Tranexamic acid use is associated with reduced intraoperative blood loss during spine surgery for Marfan syndrome

Ijezie A. Ikwuezunma, Adam Margalit, Paul D. Sponseller

Research output: Contribution to journalComment/debatepeer-review


Purpose: The utility of tranexamic acid (TXA) in patients with Marfan syndrome (MFS) is uncertain given associated aberrations within the vasculature and clotting cascade. Therefore, this study aimed to assess the association of TXA use with intraoperative blood loss and allogeneic blood transfusions in patients with MFS who underwent spinal arthrodesis. Methods: We queried our institutional database for MFS patients who underwent spinal arthrodesis for scoliosis between 2000 and 2020 by one surgeon. We excluded procedures spanning < 4 vertebral levels, those using anterior or combined anterior/posterior approaches, and those involving growing rods, postoperative infection, or spondylolisthesis. Fifty-two patients met our criteria, of whom 22 were treated with TXA and 30 were not. Mean differences in blood loss, transfusion volume, and proportions receiving transfusion were compared between TXA and the control groups using Student t, chi-squared, or Fisher exact tests. Alpha = 0.05. Results: MFS patients treated with TXA experienced less mean (± standard deviation) intraoperative blood loss (1023 ± 534 mL) compared to the control group (1436 ± 1022 mL) (p = 0.01). The TXA group had estimated blood volume loss of 27% ± 16% compared to 36% ± 21% for controls (p = 0.05). No differences were found in allogeneic transfusion rate (p = 0.66) or transfusion volume (p = 0.15). Conclusions: We found an association between TXA use and reduced blood loss during surgical treatment of MFS-associated scoliosis, suggesting that the connective tissue deficiency in MFS does not interfere with TXA’s mechanism of action. Level of evidence: III.

Original languageEnglish (US)
Pages (from-to)419-423
Number of pages5
JournalSpine deformity
Issue number2
StatePublished - Mar 2022


  • Connective tissue deficiency
  • Intraoperative blood loss
  • Marfan syndrome
  • Posterior spinal arthrodesis
  • Risk modification
  • Syndromic scoliosis
  • Tranexamic acid

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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