{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T19:57:21Z","timestamp":1772827041626,"version":"3.50.1"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Intraoperative antifibrinolytic therapy with tranexamic acid (TXA) is a focus of interest for blood loss reduction in multilevel adult spinal deformity (ASD) correction surgery. There is considerable heterogeneity in the reported findings regarding the safety and efficacy of this therapy. In the present study, the authors aimed to rigorously investigate the safety and efficacy of TXA in multilevel ASD correction surgery and to explore secondary perioperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective cohort study used data from the authors\u2019 institutional spine deformity database, including records of surgeries performed between January 1, 2013, and December 13, 2021, with a minimum follow-up of 2 years. Adult patients undergoing elective thoracolumbosacral posterior spinal fusion involving 6 or more vertebrae were included. The primary outcome was the safety and efficacy of TXA, with secondary outcomes including postoperative complications and overall outcomes. Propensity-scored stabilized inverse probability of treatment weighting was used to adjust for confounding factors. Subsequent weighted analysis of the treatment effect was performed using regression models for hypothesis testing, with 95% confidence intervals calculated based on weighted means, variances, and standard errors. The p values of primary outcomes and subgroup analyses were adjusted for multiplicity testing with the Benjamini-Hochberg correction at a false discovery rate of 0.05. The conduct and reporting of this study were supported by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The study included 598 patients, with 257 receiving TXA and 341 controls. Weighted analysis revealed that TXA administration was associated with significant reductions in estimated blood loss (p = 0.007), percentage of estimated blood volume lost (p = 0.035), intraoperative total red blood cell transfusion volume (p = 0.035), and postoperative packed red blood cells transfusion volume (p = 0.035). No significant differences were observed in postoperative thromboembolic events (p = 0.397).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>TXA was significantly associated with reduced blood loss and transfusion requirements in multilevel ASD correction surgery without increasing the risk of thromboembolic complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.10.spine24701","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T21:07:35Z","timestamp":1738962455000},"page":"481-489","source":"Crossref","is-referenced-by-count":1,"title":["Intravenous tranexamic acid and reduction in blood loss and perioperative transfusion requirements in adult spinal deformity: a multicenter propensity-scored observational study"],"prefix":"10.3171","volume":"42","author":[{"given":"Mert Marcel","family":"Dagli","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Connor A.","family":"Wathen","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua L.","family":"Golubovsky","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yohannes","family":"Ghenbot","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John D.","family":"Arena","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Heintz","sequence":"additional","affiliation":[{"name":"Biostatistics Analysis Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominick","family":"Macaluso","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabrielle","family":"Santangelo","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zarina S.","family":"Ali","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jang W.","family":"Yoon","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William C.","family":"Welch","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Arlet","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali K.","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"J Neurosurg Spine","first-page":"667","article-title":"Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors","volume":"15","author":"Acosta FL Jr","year":"2011","unstructured":"Acosta FL Jr, McClendon J Jr, O\u2019Shaughnessy BA,  Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. J Neurosurg Spine. 2011;15(6):667\u2013674."},{"issue":"9","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"1082","article-title":"Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population","volume":"30","author":"Schwab F","year":"2005","unstructured":"Schwab F, Dubey A, Gamez L,  Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005;30(9):1082\u20131085."},{"issue":"3","key":"b3","series-title":"Neurosurgery","first-page":"378","article-title":"Analysis of national rates, cost, and sources of cost variation in adult spinal deformity","volume":"82","author":"Zygourakis CC","year":"2018","unstructured":"Zygourakis CC, Liu CY, Keefe M,  Analysis of national rates, cost, and sources of cost variation in adult spinal deformity. Neurosurgery. 