Bleeding management in adolescent idiopathic scoliosis: the role of low-dose tranexamic acid
Manejo do sangramento na escoliose idiopática do adolescente: o papel do ácido tranexâmico em baixa dose
Paula Alexandra Sá, Filipa Pereira, Daniel Soares, António Oliveira, Eugénia Cruz, Sibylle Langenecker
Abstract
Background
Despite advances in surgical and blood management techniques, it continues to carry risks of excessive blood loss and transfusion. Tranexamic Acid (TXA), an antifibrinolytic agent, has shown efficacy in reducing these risks across various surgeries. This retrospective cohort study evaluated factors influencing intraoperative blood loss in Adolescent Idiopathic Scoliosis (AIS) surgery, focusing on low-dose TXA administration.
Methods
This retrospective cohort study included 187 AIS patients undergoing posterior spinal fusion with or without intraoperative TXA. Patients were grouped into non-TXA (116 patients)
and TXA (71 patients) cohorts. The TXA group received a 10 mg.kg-1 intravenous loading dose over 15 minutes, followed by a continuous infusion of 1 mg.kg-1.h-1 until skin closure. Outcomes included estimated blood loss, transfusion needs, length of stay, and thromboembolic or neurologic complications. Multivariate regression adjusted intraoperative blood volume loss for potential covariates.
Results
Baseline demographic characteristics were similar between groups. However, differences in surgical complexity cannot be excluded and are acknowledged. TXA use was associated with a 39% reduction in estimated intraoperative blood volume loss compared with the non-TXA group. Blood loss correlated significantly with TXA use, sex, ASA status, number of fused levels, curve type, and surgery duration.
Conclusion
Low-dose TXA significantly reduced intraoperative blood loss and transfusion requirements during AIS surgery. Greater blood loss was linked to longer procedures and more fused levels, whereas lumbar curve type appeared protective. This study provides insights into AIS outcomes and their associations with predictive factors and TXA use.
Level of evidence
Level III − retrospective cohort study.
Keywords
Resumo
Introdução
Apesar dos avanços nas técnicas cirúrgicas e no manejo do sangue, ainda há riscos de perda sanguínea excessiva e necessidade de transfusão. O ácido tranexâmico (TXA), um agente antifibrinolítico, tem demonstrado eficácia na redução desses riscos em diversas cirurgias. Este estudo de coorte retrospectivo avaliou fatores que influenciam a perda sanguínea intraoperatória em cirurgias de Escoliose Idiopática do Adolescente (EIA), com foco na administração de TXA em baixa dose.
Métodos
Este estudo de coorte retrospectivo incluiu 187 pacientes com EIA submetidos à fusão espinhal posterior com ou sem TXA intraoperatório. Os pacientes foram divididos em grupos sem TXA (116 pacientes) e com TXA (71 pacientes). O grupo TXA recebeu uma dose de ataque intravenosa de 10 mg.kg⁻¹ ao longo de 15 minutos, seguida de infusão contínua de 1 mg.kg⁻¹.h⁻¹ até o fechamento da pele. Os desfechos incluíram perda sanguínea estimada, necessidade de transfusão, tempo de internação e complicações tromboembólicas ou neurológicas. A regressão multivariada ajustou a perda de volume sanguíneo intraoperatório para possíveis covariáveis.
Resultados
As características demográficas basais foram semelhantes entre os grupos. No entanto, diferenças na complexidade cirúrgica não podem ser excluídas e são reconhecidas. O uso de TXA esteve associado a uma redução de 39% na perda estimada de volume sanguíneo intraoperatório em comparação com o grupo sem TXA. A perda sanguínea correlacionou-se significativamente com o uso de TXA, sexo, classificação ASA, número de níveis fusionados, tipo de curva e duração da cirurgia.
Conclusão
O uso de TXA em baixa dose reduziu significativamente a perda sanguínea intraoperatória e a necessidade de transfusão durante cirurgias de EIA. Maior perda sanguínea esteve associada a procedimentos mais longos e a maior número de níveis fusionados, enquanto o tipo de curva lombar apresentou efeito protetor. Este estudo fornece insights sobre os desfechos na EIA e suas associações com fatores preditores e o uso de TXA.
Nível de evidência
Nível III – estudo de coorte retrospectivo.
Palavras-chave
Referencias
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Submitted date:
17/09/2025
Accepted date:
03/03/2026
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