Comparison of Efficacy of High versus Low Dose Tranexamic Acid in Reducing, Perioperative Blood Loss and Transfusion Requirements, in Adolescent Idiopathic Scoliosis - An Analytical Study from Retrospective Data Evaluation

Author(s): Ashok Ramakrishnan1 , Dhanya Vijayan2 , Jayakumar Christudas3

BACKGROUND Adolescent idiopathic scoliosis (AIS) is defined as a lateral deviation of the spine associated with vertebral rotation in an otherwise healthy person. We wanted to determine if a high dose of tranexamic acid was more efficacious than a low dose in reducing blood loss in adolescent patients undergoing corrective surgery for idiopathic scoliosis, determine the difference in transfusion requirements between the two groups and elucidate the safety profile of high dose tranexamic acid in paediatric patients. METHODS This was an analytical study from retrospective data analysis of 60 adolescent patients who underwent scoliosis correction by posterior spinal fusion by a single team of two surgeons in our institution. Group 1 received injection tranexamic acid 10 mg/Kg bolus dose completed 15 minutes before incision followed by infusion at the rate of 1 mg/Kg/hr continued till the end of surgery. Group 2 received tranexamic acid bolus dose of 50 mg/Kg followed by infusion at the rate of 15 mg/Kg/hr. Estimated blood loss and transfusion requirements were compared between the two groups. Data on patient demographics such as age, weight, gender and ASA status were collected. Duration of surgery (skin incision to completion of skin closure) was also noted. Outcome parameters included intraoperative blood loss and the volume of transfused blood. RESULTS All 60 patients had similar baseline characteristics and a common clinical diagnosis of adolescent idiopathic scoliosis. Compared to group 1, blood loss was significantly reduced in group 2. (1018.33 mL v/s 491.67 ml, p-value = 0.0001). Also, there was a statistically significant reduction in intraoperative and postoperative transfusion requirements in the high dose group (337.5 mL v/s 597.5 ml, p-value=0.0001). No adverse effects attributable to tranexamic acid, including thromboembolic events, were observed in either group of patients. CONCLUSIONS High dose tranexamic acid was found to be a safe, economical and effective intervention to reduce blood loss in idiopathic scoliosis corrective surgery.