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Antifibrinolytic agents reduce blood loss during pediatric vertebral column resection procedures

Peter O Newton1, Tracey P Bastrom, John B Emans

  • 1Rady Children's Hospital, San Diego, CA, USA. pnewton@rchsd.org

Spine
|August 9, 2012
PubMed

Insights

Antifibrinolytic (AF) agents like tranexamic acid (TXA) significantly reduce blood loss during pediatric vertebral column resection (VCR). TXA demonstrated a notable decrease in estimated blood loss (EBL) compared to no AF use.

Area of Science:

  • Pediatric Orthopedics
  • Surgical Hemorrhage Control
  • Pharmacology

Background:

  • Vertebral column resection (VCR) in pediatric patients can lead to significant intraoperative blood loss.
  • Effective strategies to mitigate blood loss during VCR are crucial for patient safety and outcomes.

Purpose of the Study:

  • To evaluate the impact of intraoperative antifibrinolytic (AF) agents on blood loss during VCR procedures in pediatric patients.
  • To compare the efficacy of different AF agents, including tranexamic acid (TXA), aminocaproic acid, and aprotinin, in reducing blood loss.

Main Methods:

  • A retrospective multicenter review of 147 pediatric patients (<21 years) undergoing VCR for spinal deformity correction.
  • Estimated blood loss (EBL) was calculated as a percentage of blood volume (%BV) and normalized per vertebral level excised (%BV/level).
  • Analysis of covariance was used to compare EBL between groups receiving no AF, TXA, or aprotinin, controlling for deformity magnitude.

Main Results:

  • The overall normalized EBL was 41% ± 39%, with significant variability.
  • Patients receiving TXA (30% ± 34%) or aprotinin (32% ± 24%) had significantly lower normalized EBL compared to those receiving no AF (52% ± 37%).
  • The efficacy of AF agents varied across participating centers.

Conclusions:

  • Intraoperative antifibrinolytic agents, particularly TXA, can significantly reduce blood loss during pediatric VCR.
  • While aprotinin also showed efficacy, it has since been withdrawn from the market.
  • TXA offers a viable option for managing blood loss in these complex spinal surgeries, though site-specific effects warrant consideration.
Abstract

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