{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T03:32:05Z","timestamp":1794022325775,"version":"4.8.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Complex spinal deformity surgeries may involve significant blood loss. The use of antifibrinolytic agents such as tranexamic acid (TXA) has been proven to reduce perioperative blood loss. However, for patients with a history of thromboembolic events, there is concern of increased risk when TXA is used during these surgeries. This study aimed to assess whether TXA use in patients undergoing complex spinal deformity correction surgeries increases the risk of thromboembolic complications based on preexisting thromboembolic risk factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Data were analyzed for adult patients who received TXA during surgical correction for spinal deformity at 21 North American centers between August 2018 and October 2022. Patients with preexisting thromboembolic events and other risk factors (history of deep venous thrombosis [DVT], pulmonary embolism [PE], myocardial infarction [MI], stroke, peripheral vascular disease, or cancer) were identified. Thromboembolic complication rates were assessed during the postoperative 90 days. Univariate and multivariate analyses were performed to assess thromboembolic outcomes in high-risk and low-risk patients who received intravenous TXA.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Among 411 consecutive patients who underwent complex spinal deformity surgery and received TXA intraoperatively, 130 (31.6%) were considered high-risk patients. There was no significant difference in thromboembolic complications between patients with and those without preexisting thromboembolic risk factors in univariate analysis (high-risk group vs low-risk group: 8.5% vs 2.8%, p = 0.45). Specifically, there were no significant differences between groups regarding the 90-day postoperative rates of DVT (high-risk group vs low-risk group: 1.5% vs 1.4%, p = 0.98), PE (2.3% vs 1.8%, p = 0.71), acute MI (1.5% vs 0%, p = 0.19), or stroke (0.8% vs 1.1%, p &gt; 0.99). On multivariate analysis, high-risk status was not a significant independent predictor for any of the thromboembolic complications.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Administration of intravenous TXA during the correction procedure did not change rates of thromboembolic events, acute MI, or stroke in this cohort of adult spinal deformity surgery patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.1.spine231098","type":"journal-article","created":{"date-parts":[[2024,3,9]],"date-time":"2024-03-09T01:54:38Z","timestamp":1709949278000},"page":"684-691","source":"Crossref","is-referenced-by-count":5,"title":["Analysis of tranexamic acid usage in adult spinal deformity patients with relative contraindications: does it increase the risk of complications?"],"prefix":"10.3171","volume":"40","author":[{"given":"Jeffrey P.","family":"Mullin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York;"},{"name":"Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A. R.","family":"Soliman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York;"},{"name":"Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rady Children\u2019s Hospital, San Diego, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Buell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassel","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin K.","family":"Scheer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breton","family":"Line","sequence":"additional","affiliation":[{"name":"Presbyterian St. Luke\u2019s Medical Center, Denver, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lennox Hill Hospital, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lennox Hill Hospital, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Texas Health Houston, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Gum","sequence":"additional","affiliation":[{"name":"Leatherman Spine Center, Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Kebaish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert K.","family":"Eastlack","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Scripps Clinic, San Diego, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan H.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Soroceanu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Calgary, Calgary, Alberta, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Mundis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Scripps Clinic, San Diego, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hostin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Themistocles S.","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Kojo","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish C.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Orthopedic Surgery, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J.","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lennox Hill Hospital, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence G.","family":"Lenke","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and Orthopedic Surgery, Spine Division, Duke University, Durham, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Presbyterian St. Luke\u2019s Medical Center, Denver, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Spine J","first-page":"627","article-title":"Increase in spinal deformity surgery in patients age 60 and older is not associated with increased complications","volume":"17","author":"Sing DC","year":"2017","unstructured":"Sing DC, Berven SH, Burch S, Metz LN. 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Neurosurgery. 2023;92(5):945\u2013954."},{"issue":"1","key":"b3","series-title":"Eur Spine J","first-page":"170","article-title":"Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study","volume":"28","author":"Kwan KYH","year":"2019","unstructured":"Kwan KYH, Bow C, Samartzis D,  Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study. Eur Spine J. 2019;28(1):170\u2013179."