This association remained after controlling for several confounding variables.