Analysis of tranexamic acid usage in adult spinal deformity patients with relative contraindications: does it increase the risk of complications?

dc.contributor.author

Mullin, Jeffrey P

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Soliman, Mohamed AR

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Smith, Justin S

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Kelly, Michael P

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Buell, Thomas J

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Diebo, Bassel

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Scheer, Justin K

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Line, Breton

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Lafage, Virginie

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Lafage, Renaud

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Klineberg, Eric

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Kim, Han Jo

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Passias, Peter G

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Gum, Jeffrey L

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Kebaish, Khaled

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Eastlack, Robert K

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Daniels, Alan H

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Soroceanu, Alex

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Mundis, Gregory

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Hostin, Richard

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Protopsaltis, Themistocles S

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Hamilton, D Kojo

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Gupta, Munish C

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Lewis, Stephen J

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Schwab, Frank J

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Lenke, Lawrence G

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Shaffrey, Christopher I

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Bess, Shay

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Ames, Christopher P

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Burton, Douglas

dc.date.accessioned

2024-03-25T18:49:49Z

dc.date.available

2024-03-25T18:49:49Z

dc.date.issued

2024-03

dc.description.abstract

Objective

Complex spinal deformity surgeries may involve significant blood loss. The use of antifibrinolytic agents such as tranexamic acid (TXA) has been proven to reduce perioperative blood loss. However, for patients with a history of thromboembolic events, there is concern of increased risk when TXA is used during these surgeries. This study aimed to assess whether TXA use in patients undergoing complex spinal deformity correction surgeries increases the risk of thromboembolic complications based on preexisting thromboembolic risk factors.

Methods

Data were analyzed for adult patients who received TXA during surgical correction for spinal deformity at 21 North American centers between August 2018 and October 2022. Patients with preexisting thromboembolic events and other risk factors (history of deep venous thrombosis [DVT], pulmonary embolism [PE], myocardial infarction [MI], stroke, peripheral vascular disease, or cancer) were identified. Thromboembolic complication rates were assessed during the postoperative 90 days. Univariate and multivariate analyses were performed to assess thromboembolic outcomes in high-risk and low-risk patients who received intravenous TXA.

Results

Among 411 consecutive patients who underwent complex spinal deformity surgery and received TXA intraoperatively, 130 (31.6%) were considered high-risk patients. There was no significant difference in thromboembolic complications between patients with and those without preexisting thromboembolic risk factors in univariate analysis (high-risk group vs low-risk group: 8.5% vs 2.8%, p = 0.45). Specifically, there were no significant differences between groups regarding the 90-day postoperative rates of DVT (high-risk group vs low-risk group: 1.5% vs 1.4%, p = 0.98), PE (2.3% vs 1.8%, p = 0.71), acute MI (1.5% vs 0%, p = 0.19), or stroke (0.8% vs 1.1%, p > 0.99). On multivariate analysis, high-risk status was not a significant independent predictor for any of the thromboembolic complications.

Conclusions

Administration of intravenous TXA during the correction procedure did not change rates of thromboembolic events, acute MI, or stroke in this cohort of adult spinal deformity surgery patients.
dc.identifier.issn

1547-5654

dc.identifier.issn

1547-5646

dc.identifier.uri

https://hdl.handle.net/10161/30385

dc.language

eng

dc.publisher

Journal of Neurosurgery Publishing Group (JNSPG)

dc.relation.ispartof

Journal of neurosurgery. Spine

dc.relation.isversionof

10.3171/2024.1.spine231098

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.subject

adult spinal deformity surgery

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antifibrinolytic therapy

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high-risk

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thromboembolic complications

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tranexamic acid

dc.title

Analysis of tranexamic acid usage in adult spinal deformity patients with relative contraindications: does it increase the risk of complications?

dc.type

Journal article

duke.contributor.orcid

Passias, Peter G|0000-0002-1479-4070|0000-0003-2635-2226

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

1

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8

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

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