},{"issue":"3","key":"b4","series-title":"Oper Neurosurg (Hagerstown)","first-page":"94","article-title":"Outcomes of surgical treatment for 138 patients with severe sagittal deformity at a minimum 2-year follow-up: a case series","volume":"21","author":"Scheer JK","year":"2021","unstructured":"Scheer JK, Lenke LG, Smith JS,  Outcomes of surgical treatment for 138 patients with severe sagittal deformity at a minimum 2-year follow-up: a case series. Oper Neurosurg (Hagerstown). 2021;21(3):94\u2013103."},{"issue":"2","key":"b5","series-title":"J Spine Surg","first-page":"333","article-title":"Incidence and predictors of all-cause mortality within one year after adult spinal deformity surgery","volume":"4","author":"Zuckerman SL","year":"2018","unstructured":"Zuckerman SL, Lakomkin N, Smith JS, Shaffrey CI, Devin CJ. Incidence and predictors of all-cause mortality within one year after adult spinal deformity surgery. J Spine Surg. 2018;4(2):333\u2013341."},{"issue":"9 suppl","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"S47","article-title":"Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion surgery?","volume":"35","author":"Elgafy H","year":"2010","unstructured":"Elgafy H, Bransford RJ, McGuire RA, Dettori JR, Fischer D. Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion surgery? Spine (Phila Pa 1976). 2010;35(9 suppl):S47\u2013S56."},{"issue":"1","key":"b7","series-title":"J Neurosurg Spine","first-page":"9","article-title":"Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance","volume":"5","author":"Yang BP","year":"2006","unstructured":"Yang BP, Ondra SL, Chen LA, Jung HS, Koski TR, Salehi SA. Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. J Neurosurg Spine. 2006;5(1):9\u201317."},{"issue":"6","key":"b8","series-title":"World Neurosurg","first-page":"e815","article-title":"The implementation and efficacy of the Northwestern High Risk Spine Protocol","volume":"82","author":"Zeeni C","year":"2014","unstructured":"Zeeni C, Carabini LM, Gould RW,  The implementation and efficacy of the Northwestern High Risk Spine Protocol. 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Eur Spine J. 2011;20(5):753\u2013758."},{"issue":"1","key":"b11","series-title":"J Korean Neurosurg Soc","first-page":"75","article-title":"Effectiveness and safety of tranexamic acid in spinal deformity surgery","volume":"60","author":"Choi HY","year":"2017","unstructured":"Choi HY, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Effectiveness and safety of tranexamic acid in spinal deformity surgery. J Korean Neurosurg Soc. 2017;60(1):75\u201381."},{"key":"b12","series-title":"N Am Spine Soc J","first-page":"100086","article-title":"Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: a systematic review and network meta-analysis: tranexamic acid for multilevel spine surgery","volume":"8","author":"Rahmani R","year":"2021","unstructured":"Rahmani R, Singleton A, Fulton Z, Pederson JM, Andreshak T. 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Eur Spine J. 2017;26(1):140\u2013154."},{"key":"b14","series-title":"World Neurosurg","first-page":"e572","article-title":"A randomized controlled trial of low-dose tranexamic acid versus placebo to reduce red blood cell transfusion during complex multilevel spine fusion surgery","volume":"110","author":"Carabini LM","year":"2018","unstructured":"Carabini LM, Moreland NC, Vealey RJ,  A randomized controlled trial of low-dose tranexamic acid versus placebo to reduce red blood cell transfusion during complex multilevel spine fusion surgery. World Neurosurg. 2018;110:e572\u2013e579."},{"key":"b15","series-title":"World Neurosurg","first-page":"289","article-title":"Does tranexamic acid improve bleeding, transfusion, and hemoglobin level in patients undergoing multilevel spine surgery? A systematic review and meta-analysis","volume":"127","author":"Zhang Y","year":"2019","unstructured":"Zhang Y, Liu H, He F, Chen A, Yang H, Pi B. 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Br J Anaesth. 2017;118(3):380\u2013390."},{"issue":"3","key":"b19","series-title":"Asian Spine J","first-page":"484","article-title":"Minimal dose of tranexamic acid is effective in reducing blood loss in complex spine surgeries: a randomized double-blind placebo controlled study","volume":"12","author":"Shakeri M","year":"2018","unstructured":"Shakeri M, Salehpour F, Shokouhi G,  Minimal dose of tranexamic acid is effective in reducing blood loss in complex spine surgeries: a randomized double-blind placebo controlled study. Asian Spine J. 2018;12(3):484\u2013489."},{"issue":"5","key":"b20","series-title":"J Neurosurg Spine","first-page":"768","article-title":"The effectiveness of tranexamic acid on operative and perioperative blood loss in long-segment spinal fusions: a consecutive series of 119 primary procedures","volume":"32","author":"Pernik MN","year":"2020","unstructured":"Pernik MN, Dosselman LJ, Aoun SG,  The effectiveness of tranexamic acid on operative and perioperative blood loss in long-segment spinal fusions: a consecutive series of 119 primary procedures. 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The perioperative efficacy and safety of antifibrinolytics in adult spinal fusion surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2018;43(16):E949\u2013E958."},{"issue":"1","key":"b23","series-title":"Crit Care","first-page":"380","article-title":"Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis","volume":"25","author":"Murao S","year":"2021","unstructured":"Murao S, Nakata H, Roberts I, Yamakawa K. Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis. Crit Care. 2021;25(1):380."},{"issue":"1 suppl","key":"b24","series-title":"Global Spine J","first-page":"53S","article-title":"Anticoagulation and spine surgery","volume":"10","author":"Porto GBF","year":"2020","unstructured":"Porto GBF, Jeffrey Wessell DO, Alvarado A, Arnold PM, Buchholz AL. Anticoagulation and spine surgery. 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