Date of Award

January 2017

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Brian G. Smith

Abstract

COMPARING THE EFFICACY OF TRANEXAMIC ACID AND AMINOCAPROIC ACID IN POSTERIOR SPINAL FUSION FOR ADOLESCENT IDIOPATHIC SCOLIOSIS. Yunsoo A. Lee and Brian G. Smith. Department of Orthopedics, Yale University, School of Medicine, New Haven, CT.

Objective: To compare the efficacy of tranexamic acid and aminocaproic acid in decreasing blood loss and blood transfusion requirements during posterior spinal fusion for the treatment of adolescent idiopathic scoliosis.

Background: Due to the extent of the operation, posterior spinal fusion is associated with significant blood loss often requiring blood transfusions that increase the risk of morbidity and mortality. Antifibrinolytic medications, mainly tranexamic acid (TXA) and aminocaproic acid (Amicar), have been shown to reduce blood loss and blood transfusion requirements in studies on surgery for scoliosis. Our study compares the efficacy of using TXA and Amicar to using no anti-fibrinolytic in reducing blood loss and blood transfusion requirements.

Methods: A retrospective chart review was performed on all patients with idiopathic scoliosis undergoing exclusive posterior spinal fusion from 2008 to 2016 at one institution. Patients were put into three groups, a historical control group that was not given anti-fibrinolytics (67), a group given TXA (46), and a group given Amicar (21). There were no significant differences in age, gender, number of fused vertebrae, or Major Cobb angle between the three groups.

Results: The TXA group required significantly fewer average units of packed red blood cell (PRBC) transfusion (1.76 ± 1.25) than the control group (2.57 ± 1.41). The Amicar group (2.24 ± 1.04) did not demonstrate a significantly reduced blood transfusion requirement. There were no significant differences seen in intraoperative estimated blood loss across the three groups. Multiple regression analysis showed that TXA was significantly associated with a reduction in PRBC transfusion and that the number of vertebrae levels fused was significantly associated with an increase in blood transfusion. In contrast, Amicar did not demonstrate a statistically significant reduction in blood transfusion requirements.

Conclusion: We analyzed 134 patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis to compare the effects of tranexamic acid (TXA) and aminocaproic acid (Amicar) to a control group given no anti-fibrinolytic therapy. TXA was found to significantly decrease packed red blood cell transfusion requirements while Amicar did not show a statistically significant change. Neither were associated with a decrease in intraoperative estimated blood loss.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/12/2019

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