Tranexamic Acid in Adult Spinal Deformity Surgery

Phase

Condition

Holoprosencephaly

Spinal Stenosis

Birth Defects

Treatment

Placebo

Tranexamic Acid 100 MG/ML

Clinical Study ID

NCT03553186

2017-0920

Ages 18-80
All Genders

Study 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.

Eligibility Criteria

Inclusion

Inclusion Criteria:

Age 18-80
Scheduled to undergo posterior long segment ( ≥ 5 levels) posterior spinal fusionfor adult scoliosis or degenerative joint diseae
fusion to pelvis

Exclusion

Exclusion Criteria:

Surgical factors:
Anterior Approach
Presence or history of dural tear without repair as evidenced bypseudomeningocele 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 2xupper 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 ofsurgery
Atrial fibrillation
Concurrent anticoagulation therapy that cannot be discontinued within 3 days beforesurgery (Coumadin, plavix, LVX)
Concurrent anticoagulation with ASA 325 that cannot be discontinued 10 days beforesurgery
Bleeding disorder or abnormal preoperative coagulation profile (as identified by apreoperative 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

Placebo

July 11, 2018

March 31, 2026

Study 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.

Connect with a study center

Hospital for Special Surgery
New York, New York 10021
United States
Active - Recruiting

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