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Spine (Phila Pa 1976). 2019 Sep 30. doi: 10.1097/BRS.0000000000003273. [Epub ahead of print]

Antifibrinolytic Drugs and Allogeneic Transfusion In Pediatric Multi-Level Spine Surgery: A Propensity Score Matched Cohort Study.

Author information

1
University of Virginia School of Medicine.
2
University of Maryland School of Medicine.

Abstract

STUDY DESIGN:

Observational cohort study with propensity score matching.

OBJECTIVE:

Determine whether antifibrinolytic drug use is associated with decreased allogeneic blood transfusion in multi-level pediatric spine surgery.

SUMMARY OF BACKGROUND DATA:

Antifibrinolytic drugs are commonly used in adult multi-level spine surgery to reduce blood loss and allogeneic transfusion; however, only small studies have examined their efficacy in pediatric patients having multi-level spine surgery.

METHODS:

Pediatric patients who had posterior multi-level spine surgery between 2016 and 2017 were identified in the national surgery quality improvement program (NSQIP) participant use file (PUF). Propensity score matching was used to reduce bias from confounding and the rate of intraoperative allogeneic transfusion was compared between patients who received antifibrinolytic drugs and those who did not. Secondary outcomes included intraoperative cell saver volume, postoperative allogeneic transfusion, massive intraoperative transfusion, and adverse events including venous thromboembolism and seizure.

RESULTS:

6,904 patients underwent posterior multi-level spine surgery during the study period and 83% received antifibrinolytics. The matched cohort included 604 patients. Antifibrinolytic use had no association with reduced intraoperative allogeneic transfusion: OR = 0.71 (99%CI = 0.40 to 1.26, p = 0.12) or cell saver volume, median volume = 114 mL [0, 250 mL] in antifibrinolytic group versus 100 mL [0, 246 mL] in control group, p = 0.04. There was also no association with reduced postoperative allogeneic transfusion OR = 1.23 (99%CI = 0.54 to 2.81, p = 0.52) or massive transfusion OR = 1.0 (99%CI = 0.34 to 2.92, p = 1.0). No patient in the matched cohort had a venous thromboembolism or seizure.

CONCLUSION:

Antifibrinolytic drugs are commonly used in pediatric multi-level spine surgery in the United States, but no efficacy was demonstrated in our study. There were no venous thromboembolisms or seizures implying an excellent safety profile in pediatric patients.

LEVEL OF EVIDENCE:

3.

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