A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery

Pediatric patients who undergo posterior spinal fusion surgery to correct s coliosis often require multiple blood transfusions. Tranexamic acid is a sy nthetic antifibrinolytic drug that reduces transfusion requirements in card iac surgery and total knee arthroplasty. We evaluated the efficacy of proph ylactic tranexamic acid to reduce perioperative blood transfusion requireme nts in a prospective, double-blinded, placebo control study. Forty patients , 9 -18 yr of age, were randomized to either tranexamic acid (initial dose of 10 mg/kg and infusion of 1 mg.kg(-1).h(-1)) or placebo (isotonic saline) . Perioperative management was standardized. A uniform transfusion threshol d for noncell saved red blood cells was 7.0 g/dL. The total amount of blood transfused in the perioperative period was significantly reduced in the Tr anexamic group (P = 0.045). No thrombotic complications were detected in ei ther group. The administration of prophylactic tranexamic acid in patients with scoliosis undergoing posterior spinal fusion surgery has the potential to reduce perioperative blood transfusion requirements.