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Cartagena-Reyes MA, Silva-Aponte JA, Nazario-Ferrer GI, Benes GA, Choudhary A, Raad M, Frank SM, Musharbash FN, Jain A. The cost-utility of intraoperative tranexamic acid in adult spinal deformity patients undergoing long posterior spinal fusion. Spine Deform 2024; 12:587-593. [PMID: 38427155 DOI: 10.1007/s43390-023-00818-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/29/2023] [Indexed: 03/02/2024]
Abstract
PURPOSE This study aims to evaluate the cost-utility of intraoperative tranexamic acid (TXA) in adult spinal deformity (ASD) patients undergoing long posterior (≥ 5 vertebral levels) spinal fusion. METHODS A decision-analysis model was built for a hypothetical 60-year-old adult patient with spinal deformity undergoing long posterior spinal fusion. A comprehensive review of the literature was performed to obtain event probabilities, costs and health utilities at each node. Health utilities were utilized to calculate Quality-Adjusted Life Years (QALYs). A base-case analysis was carried out to obtain the incremental cost and effectiveness of intraoperative TXA. Probabilistic sensitivity analysis was performed to evaluate uncertainty in our model and obtain mean incremental costs, effectiveness, and net monetary benefits. One-way sensitivity analyses were also performed to identify the variables with the most impact on our model. RESULTS Use of intraoperative TXA was the favored strategy in 88% of the iterations. The mean incremental utility ratio for using intraoperative TXA demonstrated higher benefit and lower cost while being lower than the willingness-to-pay threshold set at $50,000 per quality adjusted life years. Use of intraoperative TXA was associated with a mean incremental net monetary benefit (INMB) of $3743 (95% CI 3492-3995). One-way sensitivity analysis reported cost of blood transfusions due to post-operative anemia to be a major driver of cost-utility analysis. CONCLUSION Use of intraoperative TXAs is a cost-effective strategy to reduce overall perioperative costs related to post-operative blood transfusions. Administration of intraoperative TXA should be considered for long fusions in ASD population when not explicitly contra-indicated due to patient factors.
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Affiliation(s)
- Miguel A Cartagena-Reyes
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, JHOC 5230, Baltimore, MD, 21287, USA
| | - Juan A Silva-Aponte
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, JHOC 5230, Baltimore, MD, 21287, USA
| | - Gabriel I Nazario-Ferrer
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, JHOC 5230, Baltimore, MD, 21287, USA
| | - Gregory A Benes
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, JHOC 5230, Baltimore, MD, 21287, USA
| | - Ananya Choudhary
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, JHOC 5230, Baltimore, MD, 21287, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, JHOC 5230, Baltimore, MD, 21287, USA
| | - Steven M Frank
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University, 1800 Orleans St., Zayed 6208, Baltimore, MD, 21287, USA
| | - Farah N Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, JHOC 5230, Baltimore, MD, 21287, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, JHOC 5230, Baltimore, MD, 21287, USA.
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Yoo JS, Ahn J, Karmarkar SS, Lamoutte EH, Singh K. The use of tranexamic acid in spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S172. [PMID: 31624738 PMCID: PMC6778277 DOI: 10.21037/atm.2019.05.36] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 11/06/2022]
Abstract
Patients undergoing surgical procedures of the spine with associated large volume blood loss often require perioperative blood conservation strategies. Synthetic antifibrinolytic medications such as tranexamic acid (TXA) may reduce blood transfusion requirements and postoperative complications following spinal procedures. Studies investigating the role of TXA in spine surgery have presented promising results and have proven its safety and efficacy. However, further investigation is needed to determine the optimal dosing regimen of TXA. In this article, we provide an overview of the basic science and pharmacology of TXA. A comprehensive summary of the findings from clinical trials and a review of the literature that demonstrate the risks and benefits of TXA in spine surgery are also presented.
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Affiliation(s)
- Joon S Yoo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Junyoung Ahn
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sailee S Karmarkar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Eric H Lamoutte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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In reply. Anesthesiology 2014; 121:902-3. [PMID: 25247859 DOI: 10.1097/aln.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gautam VK, Sambandam B, Singh S, Gupta P, Gupta R, Maini L. The role of tranexamic acid in reducing blood loss in total knee replacement. J Clin Orthop Trauma 2013; 4:36-9. [PMID: 26403773 PMCID: PMC3880537 DOI: 10.1016/j.jcot.2013.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 01/17/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Total knee arthroplasty is associated with significant perioperative blood loss which may necessitate blood transfusion. In this prospective randomised case control study we analysed the efficacy and safety of tranexamic acid in reducing perioperative blood loss and requirement of blood transfusion in total knee arthroplasty. METHODS Fourteen patients (group A) undergoing total knee replacement were given intravenous tranexamic acid twice, once ten minutes before tourniquet deflation and once after four hours. Thirteen patients (group B) were observed as a separate group without the administration of the drug. Total perioperative blood loss, need of blood transfusion and D-dimer assay were analysed subsequently. RESULTS The average blood loss in the first group was 266.2 ml and in the second group was 667.5 ml (p < 0.001). average requirement of transfusion in both the groups were 0.54 and 1.6 units of blood respectively (p < 0.001). There was no case of deep vein thrombosis or any other untoward effects. CONCLUSION Hence from these evidences it was concluded that administration of tranexamic acid during total knee replacement helps to reduce blood loss without increasing the risk of deep vein thrombosis.
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McMillan D, Potger K, Southwell J, Ambrose M, Connolly T, Louis M. Getting it right: optimizing transfusion management during the procedure. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2009; 41:P65-P70. [PMID: 20092090 PMCID: PMC4813542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
There is little doubt that blood transfusions have saved many lives in cases of acute hypovolemia and anemia, but both the literature and practitioners still do not agree as to what the appropriate indicators for transfusion are in a cardiac surgical patient. Furthermore, there are those who claim that the benefit of blood transfusions has never been conclusively demonstrated, and evidence of transfusion related harm continues to accumulate. Cardiac surgical patients may be transfused not only because of bleeding but also due to hemodilution from preoperative and intraoperative intravenous fluids and pump primes in conjunction with a possible preoperative anemia. Getting transfusion right to improve our practice has to be approached multifactorially. The use of prophylactic dosing of blood products has been suggested to be ineffective in reducing blood loss. There are many factors that impact transfusion rates including determining the optimal hematocrit where it is highly unlikely that one figure will be applicable to all patients. The formulation of transfusion guidelines and algorithms that have been agreed upon by all practitioners involved in the care of cardiac surgical patients may have a positive effect-if everyone agrees to transfuse patients via the formulated guidelines or algorithms. Importantly, no one individual should be able make the decision on whether a patient requires a blood transfusion-it must at all times be a team decision, whether in the operating room or intensive care unit.
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Affiliation(s)
- Darryl McMillan
- Cardiopulmonary Perfusion and Autotransfusion Unit, Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, Australia
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Lehmann A. Ecallantide (DX-88), a plasma kallikrein inhibitor for the treatment of hereditary angioedema and the prevention of blood loss in on-pump cardiothoracic surgery. Expert Opin Biol Ther 2008; 8:1187-99. [DOI: 10.1517/14712598.8.8.1187] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nuttall GA, Gutierrez MC, Dewey JD, Johnson ME, Oyen LJ, Hanson AC, Oliver WC. A Preliminary Study of a New Tranexamic Acid Dosing Schedule for Cardiac Surgery. J Cardiothorac Vasc Anesth 2008; 22:230-5. [DOI: 10.1053/j.jvca.2007.12.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Indexed: 11/11/2022]
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