Posterior spinal fusion is a complex surgical procedure indicated to correct spinal deformation in idiopathic or neuromuscular scoliosis. Spine surgery can be associated with significant intraoperative blood losses and may require the transfusion of large volumes of blood products.

Over the past decades, multidisciplinary and multimodal strategies have been implemented to prevent and reduce intraoperative bleeding and improve perioperative blood management in patients undergoing spine surgery. Prophylactic administration of tranexamic acid (TXA) has been proven to effectively reduce bleeding and transfusion in children and adolescent undergoing spine surgery, and TXA is recommended by all International guidelines.

In this prospective single-centre randomised trial, Goobie et al. aimed to validate the efficacy of TXA in reducing bleeding associated with surgery for adolescent-onset idiopathic scoliosis. The authors randomized 111 patients to receive either a placebo or TXA (50 mg/kg loading dose followed by an infusion of 10 mg/kg/h).

The risk of clinically relevant blood loss, defined as blood loss exceeding 20 mL/kg, was more than twice as high in the placebo group that in the TXA group (44% vs. 21%). Patients receiving TXA had a 27% reduction in intraoperative blood loss, a significantly lower rate of intraoperative bleeding per hour, and less intraoperative and postoperative blood loss. No perioperative adverse events, including thromboembolic events or seizures, were observed.

This prospective randomised study confirms the efficacy of TXA in reducing blood loss and transfusion in adolescents undergoing spine surgery. Considering the safety of the drug, prophylactic administration of TXA should be considered as standard of care in that population.

– David Faraoni