Evaluation of the safety of tranexamic acid use in pediatric patients undergoing spinal fusion surgery: a retrospective comparative cohort study.

TitleEvaluation of the safety of tranexamic acid use in pediatric patients undergoing spinal fusion surgery: a retrospective comparative cohort study.
Publication TypeJournal Article
Year of Publication2022
AuthorsIvasyk I, Chatterjee A, Jordan C, Geiselmann MT, Chang PS, Kamel H, Khormaee S
JournalBMC Musculoskelet Disord
Volume23
Issue1
Pagination651
Date Published2022 Jul 08
ISSN1471-2474
KeywordsAdolescent, Antifibrinolytic Agents, Blood Loss, Surgical, Child, Cohort Studies, Humans, Pulmonary Embolism, Retrospective Studies, Scoliosis, Seizures, Spinal Fusion, Stroke, Tranexamic Acid
Abstract

BACKGROUND: Pediatric spinal fusion may be associated with significant intraoperative blood loss, leading to complications from transfusion, hypoperfusion and coagulopathy. One emerging strategy to mediate these risks is by utilization of the anti-fibrinolytic agent tranexamic acid (TXA). However, concerns regarding potential adverse reactions, specifically postoperative seizures and thrombotic events, still exist. To assess these risks, we examined the perioperative morbidity of TXA use in a large national database.

METHODS: Retrospective data from pediatric patients (age 18 years or younger), discharged between January 2013 to December 2015, who underwent primary or revision posterior spinal fusions, was collected from the Premier Perspective database (Premier, Charlotte, NC). Patients were stratified by TXA use and records were assessed for complications of new onset seizures, strokes, pulmonary embolisms (PE) or deep vein thromboses (DVT) occurring during the perioperative period.

RESULTS: In this cohort of 2,633 pediatric patients undergoing posterior spinal fusions, most often to treat adolescent idiopathic scoliosis, 15% received TXA. Overall, adverse events were rare in this patient population. The incidence of seizure, stoke, PE, or DVT in the control group was 0.54% (95% CI, 0.31% to 0.94%) and not significantly different from the TXA group. There was no significant difference in the incidence of DVTs, and no incidences of stroke in either group. There were no new-onset seizures or PEs in patients who received TXA.

CONCLUSIONS: The use of TXA was not associated with an increased risk of adverse events including seizure, stroke, PE, and DVT. Our findings support the safety of TXA use in pediatric patients undergoing spinal fusion surgery.

DOI10.1186/s12891-022-05604-2
Alternate JournalBMC Musculoskelet Disord
PubMed ID35804327
PubMed Central IDPMC9264589

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