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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.

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. [ABSTRACT FROM AUTHOR]

Background: Tranexamic acid (TXA) is effective in reduction of hemorrhage after major surgical procedures. In total joint replacement it is commonly administered intravenously. Despite various studies regarding the safety of its antifibrinolytic effect there are contraindications for systemic use. In total knee arthroplasty (TKA) TXA can also be administered intraarticular. However, there is a lack of studies focusing on dosage, effectiveness and complications of this local treatment. This study aimed to evaluate if blood loss and transfusion rate can be reduced in primary TKA by local application of TXA.Methods: We included a total of 202 consecutive primary, unilateral TKA patients, 101 without and 101 with intraartricular application of 2 g TXA. Surgery was conducted after a standardized protocol. Blood loss, transfusion and complication rates were evaluated until three months after surgery. Blood loss was estimated using the hematocrit-value (Hk) prior and five days after surgery by Rosenecher's and Mercuriali's formula.Results: By the use of TXA a significant reduction of blood loss (Rosencher average 1220 ml vs 1900 ml, Mercuriali average 430 ml vs 700 ml p < 0,001) and transfusion rate (0% vs 24.75% of patients, p < 0,001) was observed. There were no differences regarding complication rates. Due to the lower cost of TXA compared to applied erythrocyte concentrates a side effect of the treatment was a cost reduction of € 1.609 within this cohort.Conclusions: The intraarticular application of 2 g TXA resulted in a significant reduction of blood loss and transfusion rate after primary TKA without increased complication rates. This method therefore seems to be a safe and cost effective instrument to reduce perioperative blood loss. However, it has to be considered that this is an off-label use. [ABSTRACT FROM AUTHOR]