Efficacy of topical versus intravenous tranexamic acid in spinal deformity

To compare topical tranexamic acid versus intravenous tranexamic acid in reducing intra- and postoperative blood loss and transfusion rate in deformity patients.

We performed a retrospective cohort study with posterior fusion deformity patients, between 2009 and 2016. Patients were categorized in 4 groups: "No TXA" (n = 35) if the wound was packed with saline soaked sponges, "IV TXA" (n = 37) the patient received 20 mg/kg bolus at the beginning of the surgery followed by continuous infusion of 1 mg/kg/hr until closure, "Topical TXA" (n = 23) the wound was packed with sponges soaked in 6 g of TXA diluted in a 3 L saline solution, or "Combined TXA" (n = 86) the patient received both IV and topical TXA. The primary outcomes were total, intra- and postoperative blood loss, surgical time, postoperative Ht/Hb, transfusion rates, and duration of drain insertion.

A total of 181 patients were analyzed (78.6% F, 15.08 yo). No differences were found in total and intraoperative blood loss, surgical time, postoperative Ht/Ht, and transfusion rates. "Combined TXA" group had significantly less postoperative bleeding than "no TXA" group (p = 0.022). IV TXA patients (with o/without topical TXA) removed drains one day earlier than the no TXA group (p = 0.002). There were no complications related to the use of tranexamic acid.

There is significant decrease in postoperative bleeding in pediatric deformity patients with combined topical and IV tranexamic acid.