Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：复杂的脊柱畸形手术可能涉及大量失血。抗纤维蛋白溶解剂如氨甲环酸（TXA）的使用已被证明可以减少围手术期的失血。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会增加风险.本研究旨在评估在复杂脊柱畸形矫正手术患者中使用TXA是否会根据预先存在的血栓栓塞危险因素增加血栓栓塞并发症的风险。
方法：分析了2018年8月至2022年10月期间21个北美中心在脊柱畸形手术矫正期间接受TXA的成年患者的数据。预先存在血栓栓塞事件和其他危险因素的患者（深静脉血栓形成史[DVT]，肺栓塞[PE]，心肌梗死[MI]，中风,外周血管疾病,或癌症）被确定。在术后90天内评估血栓栓塞并发症的发生率。进行了单变量和多变量分析，以评估接受静脉TXA的高危和低危患者的血栓栓塞结果。
结果：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名（31.6％）被认为是高危患者。在单因素分析中，有血栓栓塞危险因素的患者和没有血栓栓塞危险因素的患者之间的血栓栓塞并发症没有显着差异（高风险组与低风险组：8.5％vs2.8％，p=0.45)。具体来说,在术后90天DVT发生率方面，两组之间没有显着差异（高风险组与低风险组：1.5％vs1.4％，p=0.98),市盈率（2.3%对1.8%，p=0.71),急性MI（1.5%vs0%，p=0.19),或中风(0.8%对1.1%，p>0.99）。在多变量分析中，高危状态并不是任何血栓栓塞并发症的显著独立预测因子.
结论：在校正过程中静脉注射TXA并没有改变血栓栓塞事件的发生率，急性MI,或中风在这群成年脊柱畸形手术患者中。
方法：分析了2018年8月至2022年10月期间21个北美中心在脊柱畸形手术矫正期间接受TXA的成年患者的数据。预先存在血栓栓塞事件和其他危险因素的患者（深静脉血栓形成史[DVT]，肺栓塞[PE]，心肌梗死[MI]，中风,外周血管疾病,或癌症）被确定。在术后90天内评估血栓栓塞并发症的发生率。进行了单变量和多变量分析，以评估接受静脉TXA的高危和低危患者的血栓栓塞结果。
结果：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名（31.6％）被认为是高危患者。在单因素分析中，有血栓栓塞危险因素的患者和没有血栓栓塞危险因素的患者之间的血栓栓塞并发症没有显着差异（高风险组与低风险组：8.5％vs2.8％，p=0.45)。具体来说,在术后90天DVT发生率方面，两组之间没有显着差异（高风险组与低风险组：1.5％vs1.4％，p=0.98),市盈率（2.3%对1.8%，p=0.71),急性MI（1.5%vs0%，p=0.19),或中风(0.8%对1.1%，p>0.99）。在多变量分析中，高危状态并不是任何血栓栓塞并发症的显著独立预测因子.
结论：在校正过程中静脉注射TXA并没有改变血栓栓塞事件的发生率，急性MI,或中风在这群成年脊柱畸形手术患者中。
