• Daniel J Johnson, Christine C Johnson, Susan M Goobie, Nina Nami, Joshua A Wetzler, Paul D Sponseller, and Steven M Frank.
• *Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions§Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD†Department of Orthopedic Surgery, Hospital of Special Surgery, New York, NY‡Department of Anesthesiology, Boston Children's Hospital, Boston, MA.
• J Pediatr Orthop. 2017 Dec 1; 37 (8): e552-e557.

BackgroundOur objective was to quantify blood loss and transfusion requirements for high-dose and low-dose tranexamic acid (TXA) dosing regimens in pediatric patients undergoing spinal fusion for correction of idiopathic scoliosis. Previous investigators have established the efficacy of TXA in pediatric scoliosis surgery; however, the dosing regimens vary widely and the optimal dose has not been established.MethodsWe retrospectively analyzed electronic medical records for 116 patients who underwent spinal fusion surgery for idiopathic scoliosis by a single surgeon and were treated with TXA. In total, 72 patients received a 10 mg/kg loading dose with a 1 mg/kg/h maintenance dose (low-dose) and 44 patients received 50 mg/kg loading dose with a 5 mg/kg/h maintenance dose (high-dose). Estimated blood loss and transfusion requirements were compared between dosing groups.ResultsPatient characteristics were nearly identical between the 2 groups. Compared with the low-dose TXA group, the high-dose TXA group had decreased estimated blood loss (695 vs. 968 mL, P=0.01), and a decrease in both intraoperative (0.3 vs. 0.9 units, P=0.01) and whole hospitalization (0.4 vs. 1.0 units, P=0.04) red blood cell transfusion requirements. The higher-dose TXA was associated with decreased intraoperative (P=0.01), and whole hospital transfusion (P=0.01) requirements, even after risk-adjustment for potential confounding variables.ConclusionsHigh-dose TXA is more effective than low-dose TXA in reducing blood loss and transfusion requirements in pediatric idiopathic scoliosis patients undergoing surgery.Level Of EvidenceLevel-III, retrospective cohort study.

22 keywords...

hide…