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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT03553186
Other study ID # 2017-0920
Secondary ID
Status Recruiting
Phase Phase 3
First received
Last updated
Start date July 11, 2018
Est. completion date March 2025

Study information

Verified date April 2024
Source Hospital for Special Surgery, New York
Contact Jordan A Gruskay, MD
Phone 2034647759
Email gruskayj@hss.edu
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Posterior spinal surgery for adult deformity is associated with high incidence of blood loss and need for blood transfusion and intraoperative blood salvage, with associated increased cost and risk for perioperative complications. Tranexamic acid (TXA) is relatively inexpensive anti-fibrinolytic agent that has been proven effective for decreasing intraoperative blood loss in various surgical specialties. Intravenous TXA (ivTXA) is routinely used at our institution for adult spinal deformity cases. Meanwhile, topical TXA (tTXA) is an attractive alternative/adjunct to ivTXA used with good results in orthopedic arthroplasty and cardiac surgery. To the investigators' knowledge, no data exists in the literature on the use of tTXA in either adult or pediatric spinal deformity surgery. The goal of this study is to determine the role tTXA has an adjunct to ivTXA in decreasing perioperative blood loss, drainage, transfusion requirements and length of stay following adult deformity spine surgery.


Description:

Blood loss is a significant issue in spinal deformity surgery, often requiring allogenic blood transfusion and/or intraoperative blood salvage and leading to increased risk of postoperative morbidity, increased length of stay, and higher total hospital costs. Tranexamic acid is an antifibrinolytic agent that is used in many surgical specialties to prevent perioperative blood loss. Intravenous (ivTXA) dosing has proven effective in reducing blood loss and perioperative transfusion in spinal surgery, while the topical (tTXA) form has been shown to be at least non-inferior to IV transfusion in the total arthroplasty literature. Intravenous TXA is routinely used at the investigators' institution in spinal deformity cases, but even with ivTXA infusion, perioperative blood loss remains a significant issue, with total estimated and calculated blood loss between ~1500-3000 mL. Usage of local tTXA in addition to ivTXA may provide additional benefits including an additive effect on decreasing blood loss, allowing for lowered dosages of ivTXA, decreasing risks associated with systemic exposure. Combination ivTXA and tTXA has shown excellent results in total joint arthroplasty. The objective of this study is to determine the additive benefit and risks of co-administration of the two in spinal deformity surgery. This population of spinal patients was chosen because the estimated blood loss is high and the potential clinical benefit of the intervention is large. Patients will be enrolled if they are undergoing surgery > 5 levels with extension to the pelvis. The investigators have previously utilized topical TXA for these cases by applying operative sponges soaked with solution into the wound during routine x-ray check following instrumentation, with anecdotally good effect. However, this practice has not been prospectively studied. In this prospective, randomized, blinded, placebo controlled study, a similar combined effect of ivTXA and tTXA on decreasing perioperative blood loss as seen in total joint arthroplasty, with a similar safety profile is expected.


Recruitment information / eligibility

Status Recruiting
Enrollment 100
Est. completion date March 2025
Est. primary completion date March 2025
Accepts healthy volunteers No
Gender All
Age group 18 Years to 80 Years
Eligibility Inclusion Criteria: - Age 18-80 - Scheduled to undergo posterior long segment ( = 5 levels) posterior spinal fusion for adult scoliosis or degenerative joint diseae - + fusion to pelvis Exclusion Criteria: - Surgical factors: - Anterior Approach - Presence or history of dural tear without repair as evidenced by pseudomeningocele on MRI imaging or by intraoperative exploration - Patients donating autologous blood preoperatively Patient factors: - Diagnosis of renal (Cr>1.5 or CrCl <30ml/min) or hepatic insufficiency (AST, ALT 2x upper limit of normal) - Diagnosis of seizure disorder or prior seizure - History of thromboembolic events (CVA, TIA, DVT, PE) if within 1 year of surgery - Hypercoagulability (e.g. antiphospholipid syndrome) - History of coronary artery disease (stent, MI, +stress test) within 1 year of surgery - Atrial fibrillation - Concurrent anticoagulation therapy that cannot be discontinued within 3 days before surgery (Coumadin, plavix, LVX) - Concurrent anticoagulation with ASA 325 that cannot be discontinued 10 days before surgery - Bleeding disorder or abnormal preoperative coagulation profile (as identified by a preoperative platelet count of <100,000/mm3, an international normalized ratio of >1.4, or a prolonged partial thromboplastin time >1.4 times normal) - Preexisting anemia <10 g/dL - Color blindness or disturbance of color vision - Leukemia or active cancer - Religious restrictions on blood transfusion - Pregnancy or women who are lactating/breastfeeding

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Tranexamic Acid 100 MG/ML
TXA lavage solution (200 cc sterile normal saline + 5 g tranexamic acid 100mg/ml (50cc)) will be poured into the surgical field and left in contact for five minutes. This will occur after instrumentation. Excess solution will be suctioned away using a non-cell saver suction.
Placebo
Placebo solution (200 cc sterile normal saline + placebo TXA ampule (50cc)) will be poured into the surgical field and left in contact for five minutes. This will occur after pedicle screw instrumentation. Excess solution will be suctioned away using a non-cell saver suction.

Locations

Country Name City State
United States Hospital for Special Surgery New York New York

Sponsors (1)

Lead Sponsor Collaborator
Hospital for Special Surgery, New York

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Postoperative Drain output Drain Output 48 hours
Secondary Perioperative blood transfusion Number of units of blood transfused perioperatively, including cell saver administration Up to 30 days postoperatively
Secondary Perioperative blood drop CBC with hct/hg tracked postoperatively Up to 72 hours postoperatively
Secondary Perioperative adverse events Minor and major adverse events occuring during hospitalization or after discharge Up to 30 days postoperatively
Secondary Length of stay # of days from surgery to discharge Up to 30 days postoperatively
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