(804) The Efficacy of Antifibrinolytics in Adolescents Undergoing Scoliosis Surgery

Sunday, January 21, 2024

11:00 AM – 12:00 PM MT

Location: Connections Central - RST 12

First Author(s)

Katherine Hickey

Pediatric ICU Fellow
The Mount Sinai Hospital
New York

Co-Author(s)

MS

Morgan Smith

Pediatric Resident
New York Presbyterian Hospital - Weill Cornell Medical College
New York, NY
OK

Oliver Karam, MD, PhD,

Professor of Pediatrics (Critical Care Medicine); Chief of Pediatric Critical Care, Pediatrics
Yale School of Medicine
New Haven, Connecticut, United States
DF

David Faraoni, MD, PhD

MD
Texas Children's Hospital, United States
MD

Michelle Demetres, NA

Clinical Librarian
Weil Cornell, United States
VD

Vincent Duron, MD

MD
Morgan Stanley Children's Hospital, United States
YS

Yeu Sanz Wu, MD

MD
Morgan Stanely Children's Hospital, United States
Marianne Nellis, MD, MS

Associate Professor
New York-Presbyterian Hospital/Weill Cornell Medical College
New York, NY, United States

Introduction: Spinal fusion is commonly accompanied by substantial intra-operative blood loss. Antifibrinolytic therapies have been studied in pediatric cardiac surgery and have been shown to reduce blood loss and decrease the need for transfusions. We sought to determine if intraoperative administration of antifibrinolytics, including tranexamic acid (TXA), aminocaproic acid (EACA), or aprotinin decreases estimated blood loss during scoliosis surgery.

Methods: We conducted a systematic review and meta-analysis of three databases from inception to April 2023. Adult-only studies (mean age >21 years), non-human studies, and case series were excluded. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The estimated blood loss in the operating room was evaluated.

Results: A total of 38 studies including 4,459 patients were analyzed. Thirty-two studies were included. TXA compared to control resulted in a mean decrease in estimated blood loss of 424 mL (95% CI 274-575 mL) p< 0.001, EACA compared to control resulted in a mean decrease in estimated blood loss of 469 mL (95% CI 99-841 mL) p< 0.013, and aprotinin compared to control resulted in a mean decrease in estimated blood loss of 469 mL (95% CI 276-661 mL) p< 0.001. Four studies compared high dose TXA to low dose and resulted in a mean decrease in estimated blood loss of 43 mL for those receiving high dose TXA, but this did not achieve statistical significance. Six studies compared TXA to EACA and resulted in a mean decrease in estimated blood loss of 390 mL (95% CI 58-724 mL), p=0.02 for those receiving TXA.

Conclusions: TXA, EACA and aprotinin are potentially useful for decreasing intraoperative blood loss during pediatric scoliosis surgery. TXA may be more efficacious than EACA for reducing blood loss. High dose TXA may be more efficacious than low dose, but more studies are needed to achieve significance.