Effect of antifibrinolytic therapy on complications, thromboembolic events, blood product utilization, and fusion in adult spinal deformity surgery

Alex Soroceanu, Jonathan H. Oren, Justin S. Smith, Richard Hostin, Christopher I. Shaffrey, Gregory M. Mundis, Christopher P. Ames, Douglas C. Burton, Shay Bess, Munish C. Gupta, Vedat Deviren, Frank J. Schwab, Virginie Lafage, Thomas J. Errico

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Study Design. A multicenter, prospective, consecutive database of surgical patients with adult spinal deformity (ASD). Objective. This study investigated the use of antifibrinolytic (AF) therapy in ASD surgery. Summary of Background Data. AF therapy has been shown to be effective in preventing blood loss in some settings. Its effect on major and minor perioperative complications, blood product utilization, vascular events, and postoperative fusion in patients undergoing ASD surgery remains unclear. Methods. All patients with data on AF use were included. Parameters of blood utilization included transfusion rates and units of packed red blood cells and fresh frozen plasma transfused. Thromboembolic events included stroke, deep vein thrombosis, and pulmonary embolus. Multivariate regression was used, accounting for confounders. Results. Four hundred three patients were included. One hundred thirty-seven patients received aminocaproic acid (EACA), 81 received tranexamic acid (TXA), and 185 received no AFs. The use of AF was associated with a decrease in transfusion (EACA: odds ratio [OR]=0.38, P=0.043; TXA: OR=0.31, P=0.047), a decrease in the number of units of packed red blood cells transfused (EACA: incidence risk ratio [IRR]=0.45, P=0.0005; TXA: IRR=0.7, P=0.0005), and a decrease in the number of fresh frozen plasma transfused (EACA: IRR=0.65, P=0.003; TXA: IRR=0.67, P=0.006). AF use was associated with an increase in minor intraoperative complications (EACA: IRR=2.15, P=0.008; TXA: IRR=2.12, P=0.011). TXA use (but not EACA) was associated with a decrease in the incidence of major perioperative complications compared with no AF (IRR=0.37, P=0.019). There was no difference in the incidence of thromboembolic events. Conclusion. TXA or EACA use was associated with increased minor intraoperative complications. TXA was associated with decreased major perioperative complications. AF was associated with decreased utilization of blood products without an increased rate of thromboembolic events. Given the nature of this study, transfusion threshold was not standardized. Future studies with rigid criteria for transfusion should be prospectively performed to better evaluate the impact of AF during ASD surgery.

Original languageEnglish (US)
Pages (from-to)E879-E886
JournalSpine
Volume41
Issue number14
DOIs
StatePublished - Jul 15 2016

Fingerprint

Antifibrinolytic Agents
Tranexamic Acid
Odds Ratio
Incidence
Therapeutics
Intraoperative Complications
Erythrocytes
Aminocaproic Acid
Embolism
Venous Thrombosis
Blood Vessels
Stroke
Databases
Lung

Keywords

  • adult spinal deformity
  • aminocaproic acid
  • antifibrinolytics
  • blood loss
  • fresh frozen plasma transfusion
  • major complications
  • minor complications
  • packed red blood cell transfusion
  • thromboembolic events
  • tranexamic acid

ASJC Scopus subject areas

  • Medicine(all)
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Soroceanu, A., Oren, J. H., Smith, J. S., Hostin, R., Shaffrey, C. I., Mundis, G. M., ... Errico, T. J. (2016). Effect of antifibrinolytic therapy on complications, thromboembolic events, blood product utilization, and fusion in adult spinal deformity surgery. Spine, 41(14), E879-E886. https://doi.org/10.1097/BRS.0000000000001454

Effect of antifibrinolytic therapy on complications, thromboembolic events, blood product utilization, and fusion in adult spinal deformity surgery. / Soroceanu, Alex; Oren, Jonathan H.; Smith, Justin S.; Hostin, Richard; Shaffrey, Christopher I.; Mundis, Gregory M.; Ames, Christopher P.; Burton, Douglas C.; Bess, Shay; Gupta, Munish C.; Deviren, Vedat; Schwab, Frank J.; Lafage, Virginie; Errico, Thomas J.