2018;82(3):378\u2013387."},{"issue":"1","key":"b4","series-title":"Spine Deform","first-page":"141","article-title":"Multilevel arthrodesis for adult spinal deformity: when should we anticipate major blood loss","volume":"7","author":"Raad M","year":"2019","unstructured":"Raad M, Amin R, Jain A, Frank SM, Kebaish KM. Multilevel arthrodesis for adult spinal deformity: when should we anticipate major blood loss? Spine Deform. 2019;7(1):141\u2013145."},{"issue":"2","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"235","article-title":"Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls","volume":"35","author":"Baldus CR","year":"2010","unstructured":"Baldus CR, Bridwell KH, Lenke LG, Okubadejo GO. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls. 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J Bone Joint Surg Am. 2018;100(9):758\u2013764."},{"issue":"4","key":"b12","series-title":"Spine J","first-page":"647","article-title":"Preliminary investigation of high-dose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery","volume":"15","author":"Xie J","year":"2015","unstructured":"Xie J, Lenke LG, Li T,  Preliminary investigation of high-dose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery. Spine J. 2015;15(4):647\u2013654."},{"issue":"9596","key":"b13","series-title":"Lancet","first-page":"1453","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm E","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453\u20131457."},{"issue":"2","key":"b14","series-title":"Surgery","first-page":"224","article-title":"Prediction of blood volume in normal human adults","volume":"51","author":"Nadler SB","year":"1962","unstructured":"Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51(2):224\u2013232."},{"issue":"17","key":"b15","series-title":"J Bone Joint Surg Am","first-page":"1627","article-title":"Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis","volume":"93","author":"Koutsoumbelis S","year":"2011","unstructured":"Koutsoumbelis S, Hughes AP, Girardi FP,  Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. 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Transfusion. 2013;53(11):2790\u20132794."},{"issue":"6","key":"b1","series-title":"J Neurosurg Spine","first-page":"667","article-title":"Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors","volume":"15","author":"Acosta FL Jr","year":"2011","unstructured":"Acosta FL Jr, McClendon J Jr, O\u2019Shaughnessy BA,  Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. J Neurosurg Spine. 2011;15(6):667\u2013674."},{"issue":"9","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"1082","article-title":"Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population","volume":"30","author":"Schwab F","year":"2005","unstructured":"Schwab F, Dubey A, Gamez L,  Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005;30(9):1082\u20131085."},{"issue":"3","key":"b3","series-title":"Neurosurgery","first-page":"378","article-title":"Analysis of national rates, cost, and sources of cost variation in adult spinal deformity","volume":"82","author":"Zygourakis CC","year":"2018","unstructured":"Zygourakis CC, Liu CY, Keefe M,  Analysis of national rates, cost, and sources of cost variation in adult spinal deformity. Neurosurgery. 2018;82(3):378\u2013387."},{"issue":"1","key":"b4","series-title":"Spine Deform","first-page":"141","article-title":"Multilevel arthrodesis for adult spinal deformity: when should we anticipate major blood loss","volume":"7","author":"Raad M","year":"2019","unstructured":"Raad M, Amin R, Jain A, Frank SM, Kebaish KM. Multilevel arthrodesis for adult spinal deformity: when should we anticipate major blood loss? Spine Deform. 2019;7(1):141\u2013145."},{"issue":"2","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"235","article-title":"Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls","volume":"35","author":"Baldus CR","year":"2010","unstructured":"Baldus CR, Bridwell KH, Lenke LG, Okubadejo GO. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls. Spine (Phila Pa 1976). 2010;35(2):235\u2013239."},{"key":"b6","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."},{"issue":"1","key":"b7","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."},{"issue":"15","key":"b8","series-title":"Drugs","first-page":"1679","article-title":"The safety and efficacy of tranexamic acid in adult spinal deformity surgery: a systematic review and meta-analysis","volume":"79","author":"Hariharan D","year":"2019","unstructured":"Hariharan D, Mammi M, Daniels K,  The safety and efficacy of tranexamic acid in adult spinal deformity surgery: a systematic review and meta-analysis. Drugs. 2019;79(15):1679\u20131688."},{"issue":"6","key":"b9","series-title":"Eur Spine J","first-page":"1121","article-title":"Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery","volume":"21","author":"Khurana A","year":"2012","unstructured":"Khurana A, Guha A, Saxena N, Pugh S, Ahuja S. Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery. Eur Spine J. 2012;21(6):1121\u20131126."},{"issue":"8","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"E443","article-title":"Antifibrinolytics reduce blood loss in adult spinal deformity surgery: a prospective, randomized controlled trial","volume":"40","author":"Peters A","year":"2015","unstructured":"Peters A, Verma K, Slobodyanyuk K,  Antifibrinolytics reduce blood loss in adult spinal deformity surgery: a prospective, randomized controlled trial. Spine (Phila Pa 1976). 2015;40(8):E443\u2013E449."},{"issue":"9","key":"b11","series-title":"J Bone Joint Surg Am","first-page":"758","article-title":"Effect of tranexamic acid on blood loss, D-dimer, and fibrinogen kinetics in adult spinal deformity surgery","volume":"100","author":"Pong RP","year":"2018","unstructured":"Pong RP, Leveque JA, Edwards A,  Effect of tranexamic acid on blood loss, D-dimer, and fibrinogen kinetics in adult spinal deformity surgery. J Bone Joint Surg Am. 2018;100(9):758\u2013764."},{"issue":"4","key":"b12","series-title":"Spine J","first-page":"647","article-title":"Preliminary investigation of high-dose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery","volume":"15","author":"Xie J","year":"2015","unstructured":"Xie J, Lenke LG, Li T,  Preliminary investigation of high-dose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery. Spine J. 2015;15(4):647\u2013654."},{"issue":"9596","key":"b13","series-title":"Lancet","first-page":"1453","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm E","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453\u20131457."},{"issue":"2","key":"b14","series-title":"Surgery","first-page":"224","article-title":"Prediction of blood volume in normal human adults","volume":"51","author":"Nadler SB","year":"1962","unstructured":"Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51(2):224\u2013232."},{"issue":"17","key":"b15","series-title":"J Bone Joint Surg Am","first-page":"1627","article-title":"Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis","volume":"93","author":"Koutsoumbelis S","year":"2011","unstructured":"Koutsoumbelis S, Hughes AP, Girardi FP,  Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg Am. 2011;93(17):1627\u20131633."},{"issue":"18","key":"b16","series-title":"Spine (Phila Pa 1976)","first-page":"1247","article-title":"Postoperative blood salvage and autotransfusion for adult spinal deformity: a randomized controlled trial","volume":"45","author":"Nemani VM","year":"2020","unstructured":"Nemani VM, Kim HJ, Mina CA, Sheha ED, Ross T, Boachie-Adjei O. Postoperative blood salvage and autotransfusion for adult spinal deformity: a randomized controlled trial. Spine (Phila Pa 1976). 2020;45(18):1247\u20131252."},{"issue":"9","key":"b17","series-title":"J Clin Neurosci","first-page":"1579","article-title":"The effect of blood transfusion on short-term, perioperative outcomes in elective spine surgery","volume":"21","author":"Seicean A","year":"2014","unstructured":"Seicean A, Alan N, Seicean S, Neuhauser D, Weil RJ. The effect of blood transfusion on short-term, perioperative outcomes in elective spine surgery. J Clin Neurosci. 2014;21(9):1579\u20131585."},{"issue":"23","key":"b18","series-title":"J Bone Joint Surg Am","first-page":"2105","article-title":"The association between perioperative allogeneic transfusion volume and postoperative infection in patients following lumbar spine surgery","volume":"95","author":"Woods BI","year":"2013","unstructured":"Woods BI, Rosario BL, Chen A,  The association between perioperative allogeneic transfusion volume and postoperative infection in patients following lumbar spine surgery. J Bone Joint Surg Am. 2013;95(23):2105\u20132110."},{"issue":"11","key":"b19","series-title":"Transfusion","first-page":"2790","article-title":"Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery","volume":"53","author":"Guinn NR","year":"2013","unstructured":"Guinn NR, Broomer BW, White W, Richardson W, Hill SE. Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery. Transfusion. 2013;53(11):2790\u20132794."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/42\/4\/article-p481.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/42\/4\/article-p481.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/42\/4\/article-p481.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:44:08Z","timestamp":1772804648000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/42\/4\/article-p481.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":38,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2024.10.spine24701","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2025,4,1]]}}}