Use of tranexamic acid for controlling bleeding in thoracolumbar scoliosis surgery with posterior instrumentation

• Published in: Revista brasileira de ortopedia 2015-03, Vol.50 (2), p.226-231
• Main Authors: da Rocha, Vinícius Magno, de Barros, Alderico Girão Campos, Naves, Cleiton Dias, Gomes, Nayara Lopes, Lobo, Julie Calixto, Villela Schettino, Luís Cláudio, da Silva, Luís Eduardo Carelli Teixeira
• Format: Article
• Language: English
• Subjects: Blood transfusion; Duration of bleeding; Escoliose; Escoliose/cirurgia; Original; ORTHOPEDICS; Scoliosis/surgery; Tempo de sangramento; Tranexamic acid; Transfusão de sangue; Ácido tranexâmico
• ISSN: 2255-4971; 1982-4378; 2255-4971
• DOI: 10.1016/j.rboe.2015.03.007

Scoliosis surgery involves major blood loss and frequently requires blood transfusion. The cost and risks involved in using allogeneic blood have motivated investigation of methods capable of reducing patients’ bleeding during operations. One of these methods is to use antifibrinolytic drugs, and tranexamic acid is among these. The aim of this study was to assess the use of this drug for controlling bleeding in surgery to treat idiopathic scoliosis. This was a retrospective study in which the medical files of 40 patients who underwent thoracolumbar arthrodesis by means of a posterior route were analyzed. Of these cases, 21 used tranexamic acid and were placed in the test group. The others were placed in the control group. The mean volumes of bleeding during and after the operation and the need for blood transfusion were compared between the two groups. The group that used tranexamic acid had significantly less bleeding during the operation than the control group. There was no significant difference between the groups regarding postoperative bleeding and the need for blood transfusion. Tranexamic acid was effective in reducing bleeding during the operation, as demonstrated in other studies. The correlation between its use and the reduction in the need for blood transfusion is multifactorial and could not be established in this study. We believe that tranexamic acid may be a useful resource and that it deserves greater attention in randomized double-blind prospective series, with proper control over variables that directly influence blood loss. A cirurgia de escoliose envolve elevada perda sanguínea e necessita frequentemente de hemotransfusão. O custo e os riscos envolvidos no uso do sangue alogênico têm motivado pesquisas de métodos capazes de reduzir o sangramento operatório nos pacientes. Um desses métodos é o uso de drogas antifibrinolíticas, entre as quais está o ácido tranexâmico (ATX). O objetivo deste estudo foi verificar o uso dessa droga no controle do sangramento em cirurgias de escoliose idiopática. Estudo retrospectivo no qual foram analisados os prontuários de 40 pacientes submetidos à artrodese toracolombar por via posterior. Desses, apenas 21 usaram o ATX e foram relacionados no grupo teste. Os demais foram relacionados no grupo controle. Foram comparadas as médias de sangramento per e pós-operatório e a necessidade de hemotransfusão entre os dois grupos. O grupo que usou o ATX teve sangramento peroperatório significativamente menor do que o