• Louanne M Carabini, Natalie C Moreland, Ryan J Vealey, John F Bebawy, Tyler R Koski, Antoun Koht, Dhanesh K Gupta, Michael J Avram, and Northwestern High Risk Spine Group.
• Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: l-carabini@northwestern.edu.
• World Neurosurg. 2018 Feb 1; 110: e572-e579.

BackgroundMultilevel spine fusion surgery for adult deformity correction is associated with significant blood loss and coagulopathy. Tranexamic acid reduces blood loss in high-risk surgery, but the efficacy of a low-dose regimen is unknown.MethodsSixty-one patients undergoing multilevel complex spinal fusion with and without osteotomies were randomly assigned to receive low-dose tranexamic acid (10 mg/kg loading dose, then 1 mg·kg-1·hr-1 throughout surgery) or placebo. The primary outcome was the total volume of red blood cells transfused intraoperatively.ResultsThirty-one patients received tranexamic acid, and 30 patients received placebo. Patient demographics, risk of major transfusion, preoperative hemoglobin, and surgical risk of the 2 groups were similar. There was a significant decrease in total volume of red blood cells transfused (placebo group median 1460 mL vs. tranexamic acid group 1140 mL; median difference 463 mL, 95% confidence interval 15 to 914 mL, P = 0.034), with a decrease in cell saver transfusion (placebo group median 490 mL vs. tranexamic acid group 256 mL; median difference 166 mL, 95% confidence interval 0 to 368 mL, P = 0.042). The decrease in packed red blood cell transfusion did not reach statistical significance (placebo group median 1050 mL vs. tranexamic acid group 600 mL; median difference 300 mL, 95% confidence interval 0 to 600 mL, P = 0.097).ConclusionsOur results support the use of low-dose tranexamic acid during complex multilevel spine fusion surgery to decrease total red blood cell transfusion.Copyright © 2017 Elsevier Inc. All rights reserved.

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