Antifibrinolytic agents reduce blood loss during pediatric vertebral column resection procedures

Abstract

Study design: Retrospective multicenter review.

Objective: To evaluate the effect of intraoperative antifibrinolytic (AF) agents on blood loss associated with vertebral column resection (VCR) procedures for pediatric patients.

Summary of background data: VCR procedures may be associated with substantial blood loss.

Methods: A multicenter review of 147 patients (aged <21 yr) who underwent VCR as part of their spinal deformity correction was conducted. Estimated blood loss (EBL) was calculated as percentage of blood volume (BV) (EBL/BV × 100), which was normalized on the basis of the number of vertebral levels removed (%BV/level). The use of AF agents was noted (tranexamic acid [TXA], aminocaproic acid, aprotinin, none) and based on surgeons' choice. EBL was compared using analysis of covariance (controlling for deformity magnitude) (P < 0.05).

Results: Average preoperative major deformity (kyphosis or scoliosis) was 97° ± 31°. The average number of levels excised was 1.6 (range, 1-5). Total EBL averaged 1317 mL (range, 50-6026 mL). Eleven patients were excluded: 7 with incomplete data and 4 who received aminocaproic acid (too few to compare). This resulted in 136 cases; 64 with no AF, 42 received TXA, and 30 received aprotinin. Overall %BV/level EBL was 41% ± 39% (range, 6%-162%) and was significantly higher in the no-AF group (52% ± 37%) than the TXA (30% ± 34%; P < 0.01) and aprotinin (32% ± 24%; P < 0.05) groups. The effect of the AFs varied by site.

Conclusion: EBL associated with VCR was highly variable and in many cases exceeded the patient's BV. AF agents were not routinely used and we had insufficient data to assess the efficacy of aminocaproic acid. Both aprotinin and TXA resulted in less EBL than when no AF was used; however, the effect of the reduction varied by site. Aprotinin has since been removed from the market. When normalized to patient size and levels excised, the use of TXA resulted in a reduction in intraoperative EBL.