BACKGROUND Tranexamic acid (TXA) is commonly utilized to reduce blood loss in adult spinal deformity (ASD) surgery. Despite its widespread use, there is a lack of consensus regarding the optimal dosing regimen. The aim of this study was to assess differences in blood loss and complications between high, medium, and low-dose TXA regimens among patients undergoing surgery for complex ASD. METHODS A multicenter database was retrospectively analyzed to identify 265 patients with complex ASD. Patients were separated into 3 groups by TXA regimen: (1) low dose (<20-mg/kg loading dose with ≤2-mg/kg/hr maintenance dose), (2) medium dose (20 to 50-mg/kg loading dose with 2 to 5-mg/kg/hr maintenance dose), and (3) high dose (>50-mg/kg loading dose with ≥5-mg/kg/hr maintenance dose). The measured outcomes included blood loss, complications, and red blood cell (RBC) units transfused intraoperatively and perioperatively. The multivariable analysis controlled for TXA dosing regimen, levels fused, operating room time, preoperative hemoglobin, 3-column osteotomy, and posterior interbody fusion. RESULTS The cohort was predominantly White (91.3%) and female (69.1%) and had a mean age of 61.6 years. Of the 265 patients, 54 (20.4%) received low-dose, 131 (49.4%) received medium-dose, and 80 (30.2%) received high-dose TXA. The median blood loss was 1,200 mL (interquartile range [IQR], 750 to 2,000). The median RBC units transfused intraoperatively was 1.0 (IQR, 0.0 to 2.0), and the median RBC units transfused perioperatively was 2.0 (IQR, 1.0 to 4.0). Compared with the high-dose group, the low-dose group had increased blood loss (by 513.0 mL; p = 0.022) as well as increased RBC units transfused intraoperatively (by 0.6 units; p < 0.001) and perioperatively (by 0.3 units; p = 0.024). The medium-dose group had increased blood loss (by 491.8 mL; p = 0.006) as well as increased RBC units transfused intraoperatively (by 0.7 units; p < 0.001) and perioperatively (by 0.5 units; p < 0.001) compared with the high-dose group. CONCLUSIONS Patients with ASD who received high-dose intraoperative TXA had fewer RBC transfusions intraoperatively, fewer RBC transfusions perioperatively, and less blood loss than those who received low or medium-dose TXA, with no differences in the rates of seizure or thromboembolic complications. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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在复杂成人脊柱畸形患者中，高剂量 TXA 的失血量比低剂量 TXA 少，并发症不会增加。


背景氨甲环酸 （TXA） 通常用于减少成人脊柱畸形 （ASD） 手术中的失血。尽管其广泛使用，但对于最佳给药方案缺乏共识。本研究的目的是评估接受复杂 ASD 手术的患者高、中、低剂量 TXA 方案在失血和并发症方面的差异。方法 回顾性分析多中心数据库，确定 265 例复杂 ASD 患者。通过 TXA 方案将患者分为 3 组：（1） 低剂量（<20-mg/kg 负荷剂量，≤2-mg/kg/hr 维持剂量），（2） 中等剂量（20 至 50-mg/kg 负荷剂量，2 至 5 mg/kg/hr 维持剂量），和 （3） 高剂量（>50-mg/kg 负荷剂量，≥5 mg/kg/hr 维持剂量）。测量结局包括失血量、并发症和术中和围手术期输注的红细胞 （RBC） 单位。多变量分析控制 TXA 给药方案、融合水平、手术室时间、术前血红蛋白、3 柱截骨术和后椎体间融合。结果 该队列主要是白人 （91.3%） 和女性 （69.1%），平均年龄为 61.6 岁。在 265 例患者中，54 例 （20.4%） 接受低剂量治疗，131 例 （49.4%） 接受中等剂量治疗，80 例 （30.2%） 接受高剂量 TXA。中位失血量为 1,200 mL（四分位距 [IQR]，750 至 2,000）。术中输注的中位红细胞单位为 1.0 （IQR，0.0 至 2.0），围手术期输注的中位红细胞单位为 2.0 （IQR，1.0 至 4.0）。与高剂量组相比，低剂量组出血量增加 （增加 513.0 mL;p = 0.022） 以及术中输注 （0.6 单位;p < 0.001） 和围手术期 （增加 0.3 单位;p = 0.024） 的红细胞单位增加。 与高剂量组相比，中剂量组增加失血量 （增加 491.8 mL;p = 0.006） 以及术中输注 （增加 0.7 单位;p < 0.001） 和围手术期 （增加 0.5 单位;p < 0.001） 的红细胞单位。结论 与接受低剂量或中剂量 TXA 的患者相比，接受大剂量术中 TXA 的 ASD 患者术中输注红细胞较少，围手术期输注红细胞较少，失血量较少，癫痫发作或血栓栓塞并发症发生率无差异。证据级别 治疗 III 级。有关证据级别的完整描述，请参阅作者说明。