Spinal Deformity, Paediatric Surgery, Tranexamic Acid Clinical Trial
Official title:
Topical Tranexamic Acid in Major Paediatric Spine Deformity Surgery: A Randomized Controlled Trial
Our study will evaluate the use of topical and intravenous (IV) Tranexamic Acid (TXA) in spine surgery. The purpose of TXA is to prevent clotting during surgery to reduce blood loss. When used intravenously, it has been shown to safe, efficacious, and effective in reducing transfusion requirements and blood loss in spine surgeries. We want to evaluate the effect of using TXA topically and intravenously to see if it further reduces blood loss in children undergoing major surgery compared to IV TXA only
Blood loss during major paediatric spine surgery is significant, and it is well established
that patients undergoing such surgery have a substantial risk for requiring a blood
transfusion in the perioperative period (1-4). Given the cost and associated risks with
allogeneic blood product transfusion (5-7), a significant effort has been directed towards
reducing transfusion requirements through various methods of blood conservation (8-12).
Tranexamic acid (TXA) is a synthetic antifibrinolytic that functions through competitive
blockade of the lysine-binding sites of plasminogen, plasmin, and tissue plasminogen
activator resulting in the inhibition of fibrinolysis and clot degradation (13). When used
parentally, it has been shown to safe, efficacious, and effective in reducing transfusion
requirements and blood loss during the perioperative period of various orthopaedic
procedures, including major surgeries of the spine (14-23). A growing body of literature has
supported the topical application of TXA in lower extremity joint reconstruction, among
other procedures (24-29), in which a saline solution containing TXA is placed directly in
the surgical incision prior to closure. Two randomized controlled trials have compared
topical TXA and placebo for use in lumbar fusion and laminectomy cases. Both of these trials
demonstrated a significant reduction in perioperative blood loss with the use of topical TXA
as compared to placebo, and no reported no adverse events (36, 37).
While intravenous TXA has proven efficacy in reducing perioperative blood loss, despite its
routine use during major paediatric spine surgery, blood loss and transfusion requirements
remain significant (14-23). Thus, methods to further reduce perioperative blood loss in the
children are of clinical significance. As highlighted above, topical TXA has clearly
demonstrated excellent local anti-fibrinolytic action. Furthermore, when applied within a
surgical incision, there is a negligible increase in serum TXA concentration (33-35).
We therefore propose a randomized trial to evaluate the effect of topical TXA on
perioperative blood loss when used in addition to intravenous TXA for major paediatric spine
surgery. In doing so, we seek to evaluate whether additional benefit may be conferred
through direct application of TXA within the incision intravenous to that already provided
by IV TXA. To date, such a question has not been evaluated in the surgical literature.
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment