Effects of different doses of tranexamic acid on bleeding volume and safety of simple scoliosis corrective operation / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the effects of different doses of tranexamic acid (TXA) on bleeding volume and safety for patients undergoing simple scoliosis corrective operation. Methods A retrospective study was conducted, 58 patients who had undergone simple scoliosis orthopaedic operation admitted to the Second Affiliated Hospital of Kunming Medical University from January 2016 to December 2017 were enrolled, and they were divided into a high TXA dose group (100 mg/kg load dose and then maintaining dose 10 mg·kg-1·h-1, 32 cases) and a low TXA dose group (10 mg/kg load dose and then maintaining dose 1 mg·kg-1·h-1, 26 cases) according to the different TXA dosages used in the operation. The clinical data of intra-operative blood loss volume, intra-operative bleeding ratio, intra-operative volume of blood transfusion, wound drainage volume on the postoperative first day, blood transfusion percentage, postoperative continual use of TXA situation, the levels of creatinine (SCr), D-dimer, sequential organ failure assessment (SOFA) score, etc. on the day before operation and on the first day after operation were collected, and the postoperative and 28-day post-discharge complications in the two groups were analyzed. Results There were no statistical significant differences in intra-operative blood loss volume (mL 467.2±362.0 vs. 445.0±255.9), bleeding ratio [(16.9±11.7)% vs. (19.0±10.6) %], intra-operative blood transfusion (mL 421.90±94.80 vs. 561.90±111.06), wound drainage volume on the postoperative first day (mL 287.3±163.0 vs. 325.2±155.5), blood transfusion percentage [9.4% (3/32) vs. 3.8% (1/26)] and proportion of continual use of TXA [37.5% (12/32) vs. 57.7% (15/26)] between high dose TXA group and small dose TXA group (all P > 0.05). After operation, the SOFA scores of the two groups were significantly higher than those before operation (high dose TXA group 2.22±1.31 vs. 0.47±0.11, low dose TXA group 2.85±1.49 vs. 0.35±0.09), but there was no statistical significant difference between the two groups (P > 0.05). No statistical significant difference in the level of SCr before and after operation in high dose TXA group was seen (μmol/L 52.0±15.7 vs. 50.6±13.5, P > 0.05); the postoperative SCr level was significantly higher than that before operation in low dose TXA group (μmol/L 51.3±13.5 vs. 46.2±15.0, P < 0.05), but there was no statistical significant difference in SCr level between the two groups after treatment (P > 0.05). The proportions of patients with D-dimer =0 mg/L and < 0.19 mg/L in high dose TXA group were higher than those in low dose TXA group [21.9% (7/32) vs. 15.4% (4/26) and 12.5% (4/32) vs. 0 (0/26), respectively], but there was no significant difference between the two groups (P > 0.05). No complications such as kidney injury, deep vein thrombosis, pulmonary embolism, epilepsy, etc were found in either group. Conclusions There were no significant differences between the use of high-dose and low-dose TXA in the reduction of intra-operative and postoperative bleeding volume and transfusion volume in patients undergoing simple scoliosis corrective operation. Therefore, the low dose TXA is recommended to be used in such procedure.