Impact of a Tranexamic Acid Dosing Practice Guideline in Reducing Blood Product Administration in Pediatric Scoliosis Surgery-Impact of a Tranexamic Acid Dosing Practice Guideline in Reducing Blood Product Administration in Pediatric Scoliosis Surgery

Impact of a Tranexamic Acid Dosing Practice Guideline in Reducing Blood Product Administration in Pediatric Scoliosis Surgery

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The study, published in AANA Journal, evaluates the effectiveness and compliance of a tranexamic acid (TXA) dosing protocol in reducing blood product transfusions in pediatric patients undergoing spinal corrective surgery. The research is motivated by the high intraoperative blood loss associated with such surgeries and aims to address the variable use of antifibrinolytic drugs like TXA. Conducted through a retrospective chart review of 486 cases over nine years, the study compares transfusion needs before and after implementing a standardized TXA dosing regimen.<br /><br />Key findings indicate that for patients with idiopathic scoliosis (IS), introducing the TXA protocol significantly decreased cell saver use by 20% and packed red blood cells (PRBCs) by 10%. Compliance with the dosing protocol improved by 37%. However, for those with neuromuscular scoliosis (NMS), although there was a 53% uptick in compliance, the reduction in transfusion requirements wasn't statistically significant. The structured dosing regimen, involving a loading dose and subsequent infusion calibrated to patient weight, was initially established in 2014 and revised in 2016 to accommodate differences between IS and NMS patients.<br /><br />The study supports the effectiveness of TXA in reducing intraoperative bleeding, particularly in IS cases, while highlighting the complexity and lesser efficacy in NMS patients. This is attributed to NMS surgery's extended nature and patients' varied medical profiles. Overall, installation of an evidence-based TXA dosing protocol was linked to reductions in blood loss and improvements in provider compliance, suggesting potential benefits for pediatric spinal surgery patients but highlighting the need for continual protocol evaluation and adaptation. The authors call for further studies to optimize dosing strategies and confirm these findings across more extensive datasets and diverse patient populations.

Keywords

tranexamic acid

TXA protocol

pediatric spinal surgery

blood transfusion reduction

idiopathic scoliosis

neuromuscular scoliosis

antifibrinolytic drugs

retrospective chart review

dosing compliance

intraoperative bleeding