Scoliosis; Adolescence, Bleeding, Surgery
Conditions
Keywords
adolescent idiopathic scoliosis, fibrinogen concentrate, perioperative blood loss, transfusion
Brief summary
Allogeneic blood products transfusions are often necessary to treat perioperative bleeding in patients undergoing complex scoliosis surgeries. A prospective, randomized trial is designed to evaluate if the infusion of fibrinogen concentrate may reduce allogeneic blood transfusion in patients undergoing scoliosis surgery. Eligible patients will be randomly assigned to treatment group (fibrinogen concentrate infusion) and control group (normal saline infusion), and functional fibrinogen will be measured to guide the infusion of fibrinogen concentrate. Perioperative blood loss, intraoperative blood loss, and the amount of perioperative allogeneic blood transfusion will be compared between the two groups to determine the effect of fibrinogen concentrate infusion.
Detailed description
This is a prospective, randomized, double-blinded, placebo controlled trial to evaluate the effects of fibrinogen concentrate infusion on perioperative blood loss and the amount of perioperative allogeneic blood transfusion in patients undergoing scoliosis surgery. Recently, the inherent risks of blood, along with the continued rise in blood costs, activated the development and use of alternatives to blood transfusion. Fibrinogen concentrate may limit postoperative bleeding and lead to a significant reduction in allogeneic blood products transfusions in cardiac surgery and craniosynostosis surgery. However, the effect of fibrinogen concentrate in scoliosis surgery is still uncertain. Therefore, a prospective, randomized trial is designed to evaluate if the infusion of fibrinogen concentrate may reduce allogeneic blood transfusion in patients undergoing scoliosis surgery. Patients older than 12y/o with adolescent idiopathic scoliosis planed for elective posterior scoliosis correction surgery will be enrolled for this study after informed consent. Patients will be randomly assigned to a treatment group or a control group. Functional fibrinogen will be measured using TEG 5000 (Haemoscope Corp, IL, USA) at the start of surgery and the results of FLEV and MA will be recorded. After pedicle screw placement, a second functional fibrinogen will be measured and the patients in treatment group will receive fibrinogen concentrate (FIBRORAAS, Shanghai RAAS Blood Products Co, Ltd, Shanghai, China) 30mg kg-1. For safety concern, the maximum fibrinogen concentrate administration for each individual shall not exceed either 2g. Patients in the control group will receive placebo treatment with normal saline. After 15 minutes from fibrinogen concentrate or placebo administration, a third functional fibrinogen measurement will be performed to assess the effect of treatment. The following treatment will be guaranteed by the standard protocol in the presence of ongoing bleeding. Data includes all the demographics, preoperative conditions, procedure details, intraoperative data, and outcome measurements will be recorded. Additional data including FLEV and MA value, as well as fibrinogen values both preoperatively and at the arrival at wards. The primary endpoint of this study will be the total perioperative blood loss, and secondary endpoints will include: perioperative blood loss per fused level, intraoperative blood loss per fused level, the amount of postoperative drainage, the amount of postoperative drainage per fused level, total units of perioperative allogeneic pRBCs transfused, total volume of FFP transfused, total PLT units transfused. Safety endpoints will include operative mortality and perioperative thromboembolic complications.
Interventions
After start of surgery when all pedicle screws are placed, the patients in treatment group will receive fibrinogen concentrate 30mg kg-1. For safety concern, functional fibrinogen will be measured and the maximum fibrinogen concentrate administration for each individual shall not exceed 2g. Fibrinogen concentrate will be diluted in 100mL of sterile water and then be administered to patients.
DRUGNormal saline
100mL normal saline will be administered to patients in control group as placebo
Sponsors
Peking Union Medical College Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Masking description
After randomization, the unblinded independent investigator will be in charge of fibrinogen concentrate (drug) or placebo preparation, which will be performed in a laboratory next to the operating room. When the patient meets the inclusion criteria and is enrolled in the study, the functional fibrinogen tests will be done in the same laboratory by the same researcher, and drug or placebo will be prepared in sterile bags with opaque covers afterwards. Fibrinogen concentrate will be diluted in 100mL of sterile water or an equivalent volume of 0.9% saline solution as placebo and will be delivered to the operating room by the investigator. The anesthesiologists, the surgical staff, and the patients will all be blinded.
Eligibility
Sex/Gender
ALL
Age
12 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* patients diagnosed as adolescent idiopathic scoliosis * planed for elective posterior scoliosis correction surgery at Peking Union Medical College Hospital
Exclusion criteria
* preoperative anemia * preoperative congenital or acquired coagulopathy * ongoing anticoagulation therapy or drug intake that could cause bleeding * clinical signs or diagnosis of acute thromboembolism * emergency surgery * redo surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Perioperative blood loss | hospital stay up to 30 days | the total amount of intraoperative and postoperative blood loss |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative blood loss | From the time of skin incision until wound closure, assessed up to 12 hours | the amount of intraoperative blood loss |
| Intraoperative blood loss per fused level | From the time of skin incision until wound closure, assessed up to 12 hour | amount of intraoperative blood loss divided by the number of surgical fused levels |
| Postoperative drainage | hospital stay up to 30 days | the amount of postoperative drainage |
| Perioperative blood loss per fused level | hospital stay up to 30 days | amount of intraoperative and postoperative blood loss divided by the number of surgical fused levels |
| Perioperative allogeneic red blood cell (RBC) transfusion | hospital stay up to 30 days | total units of RBC transfused perioperatively |
| Perioperative plasma transfusion | hospital stay up to 30 days | total volume of plasma transfused perioperatively |
| Perioperative platelets transfusion | hospital stay up to 30 days | total units of platelets transfused perioperatively |
| Postoperative drainage per fused level | hospital stay up to 30 days | amount of postoperative drainage divided by the number of surgical fused levels |
Countries
China
Outcome results
None listed