Antifibrinolytic Drugs and Allogeneic Transfusion in Pediatric Multilevel Spine Surgery: A Propensity Score Matched Cohort Study

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Journal Article

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antifibrinolytics; bleeding; spine surgery; transfusion


© 2018 Wolters Kluwer Health, Inc. All rights reserved. Study Design.Observational cohort study with propensity score matching.Objective.Determine whether antifibrinolytic drug use is associated with decreased allogeneic blood transfusion in multilevel pediatric spine surgery.Summary of Background Data.Antifibrinolytic drugs are commonly used in adult multilevel spine surgery to reduce blood loss and allogeneic transfusion; however, only small studies have examined their efficacy in pediatric patients having multilevel spine surgery.Methods.Pediatric patients who had posterior multilevel spine surgery between 2016 and 2017 were identified in the national surgery quality improvement program participant use file. 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.A total of 6904 patients underwent posterior multilevel 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: odds ratio (OR)=0.71 (99% confidence interval [CI]=0.40-1.26, P=0.12) or cell saver volume, median volume=114mL (0, 250mL) in antifibrinolytic group versus 100mL (0, 246mL) in control group, P=0.04. There was also no association with reduced postoperative allogeneic transfusion OR=1.23 (99% CI=0.54-2.81, P=0.52) or massive transfusion OR=1.0 (99% CI=0.34-2.92, P=1.0). No patient in the matched cohort had a venous thromboembolism or seizure.Conclusion.Antifibrinolytic drugs are commonly used in pediatric multilevel 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.