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APPLICATION OF TRANEXAMIC ACID FOR THE PERIOPERATIVE PERIOD OF PATIENTS UNDERGOING SCOLIOSIS CORRECTION SURGERY

WENPENG LI 1#, JINGTAO GUAN 1#, YINGXUE GUO 2, JIAZHI WANG 3, YEQIU WANG 3, YAN QU 3*

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This study aimed to investigate the efficacy of tranexamic acid (TXA) for the perioperative period of patients undergoing scoliosis correction surgery. 355 patients with scoliosis who were admitted to The Second Affiliated Hospital of Jiamusi University, China, from January 30, 2017, to January 30, 2019, were randomly divided into five groups: experimental group 1 (S1), experimental group 2 (S2), experimental group 3 (S3), experimental group 4 (S4) and control group (D0). Patients in experimental groups were treated with different doses of TXA (15, 30, 45 and 60 mg/kg bw) intravenously, 30 minutes before surgery and sustained infusion of 15 mg/kg bw/h TXA from the beginning until the end of the operation. Patients in D0 group received 30 mg/kg bw normal saline as control. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), haemoglobin, platelet (PT), intraoperative blood loss and postoperative drainage volume in all groups were detected before and after the operation. Plasma levels of tumour necrosis factor-α (TNF-α), interleukin-1 (IL-1), IL-6 and IL-8 were measured in S2 group and D0 group before, during and after the operation, and then, postoperative complications were recorded. The results showed that the PT, APTT and TT postoperative levels in D0 group were significantly increased compared with the levels in S2, S3 and S4 groups, and the FIB postoperative level significantly decrease compared with the level in S2, S3 and S4 groups. Postoperative levels of haemoglobin and PT in the D0 group were significantly lower compared with the levels in the S1, S2, S3 and S4 groups. The intraoperative blood loss and postoperative drainage volume in the S1 group were significantly increased compared with the levels from S2, S3 and S4 groups. The dose of 60 mg/kg bw TXA determines an increase of cases with complicated embolism compared with lower doses. The optimal dose of TXA was set at 30 mg/kg bw. The plasma levels of TNF-α, IL-1, IL-6 and IL-8 in S2 group were significantly decreased compared with the control group, indicating that the use of low doses of TXA can effectively reduce perioperative bleeding without increasing the risk of complications. In conclusion, 30 mg/kg bw is the optimal dose of TXA showing anti-inflammatory effects at different stages of the systemic inflammatory response induced by surgery.