Antifibrinolytics can safely reduce blood loss in patients undergoing surgery for adolescent idiopathic scoliosis surgery, a study presented at IMAST 2011 has found.
The study, by Verma et al, reviewed the use of antifibrinolytics in adolescent idiopathic scoliosis surgery because the use of these drugs in this setting remains unclear — although, they have been shown to be effective at reducing intraoperative bleeding in several other surgical settings.
In this prospective, double-blind comparison, 119 patients were randomised to receive tranexamic acid (TXA; 35 patients), epsilon aminocaproic acid (EACA; 38 patients) or placebo (46 patients) during surgery. TXA was given at a loading dose of 10mg/kg followed by 1mg/kg-hr while EACA was given at a 10-fold higher dose. Data recorded included estimated blood loss, haematocrit, blood product usage, post-operative drain output, and total blood loss.
Verma et al found that between the three groups, there was no significance difference in transfusion rate, operative time, levels fused, or anchors placed. Compared with placebo, after controlling for arterial blood pressure during exposure, TXA reduced estimated blood loss, reduced total blood loss, reduced total blood loss per anchor, and reduced total blood loss per degree of curve. EACA reduced estimated blood loss per anchor, compared with placebo, in patients with reduced mean exposure mean arterial blood pressure. Neither of the active treatments reduced estimated blood loss or total blood loss in patients with mean exposure mean arterial blood pressure under >75mmHg, nor did either of them reduce drain ouput. However, TXA was associated with reduced drain output per anchor and degree of curve compared with placebo.
The authors concluded: “Our results suggest that antifibrinolytics safely reduce blood loss in patients with adolescent idiopathic scoliosis. However, transfusion rates were not impacted. Mean arterial blood pressure during surgical exposure appears to be a critical factor in the efficacy of antifibrinolytic action.”