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. 2022 Jul 8;23(1):651.
doi: 10.1186/s12891-022-05604-2.

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

Iryna Ivasyk  1 , Abhinaba Chatterjee  1 , Catherine Jordan  2 , Matthew T Geiselmann  3 , Peter S Chang  4 , Hooman Kamel  5 , Sariah Khormaee  6
Affiliations

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

Iryna Ivasyk et al. BMC Musculoskelet Disord. .

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.

Keywords: Antifibrinolytic; Pediatric; Spinal fusion; Tranexamic acid; Txa.

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Conflict of interest statement

Ms. Ivasyk has no disclosures, Mr. Chatterjee has no disclosures, Ms. Jordan has no disclosures, Mr. Geiselmann has no disclosures, Dr. Chang has no disclosures, Dr. Kamel serves as a PI for the NIH-funded ARCADIA trial (NINDS U01NS095869) which receives in-kind study drug from the BMS-Pfizer Alliance for Eliquis® and ancillary study support from Roche Diagnostics, serves as Deputy Editor for JAMA Neurology, serves as a steering committee member of Medtronic’s Stroke AF trial (uncompensated), and serves on an endpoint adjudication committee for a trial of empagliflozin for Boehringer-Ingelheim, Dr. Khormaee has no disclosures.

Figures

Fig. 1
Fig. 1
Chemical structures of glycine, an excitatory neurotransmitter and TXA
Fig. 2
Fig. 2
Diagnoses of pediatric spine fusion patients associated with surgical admission
See this image and copyright information in PMC

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