Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

Choi, Ho Cheol; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

doi:10.3340/jkns.2016.0505.004

Cited by 49 publications

(45 citation statements)

References 29 publications

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“…garding EBL, present study showed noticeably less EBL (1428 mL) compared to other studies (2371-5800 mL) 5,10,12,15,33) . Possible explanation of reduced EBL in current study is various blood conservation strategies in our institution including prompt bleeding control of decorticated bone and epidural space, intraoperative tranexamic acid infusion, and packing of gauze soaked with hemostatic agent to exposed surgical field 7) . The clinical outcome was favorable following PSO, which is concordant with the previous studies 2,33) .…”

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confidence: 80%

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Choi

Hyun

Kim

et al. 2020

J Korean Neurosurg Soc

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The purpose of this study was to report the results of pedicle subtraction osteotomy (PSO) for fixed sagittal imbalance with a minimum 2-year follow-up. Besides, authors evaluated the effect of adjunctive multi-level posterior column osteotomy (PCO) on achievement of additional lumbar lordosis (LL) during PSO. Methods : A total of 31 consecutive patients undergoing PSO for fixed sagittal imbalance were enrolled and analyzed. Correction angle of osteotomized vertebra (PSO angle) and other radiographic parameters including pelvic incidence (PI), thoracic kyphosis, LL, and sagittal vertical axis (SVA) were evaluated. Clinical outcomes and surgical complications were also assessed. Results : The mean age was 66.0±9.3 years with a mean follow-up period of 33.2±10.5 months. The mean number of fused segments was 9.6±3.5. The mean operative time and surgical bleeding were 475.9±160.5 minutes and 1406.1±932.1 mL, respectively. The preoperative SRS-22 score was 2.3±0.7 and improved to 3.2±0.8 at the final follow-up. The mean PI was 54.5±9.5°. LL was changed from 7.0±28.9° to-50.2±13.2°. The PSO angle was 33.7±13.5° (15.6±20.1° preoperatively,-16.1±19.4° postoperatively). The difference of correction angle of LL (57.3°) was greater about 23.6° than which of PSO angle (33.7°). SVA was improved from 189.5±93.0 mm, preoperatively to 12.4±40.8 mm, postoperatively. There occurred six, eight, and 14 cases of complications at intraoperative, early (<2 weeks) postoperative, and late (≥2 weeks) postoperative period, respectively. Additional operations were needed in nine patients due to the complications. Conclusion : PSO could provide satisfactory results for patients with fixed sagittal imbalance regarding clinical and radiographic outcomes. Additional correction of LL could be achieved with conduction of adjunctive multi-level PCOs during PSO.

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confidence: 80%

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Choi

Hyun

Kim

et al. 2020

J Korean Neurosurg Soc

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“…ABT is associated with potential hazardous complications and, thus, ABT avoidance with blood conservation methods recruitment should institute a fundamental priority. 5 PABD and intraoperative CS with Cell-saver systems are widely utilized for blood conservation in PIF for AIS in recent years. 3,9,10,12 However, much controversy exists in current literature about these methods' safety and effi cacy, in terms of decreasing ABT potentiality.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 The above are the major adverse effects of ABT, which is also considered to have a remarkable impact on socioeconomics being related to signifi cant costs. 5 ABT avoidance represents thus a veritable requisiteness. Various techniques have emerged in recent years in this fi eld.…”

Section: Introductionmentioning

confidence: 98%

“…Various techniques have emerged in recent years in this fi eld. 5 Preoperative assessment of hemoglobin (Hb) levels, abdominal compression prevention with proper patient positioning, hypotensive anesthesia and conduction of assiduous intraoperative hemostasis, as well as pharmacologic agents utilization may be implemented by spine surgeons. 5,6…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Blood Management in Posterior Instrumented Fusion for Adolescent Idiopathic Scoliosis: Original Study and Short Review of the Literature

et al. 2018

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Background: The potential hazards of allogeneic blood transfusion are well established in literature. Few things are known, however, about the results of combining different blood saving techniques and their results in avoiding allogeneic blood transfusion (ABT) in scoliosis surgery. Aim: To report specific results about utilization of preoperative autologous blood donation (PABD) and intraoperative blood-saver (BLDS) in conjunction, aiming to minimize the need for ABT. Materials and methods: Between 1989 and 2012, 107 patients underwent posterior instrumented fusion (PIF) for adolescent idiopathic scoliosis (AIS) correction. Retrospective evaluation was conducted. Patients were classified into two groups, according to the method utilized: group A with only allogeneic blood transfusion (ABT) and group B where PABD with BLDS intraoperatively was applied. Hematocrit and hemoglobin values were evaluated preoperatively, postoperatively, and at discharge. The variables we examined included also gender, age, levels fused and number of predeposited blood units, required transfused blood units (TBU), as well as ABT rates between the two groups. Results: More than 70% of the transfusions in both groups were needed intraoperatively. In group A, an average of 2.4 units per patient was transfused and ABT reached 76%. In contrast, in group B an average of 4.5 units per patient was transfused but ABT rate was only 7.3%, while the rest 92.7% was autologous blood. However, the wasted autologous blood reached 24.9%. Conclusions: Our results demonstrated that PABD with intraoperative cell salvage (CS) is associated with statistically significant ABT rates decrement but the combination of these methods cannot assure ABT avoidance.

