From the Research
The high dose protocol for tranexamic acid (TXA) in spinal deformity surgery involves an initial loading dose of 50 mg/kg administered intravenously before surgical incision, followed by a continuous infusion of 5 mg/kg/hour throughout the surgery until skin closure, as supported by the most recent study 1. This protocol is based on the study published in 2022, which evaluated two TXA protocols in adult spinal deformity surgery and found that the high-dose protocol was associated with decreased total blood volume loss (13%) compared to the low-dose protocol. Some key points to consider when administering TXA in spinal deformity surgery include:
- Administration should begin prior to incision to ensure therapeutic levels are present during the periods of greatest blood loss.
- TXA should be given through a dedicated IV line or port to avoid incompatibility with other medications.
- Patients with renal impairment require dose adjustment, typically reducing the dose by 50% for creatinine clearance below 50 ml/min.
- The total dose should generally not exceed 100 mg/kg per day. The use of high-dose TXA in spinal deformity surgery has been shown to be safe and effective in reducing blood loss, as demonstrated by studies such as 2 and 3, which reported no significant increase in thromboembolic events or other complications. However, it is essential to note that the optimal dosing protocol for TXA in spinal deformity surgery may vary depending on the specific patient population and surgical procedure, and further studies are needed to determine the most effective and safe dosing regimen, as highlighted by 4 and 5. In clinical practice, the high-dose protocol of 50 mg/kg loading dose followed by 5 mg/kg/hour infusion is a reasonable choice for spinal deformity surgery, considering the potential benefits of reduced blood loss and the low risk of complications, as supported by the available evidence 1, 2, 3.