In: Spine, Vol. 41, No. 14, 15.07.2016, p. E879-E886.

Research output: Contribution to journalArticle

Soroceanu, A, Oren, JH, Smith, JS, Hostin, R, Shaffrey, CI, Mundis, GM, Ames, CP, Burton, DC, Bess, S, Gupta, MC, Deviren, V, Schwab, FJ, Lafage, V & Errico, TJ 2016, 'Effect of antifibrinolytic therapy on complications, thromboembolic events, blood product utilization, and fusion in adult spinal deformity surgery', Spine, vol. 41, no. 14, pp. E879-E886. https://doi.org/10.1097/BRS.0000000000001454
Soroceanu, Alex ; Oren, Jonathan H. ; Smith, Justin S. ; Hostin, Richard ; Shaffrey, Christopher I. ; Mundis, Gregory M. ; Ames, Christopher P. ; Burton, Douglas C. ; Bess, Shay ; Gupta, Munish C. ; Deviren, Vedat ; Schwab, Frank J. ; Lafage, Virginie ; Errico, Thomas J. / Effect of antifibrinolytic therapy on complications, thromboembolic events, blood product utilization, and fusion in adult spinal deformity surgery. In: Spine. 2016 ; Vol. 41, No. 14. pp. E879-E886.
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abstract = "Study Design. A multicenter, prospective, consecutive database of surgical patients with adult spinal deformity (ASD). Objective. This study investigated the use of antifibrinolytic (AF) therapy in ASD surgery. Summary of Background Data. AF therapy has been shown to be effective in preventing blood loss in some settings. Its effect on major and minor perioperative complications, blood product utilization, vascular events, and postoperative fusion in patients undergoing ASD surgery remains unclear. Methods. All patients with data on AF use were included. Parameters of blood utilization included transfusion rates and units of packed red blood cells and fresh frozen plasma transfused. Thromboembolic events included stroke, deep vein thrombosis, and pulmonary embolus. Multivariate regression was used, accounting for confounders. Results. Four hundred three patients were included. One hundred thirty-seven patients received aminocaproic acid (EACA), 81 received tranexamic acid (TXA), and 185 received no AFs. The use of AF was associated with a decrease in transfusion (EACA: odds ratio [OR]=0.38, P=0.043; TXA: OR=0.31, P=0.047), a decrease in the number of units of packed red blood cells transfused (EACA: incidence risk ratio [IRR]=0.45, P=0.0005; TXA: IRR=0.7, P=0.0005), and a decrease in the number of fresh frozen plasma transfused (EACA: IRR=0.65, P=0.003; TXA: IRR=0.67, P=0.006). AF use was associated with an increase in minor intraoperative complications (EACA: IRR=2.15, P=0.008; TXA: IRR=2.12, P=0.011). TXA use (but not EACA) was associated with a decrease in the incidence of major perioperative complications compared with no AF (IRR=0.37, P=0.019). There was no difference in the incidence of thromboembolic events. Conclusion. TXA or EACA use was associated with increased minor intraoperative complications. TXA was associated with decreased major perioperative complications. AF was associated with decreased utilization of blood products without an increased rate of thromboembolic events. Given the nature of this study, transfusion threshold was not standardized. Future studies with rigid criteria for transfusion should be prospectively performed to better evaluate the impact of AF during ASD surgery.",
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T1 - Effect of antifibrinolytic therapy on complications, thromboembolic events, blood product utilization, and fusion in adult spinal deformity surgery

AU - Soroceanu, Alex

AU - Oren, Jonathan H.

AU - Smith, Justin S.

AU - Hostin, Richard

AU - Shaffrey, Christopher I.

AU - Mundis, Gregory M.

AU - Ames, Christopher P.

AU - Burton, Douglas C.

AU - Bess, Shay

AU - Gupta, Munish C.

AU - Deviren, Vedat

AU - Schwab, Frank J.

AU - Lafage, Virginie

AU - Errico, Thomas J.

