Comparison of the Coagulation Profile of Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion With and Without Tranexamic Acid

Publication date: November 2019Source: Spine Deformity, Volume 7, Issue 6Author(s): Patrick Bosch, Tanya S. Kenkre, Doreen Soliman, Joanne A. Londino, Natalie E. NovakAbstractStudy DesignProspective, observational cohort study.ObjectiveTo improve the understanding of coagulation and bleeding mechanisms during spinal deformity surgery.Summary of Background DataFibrinolysis is the mechanism of bleeding for adolescent idiopathic scoliosis undergoing posterior spinal fusion. Antifibrinolytics have become popular; however, literature to support their use remains mixed. The mechanism of action has not been demonstrated.MethodsThe coagulation profile of 88 adolescent idiopathic scoliosis patients undergoing posterior spinal fusion was analyzed. Standard coagulation laboratory investigations and thromboelastograms were drawn hourly through the case. Fifty-eight patients received no antifibrinolytic, whereas 30 patients received tranexamic acid by standardized protocol. The coagulation parameters, estimated blood loss, and transfusion requirements were compared in the two groups.ResultsThe two cohorts had no differences in demographic or surgical characteristics. Mean age was 13.6 years, 83% were female, a mean of 11.1 levels were fused, and the mean duration of surgery was 209 minutes. The tranexamic acid cohort did not demonstrate a decrease in blood loss. The transfusion rate, however, dropped from 47% in the non–tranexamic acid cohort to 23% in the tranexamic acid cohort (p ...
Source: Spine Deformity - Category: Orthopaedics Source Type: research

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ConclusionWe report the trend of SRS podium presentation. We hope that these data will be of interest to our members as a representation of where interests have been for the SRS, and these data can be the foundation of an SRS AM abstract registry for spinal deformity research.
Source: Spine Deformity - Category: Orthopaedics Source Type: research
A previous study examined the short-term (2-year) outcomes of a short fusion strategy for Lenke type 5C curves. This strategy had a little less correction rate with no difference in coronal and sagittal balance and SRS-22 scores to those of a conventional strategy and was superior in operative time and intraoperative bleeding. However, its effectiveness in longer follow-up periods was unknown.
Source: The Spine Journal - Category: Orthopaedics Authors: Tags: Clinical Study Source Type: research
Several types of coagulation disorders are reported in patients with Duchenne muscular dystrophy (DMD). Those include repeated reports of increased rate of bleeding-complications following scoliosis surgery but also reports of thromboembolic complications. Personalized survey-links were forwarded to 682 registered patients with a genetically confirmed diagnosis of DMD via the German DMD-registry of the Treat-NMD-network. Data on the degree of mobility, disposition to hematoma, epistaxis and gum bleeding, occurrence of postsurgical hemorrhage, stroke, deep vein thrombosis, cardiac thromboembolism, long-term medication and a...
Source: Neuromuscular Disorders - Category: Neurology Authors: Source Type: research
A first-of-its-kind FDA approval represents a major win for Zimmer Biomet and, most importantly, the field of scoliosis treatment. Called The Tether – Vertebral Body Tethering System, the device is intended to treat growing children and adolescents whose spinal curves are approaching or have reached the range where surgical treatment is an option. It is intended to correct the most common form of scoliosis (idiopathic scoliosis) that has not responded to conservative treatment options, such as external bracing. “This decision takes an innovative surgical approach, vertebral body tetherin...
Source: MDDI - Category: Medical Devices Authors: Tags: Orthopedics Implants Source Type: news
AbstractScoliosis is common in children with congenital heart disease (CHD) and may have deleterious effects on quality of life and hemodynamics. Relatively little is known about the outcomes of spinal fusion for scoliosis repair in children with complex CHD. We reviewed all cases of children with CHD undergoing first time spinal fusion excluding those with minor CHD between 1995 and 2015. Seventy-eight patients were identified and included in the study. 97.4% of patients included had undergone prior cardiac surgery and sixteen patients had single ventricle circulations. 17.9% of patients experienced a significant perioper...
Source: Mammalian Genome - Category: Genetics & Stem Cells Source Type: research
This case report describes a man in his late teens with scoliosis, muscular dystrophy, and severe osteoporosis who presented with a 3-month history of tracheal discomfort and light bleeding during tracheal aspiration.
Source: JAMA Otolaryngology - Head and Neck Surgery - Category: ENT & OMF Source Type: research
AbstractStudy designSystematic review and meta-analysis of randomised controlled trials.ObjectiveThe purpose of this study is to perform a systematic review and meta-analysis of antifibrinolytic agents for paediatric spine surgery.BackgroundBleeding is an important consideration in paediatric scoliosis surgery; blood loss leads directly to higher morbidity and mortality. Antifibrinolytics are an attractive non-invasive method of reducing bleeding as evidenced in arthroplasty, cardiac surgery and adult scoliosis surgery.MethodsA thorough database search of Medline, PubMed, EMBASE and Cochrane was performed according to PRIS...
Source: European Spine Journal - Category: Orthopaedics Source Type: research
Conclusions: This study supports the role of sagittal thoracic alignment in affecting EBL/BV in AIS surgery. Male patients with severe thoracic lordosis (T5-T12≤0 degree) are the highest risk group for intraoperative bleeding. These findings are helpful in predicting the intraoperative blood loss for patients with AIS undergoing posterior spinal fusion. In addition to sex and number of fused levels, decreased thoracic kyphosis is associated with increased blood loss. Level of Evidence: Level III—prognostic study.
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Spine Source Type: research
Abstract BACKGROUND: Children undergoing posterior spinal fusion experience high blood loss often necessitating transfusion. An appropriately activated coagulation system provides hemostasis during surgery, but pathologic dysregulation can cause progressive bleeding and increased transfusions. Despite receiving antifibrinolytics for clot stabilization, many patients still require transfusions. AIMS: We sought to examine the association of dilutional coagulopathy with blood loss and blood transfusion in posterior spinal fusion for pediatric scoliosis patients. METHODS: A retrospective, single institution ...
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
Authors: Abstract OBJECTIVEVenous thromboembolic events (VTEs) are a common cause of morbidity and mortality after spine surgery. Patients admitted to the intensive care unit (ICU) following spine surgery exhibit high-risk clinical characteristics.METHODSThe authors retrospectively analyzed 1269 ICU patients who had undergone spine surgery between January 1, 2009, and May 31, 2015. Relevant demographic, procedural, and outcome variables were collected.RESULTSPatients admitted to the ICU postoperatively had a postoperative VTE rate of 10.2%, compared to 2.5% among all spine surgery patients during the study period...
Source: Journal of Neurosurgery.Spine - Category: Neurosurgery Tags: J Neurosurg Spine Source Type: research
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