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Tranexamic Acid Use and Post Operative Outcome in Patients Undergoing Spine Surgery for Scoliosis in An-Najah National University Hospital / Palestine: A Prospective, Randomized, Double Blinded Study

Wael Abdullah Sadaqa

Context: Some reports have been published regarding the effectiveness of Tranexamic acid (TXA) on reducing blood loss and blood transfusion in patients undergoing orthopedic and major orthopedic surgery We performed a prospective randomized control study to evaluate the effectiveness and safety of preoperative tranexamic acid use on blood transfusion, thromboembolic events and mortality in patients undergoing spinal surgery for scoliosis in An-Najah National University Hospital in Palestine.

Materials and Methods: A prospective, randomized, double blinded study was conducted in the tertiary care teaching hospital. the weighted mean difference in blood loss , number of transfusions per patient , and the risk ratio of transfusion and deep vein thrombosis (DVT) were calculated in the tranexamic acid (TXA) treated group and the control group . Hundred ASA grade 1-11 patients undergoing spinal surgery for scoliosis were included in this prospective study. Fifty patients received Tranexamic acid (TXA) given in a bolus dose of 10 mg/kg 15 minutes before surgical incision followed by 10 mg/kg every 3 hours . The remaining fifty patients were allocated as a control group. Postoperative bleeding (volume of blood in the drain), percentage fall of hemoglobin, transfusions and postoperative complications were recorded.

Results: Mean volume of blood in the drain was 940 ± 495 ml ( mean ± SD) as compared to 1450 ± 740 ml in placebo group showing a p<0.001. Mean percentage fall in Hb at day 0 was 3.2 ± 2.1 in the study group as compared to 8.8 ± 3.0 in the placebo group (p<0.001), and fall at day two in the study group was 1.1 ± 0.4 compared to 3.8 ± 2.7 in the placebo group (p<0.001). The number of patients required blood transfusions were lower in the study group than in placebo group (p=0.01).

Conclusion: Tranexamic acid significantly reduces postoperative blood loss and blood transfusion requirements during spinal surgery for scoliosis correction.