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“…Insgesamt konnte in vielen Studien eine Reduktion des Blutverlusts durch den Einsatz von Antifibrinolytika nachgewiesen werden. Für die Gabe von Tranexamsäure sind in einigen retrospektiven [13] und prospektiven multizentrischen Studien [14] und Metaanalysen bei Korrekturspondylodesen [11,15] [17]. In einer weiteren RCT bei Patienten mit PLIF wurden 30 mg/kgKG als Bolus gefolgt von 2 mg/kgKG als kontinuierliche Infusion ein reduzierter Blutverlust nachgewiesen allerdings, ohne dass die Transfusionrate gesenkt wurde [18].…”

Section: Perioperatives Blutungsrisikounclassified

Perioperatives Management von Patienten mit gerinnungshemmenden Medikamenten in der Wirbelsäulenchirurgie

Gerlach

Lapp

2018

Die Wirbelsäule

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Zusammenfassung Einleitung Eine zunehmende Zahl von Patienten wird wegen degenerativer Erkrankungen der Wirbelsäule operativ behandelt. Der Einsatz gerinnungshemmender Medikamente nimmt zu. Beide Tatsachen bedingen, dass Patienten mit notwendigen Operationen an der Wirbelsäule und gerinnungshemmender Therapie Wirbelsäulenchirurgen vor Schwierigkeiten bei der Entscheidung über die perioperative Fortsetzung der Medikation, bzw. die Notwendigkeit einer Umstellung stellen. Material und Methoden Indikationen der Thrombozytenfunktionshemmung und oralen Antikoagulation, das perioperative Management von Patienten sowie die Praxis der medikamentösen Prophylaxe thromboembolischer Ereignisse bei wirbelsäulenchirurgischen Patienten werden auf der Basis einer aktuellen Literaturrecherche erörtert. Ergebnisse Im Allgemeinen ist die Datenlage relativ schwach und die Empfehlungen für die Wirbelsäulenchirurgie sind z. T. aus anderen Fachgebieten abgeleitet oder beruhen auf Erfahrungswissen. Für ASS als Monotherapie zur Sekundärprophylaxe existieren Daten, dass die kontinuierliche perioperative Fortsetzung ohne wesentlich erhöhtes Blutungsrisiko möglich ist. Das bisherige perioperative Bridging bei Patienten mit Vorhofflimmern (VHF) oder Zustand nach venösen thromboembolischen Ereignissen sollte nur bei Patienten mit hohem Risiko erfolgen. Bei Patienten mit mittlerem und niedrigem Risiko sollte nur eine übliche Thrombembolieprophylaxe erfolgen. Schlussfolgerungen Patienten mit gerinnungshemmenden Medikamenten sind Risikopatienten; zum einen wegen der Komorbidität, die eine Gerinnungshemmung erforderlich macht und zum anderen wegen der Notwendigkeit des perioperativen Managements. Die standardisierte Gerinnungsanamnese hilft Blutungskomplikationen zu vermeiden und Patienten mit gerinnungshemmenden Medikamenten zu identifizieren. Spontane Blutungen bei medikamentöser Gerinnungshemmung und perioperative Blutungskomplikationen bei wirbelsäulenchirurgischen Patienten sind mit einer hohen Morbidität und unter Umständen Mortalität assoziiert. Das perioperative Management von Patienten mit pharmakologischer Gerinnungshemmung in der Wirbelsäulenchirurgie ist aufgrund der Komplexität (neue Antikoagulanzien, Co-Morbidität, Alter der Patienten) eine interdisziplinäre Aufgabe, die mit den Kardiologen, Neurologen und Gefäßmedizinern gemeinsam erfolgen sollte. Auch wenn hier Möglichkeiten im perioperativen Umgang bei Patienten mit Gerinnungshemmern aufgezeigt werden, muss die Entscheidung nach Abwägen des individuellen Risiko/Nutzenverhältnisses erfolgen.

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Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

Cited by 49 publications

References 29 publications

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Perioperative Blood Management in Posterior Instrumented Fusion for Adolescent Idiopathic Scoliosis: Original Study and Short Review of the Literature

Perioperatives Management von Patienten mit gerinnungshemmenden Medikamenten in der Wirbelsäulenchirurgie

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