Tranexamic Acid in Pediatric Idiopathic Scoliosis Surgery

Posterior spinal fusion for adolescent idiopathic scoliosis is associated with significant intraoperative blood loss and frequent need for blood transfusion. Tranexamic acid (TXA) is an antifibrinolytic agent that reduces bleeding, but optimal dosing strategies in pediatric scoliosis surgery remain unclear.

This study is a prospective, randomized, double-blind, placebo-controlled trial designed to evaluate the efficacy and safety of two intravenous TXA regimens compared with placebo in children undergoing surgical correction of idiopathic scoliosis.

Participants aged 10-18 years will be randomly assigned to receive either TXA or placebo during surgery. All patients will undergo standardized anesthesia, regional analgesia, and intraoperative neuromonitoring according to institutional protocols.

The primary objective is to assess the effect of TXA on perioperative blood loss. Secondary objectives include evaluation of transfusion requirements, laboratory parameters, and safety outcomes.

Patients will be followed for 30 days after surgery to assess postoperative outcomes and adverse events.

Inclusion criteria

• Age 10 to 18 years
• Diagnosis of idiopathic scoliosis requiring surgical correction (posterior spinal fusion)
• American Society of Anesthesiologists (ASA) physical status I-II
• Written informed consent from parents or legal guardians and assent from the child

Exclusion criteria

• Congenital or acquired coagulopathy
• History of thromboembolic disease
• History of seizures or epilepsy
• Known hypersensitivity to tranexamic acid
• Renal insufficiency (estimated glomerular filtration rate < 60 mL/min/1.73 m²)
• Cardiac arrhythmias or cardiovascular disease requiring antiplatelet or anticoagulant therapy