Mullin Jeffrey P, Soliman Mohamed A R, Smith Justin S, Kelly Michael P, Buell Thomas J, Diebo Bassel, Scheer Justin K, Line Breton, Lafage Virginie, Lafage Renaud, Klineberg Eric, Kim Han Jo, Passias Peter G, Gum Jeffrey L, Kebaish Khaled, Eastlack Robert K, Daniels Alan H, Soroceanu Alex, Mundis Gregory, Hostin Richard, Protopsaltis Themistocles S, Hamilton D Kojo, Gupta Munish C, Lewis Stephen J, Schwab Frank J, Lenke Lawrence G, Shaffrey Christopher I, Bess Shay, Ames Christopher P, Burton Douglas
1Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.
2Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York.
J Neurosurg Spine. 2024 Mar 8;40(6):684-691. doi: 10.3171/2024.1.SPINE231098. Print 2024 Jun 1.
Complex spinal deformity surgeries may involve significant blood loss. The use of antifibrinolytic agents such as tranexamic acid (TXA) has been proven to reduce perioperative blood loss. However, for patients with a history of thromboembolic events, there is concern of increased risk when TXA is used during these surgeries. This study aimed to assess whether TXA use in patients undergoing complex spinal deformity correction surgeries increases the risk of thromboembolic complications based on preexisting thromboembolic risk factors.
Data were analyzed for adult patients who received TXA during surgical correction for spinal deformity at 21 North American centers between August 2018 and October 2022. Patients with preexisting thromboembolic events and other risk factors (history of deep venous thrombosis [DVT], pulmonary embolism [PE], myocardial infarction [MI], stroke, peripheral vascular disease, or cancer) were identified. Thromboembolic complication rates were assessed during the postoperative 90 days. Univariate and multivariate analyses were performed to assess thromboembolic outcomes in high-risk and low-risk patients who received intravenous TXA.
Among 411 consecutive patients who underwent complex spinal deformity surgery and received TXA intraoperatively, 130 (31.6%) were considered high-risk patients. There was no significant difference in thromboembolic complications between patients with and those without preexisting thromboembolic risk factors in univariate analysis (high-risk group vs low-risk group: 8.5% vs 2.8%, p = 0.45). Specifically, there were no significant differences between groups regarding the 90-day postoperative rates of DVT (high-risk group vs low-risk group: 1.5% vs 1.4%, p = 0.98), PE (2.3% vs 1.8%, p = 0.71), acute MI (1.5% vs 0%, p = 0.19), or stroke (0.8% vs 1.1%, p > 0.99). On multivariate analysis, high-risk status was not a significant independent predictor for any of the thromboembolic complications.
Administration of intravenous TXA during the correction procedure did not change rates of thromboembolic events, acute MI, or stroke in this cohort of adult spinal deformity surgery patients.
复杂脊柱畸形手术可能导致大量失血。已证实使用抗纤维蛋白溶解剂如氨甲环酸（TXA）可减少围手术期失血。然而，对于有血栓栓塞事件病史的患者，在这些手术中使用TXA时存在风险增加的担忧。本研究旨在评估基于预先存在的血栓栓塞风险因素，在接受复杂脊柱畸形矫正手术的患者中使用TXA是否会增加血栓栓塞并发症的风险。
分析了2018年8月至2022年10月期间在北美21个中心接受脊柱畸形手术矫正并在术中使用TXA的成年患者的数据。确定了有预先存在的血栓栓塞事件和其他风险因素（深静脉血栓形成[DVT]、肺栓塞[PE]、心肌梗死[MI]、中风、外周血管疾病或癌症病史）的患者。在术后90天内评估血栓栓塞并发症发生率。对接受静脉注射TXA的高危和低危患者进行单因素和多因素分析，以评估血栓栓塞结局。
在411例连续接受复杂脊柱畸形手术并在术中接受TXA的患者中，130例（31.6%）被视为高危患者。在单因素分析中，有和没有预先存在的血栓栓塞风险因素的患者之间血栓栓塞并发症无显著差异（高危组与低危组：8.5%对2.8%，p = 0.45）。具体而言，两组在术后90天的DVT发生率（高危组与低危组：1.5%对1.4%，p = 0.98）、PE发生率（2.3%对1.8%，p = 0.71）、急性MI发生率（1.5%对0%，p = 0.19）或中风发生率（0.8%对1.1%，p > 0.99）方面均无显著差异。在多因素分析中，高危状态不是任何血栓栓塞并发症的显著独立预测因素。
在这组成年脊柱畸形手术患者的矫正过程中静脉注射TXA并未改变血栓栓塞事件、急性MI或中风的发生率。