PY - 2016/7/15

Y1 - 2016/7/15

N2 - Study Design. A multicenter, prospective, consecutive database of surgical patients with adult spinal deformity (ASD). Objective. This study investigated the use of antifibrinolytic (AF) therapy in ASD surgery. Summary of Background Data. AF therapy has been shown to be effective in preventing blood loss in some settings. Its effect on major and minor perioperative complications, blood product utilization, vascular events, and postoperative fusion in patients undergoing ASD surgery remains unclear. Methods. All patients with data on AF use were included. Parameters of blood utilization included transfusion rates and units of packed red blood cells and fresh frozen plasma transfused. Thromboembolic events included stroke, deep vein thrombosis, and pulmonary embolus. Multivariate regression was used, accounting for confounders. Results. Four hundred three patients were included. One hundred thirty-seven patients received aminocaproic acid (EACA), 81 received tranexamic acid (TXA), and 185 received no AFs. The use of AF was associated with a decrease in transfusion (EACA: odds ratio [OR]=0.38, P=0.043; TXA: OR=0.31, P=0.047), a decrease in the number of units of packed red blood cells transfused (EACA: incidence risk ratio [IRR]=0.45, P=0.0005; TXA: IRR=0.7, P=0.0005), and a decrease in the number of fresh frozen plasma transfused (EACA: IRR=0.65, P=0.003; TXA: IRR=0.67, P=0.006). AF use was associated with an increase in minor intraoperative complications (EACA: IRR=2.15, P=0.008; TXA: IRR=2.12, P=0.011). TXA use (but not EACA) was associated with a decrease in the incidence of major perioperative complications compared with no AF (IRR=0.37, P=0.019). There was no difference in the incidence of thromboembolic events. Conclusion. TXA or EACA use was associated with increased minor intraoperative complications. TXA was associated with decreased major perioperative complications. AF was associated with decreased utilization of blood products without an increased rate of thromboembolic events. Given the nature of this study, transfusion threshold was not standardized. Future studies with rigid criteria for transfusion should be prospectively performed to better evaluate the impact of AF during ASD surgery.

AB - Study Design. A multicenter, prospective, consecutive database of surgical patients with adult spinal deformity (ASD). Objective. This study investigated the use of antifibrinolytic (AF) therapy in ASD surgery. Summary of Background Data. AF therapy has been shown to be effective in preventing blood loss in some settings. Its effect on major and minor perioperative complications, blood product utilization, vascular events, and postoperative fusion in patients undergoing ASD surgery remains unclear. Methods. All patients with data on AF use were included. Parameters of blood utilization included transfusion rates and units of packed red blood cells and fresh frozen plasma transfused. Thromboembolic events included stroke, deep vein thrombosis, and pulmonary embolus. Multivariate regression was used, accounting for confounders. Results. Four hundred three patients were included. One hundred thirty-seven patients received aminocaproic acid (EACA), 81 received tranexamic acid (TXA), and 185 received no AFs. The use of AF was associated with a decrease in transfusion (EACA: odds ratio [OR]=0.38, P=0.043; TXA: OR=0.31, P=0.047), a decrease in the number of units of packed red blood cells transfused (EACA: incidence risk ratio [IRR]=0.45, P=0.0005; TXA: IRR=0.7, P=0.0005), and a decrease in the number of fresh frozen plasma transfused (EACA: IRR=0.65, P=0.003; TXA: IRR=0.67, P=0.006). AF use was associated with an increase in minor intraoperative complications (EACA: IRR=2.15, P=0.008; TXA: IRR=2.12, P=0.011). TXA use (but not EACA) was associated with a decrease in the incidence of major perioperative complications compared with no AF (IRR=0.37, P=0.019). There was no difference in the incidence of thromboembolic events. Conclusion. TXA or EACA use was associated with increased minor intraoperative complications. TXA was associated with decreased major perioperative complications. AF was associated with decreased utilization of blood products without an increased rate of thromboembolic events. Given the nature of this study, transfusion threshold was not standardized. Future studies with rigid criteria for transfusion should be prospectively performed to better evaluate the impact of AF during ASD surgery.

KW - adult spinal deformity

KW - aminocaproic acid

KW - antifibrinolytics

KW - blood loss

KW - fresh frozen plasma transfusion

KW - major complications

KW - minor complications

KW - packed red blood cell transfusion

KW - thromboembolic events

KW - tranexamic acid

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