Tranexamic acid in peadiatric scoliosis surgery (TRIPSS): A prospective randomised trial comparing high dose and low dose tranexamic acid in adolescent idiopathic scoliosis undergoing posterior spinal fusion / Siti Nadzrah Yunus

Background: Tranexamic Acid (TXA) is commonly used in scoliosis surgery to reduce the amount surgical blood loss and allogenic blood transfusion requirement. Evidence on proper dosing regimen of TXA in paediatric population is scarce. This trial was designed to determine the effectiveness of high dose TXA over low dose TXA in adolescent idiopathic scoliosis surgery to reduce surgical blood loss and allogenic transfusion requirement. Methods: This prospective randomised double-blinded trial involved 166 patients with adolescents idiopathic scoliosis in University Malaya Medical Centre (UMMC) who were randomised to receive either Group A, high dose TXA (30 mg/kg loading dose and 10 mg/kg/h infusion) or Group B, low dose TXA (10 mg/kg loading dose and 1 mg/kg/h). Haemoglobin, haematocrit and fibrinogen levels were obtained at 3 perioperative time frames; T1 (preoperation), T2 (0-hour postoperation), and T3 (48- hour postoperation) which was then analysed using repeated measure analysis of variance (ANOVA) to detect the difference over time. Results: The total surgical blood loss was insignificantly different (p = 0.865). Each group has one patient received perioperative allogenic blood transfusion. The main predictors contributing to the amount of surgical blood loss are number of vertebral level fused, duration of surgery and gender (R2 = 0.492). The perioperative drop in haemoglobin levels between T1 and T3 for Group A and Group B (mean difference [95% confidence interval], 3.01 [2.60,3.42] versus 3.30 [2.89,3.71]) showed no significant difference (p = 0.511). No serious complications occurred in both groups. iv Conclusions: Low dose TXA is as effective as high dose TXA in reduction of surgical blood loss and transfusion requirement in paediatric scoliosis surgery. Keywords Tranexamic acid, adolescent idiopathic scoliosis, blood loss, allogenic blood transfusio