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PEDIATRIC ANESTHESIA

A Randomized Trial of Tranexamic Acid to Reduce Blood Transfusion for Scoliosis Surgery

David T. Neilipovitz, FRCPC^*, Kimmo Murto, FRCPC, Leslie Hall, FRCPC, Nicholas J. Barrowman, PhD, and William M. Splinter, FRCPC

Departments of *Anaesthesiology and Critical Care, The Ottawa Hospital, Ottawa, Ontario; Department of Anaesthesia, Children’s Hospital of Eastern Ontario, Ottawa, Ontario; and Thomas C. Chalmers Centre for Systematic Reviews, Children’s Hospital of Eastern Ontario, Ottawa, Ontario

Address correspondence and reprint requests to Dr. David T. Neilipovitz, Department of Anesthesiology, The Ottawa Hospital—Civic Campus, 1053 Carling Ave., Ottawa, Ontario K1Y 4E9. Address e-mail to dneilipovitz{at}ottawahospital.on.ca

Pediatric patients who undergo posterior spinal fusion surgery to correct scoliosis often require multiple blood transfusions. Tranexamic acid is a synthetic antifibrinolytic drug that reduces transfusion requirements in cardiac surgery and total knee arthroplasty. We evaluated the efficacy of prophylactic tranexamic acid to reduce perioperative blood transfusion requirements in a prospective, double-blinded, placebo control study. Forty patients, 9–18 yr of age, were randomized to either tranexamic acid (initial dose of 10 mg/kg and infusion of 1 mg · kg^-1 · h^-1) or placebo (isotonic saline). Perioperative management was standardized. A uniform transfusion threshold for noncell saved red blood cells was 7.0 g/dL. The total amount of blood transfused in the perioperative period was significantly reduced in the Tranexamic group (P = 0.045). No thrombotic complications were detected in either group. The administration of prophylactic tranexamic acid in patients with scoliosis undergoing posterior spinal fusion surgery has the potential to reduce perioperative blood transfusion requirements.

Implications: The administration of prophylactic tranexamic acid in patients with scoliosiswho are undergoing posterior spinal fusion surgery has the potential to reduceperioperative blood transfusion requirements.

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