Tranexamic Acid Was Not Associated With a Reduction in Bleeding Complications Related to Holmium Laser Enucleation of the Prostate.

OBJECTIVE: To compare outcomes in males given perioperative tranexamic acid (TXA) during holmium laser enucleation of the prostate (HoLEP) to a historical cohort that did not receive TXA. METHODS: Our cohort included HoLEP patients (N = 1037) from August 2018 through November 2022. Exclusion criteria included history of stroke, transient ischemic attack, or coronary stent placed within 18 months. The primary predictor was TXA during HoLEP. The primary outcome variable was a return to the operating room (RTOR) for bleeding. Secondary outcomes included catheter reinsertion, transfusion, and clotting complications. Multivariable models evaluating associations of TXA with outcomes were adjusted for potential confounders. RESULTS: In our cohort, 214/1035 had one or more complications with 81 having a Clavien-Dindo Grade of 3a or higher, 114/1037 with catheter reinsertion, 36/1037 RTOR for bleeding, and 15/1035 had a transfusion. TXA use was not associated with 30-day RTOR. 3.7% of those without TXA had a RTOR, and 3.1% of those with TXA had a RTOR (adjusted odds ratio 0.63, 95% CI 0.28-1.38, P = .25). Transfusion rates were higher for those without TXA (2.0%) compared to with (0.5%). This was statistically significant after adjustment (adjusted odds ratio 0.13, 95% CI 0.03-0.69, P = .016) and after correction for multiple testing (corrected P = .048). TXA use was not associated with catheter reinsertion or clotting complications. CONCLUSION: Routine perioperative intravenous TXA in HoLEP patients was not associated with a reduction of RTOR for bleeding, catheter reinsertion, or clotting complications. TXA was associated with decreased transfusions with a low overall event rate of 1.4%.

Evaluating the effect of tranexamic acid as mesotherapy on persistent post-acne erythema: A before and after study.

BACKGROUND: Acne vulgaris is a common skin disease that is more common in young population and it can be associated with some sequels after resolving the lesions. Post-inflammatory erythema is one of these complications that can be disturbing for patients and does not have any definite treatment. This study was aimed to evaluate the efficacy and safety of tranexamic acid (TA) as mesotherapy in treatment of post-acne erythema (PAE) treatment. METHOD: This clinical trial study was performed in the dermatology clinic on 17 patients with persistent PAE (3 months after acne recovery). Two sessions of treatment were performed by a physician with 2-week intervals; TA was injected as mesotherapy into the right side of each patient's face as the case group, while the opposite side was used as the control group. A Visioface device was used to compare before and after treatment photographs of each side of the face in color mode with quantitative measures such as lesions count, area, and area percent. RESULTS: Finally, 15 patients completed treatment sessions. There were statistically significant differences in right side lesions before and after treatment with p-values of 0.047, 0.002, and 0.035 for count, area, and area percent, respectively. There was no significant difference before and after treatment in terms of count, area. and area-percent on the left side. CONCLUSION: According to the results of this study, TA injection as mesotherapy for resolving PAE can be effective. However, due to small sample size, further studies are needed.

[Perioperative hemostatic therapy in geriatric patients in urology.]

The aim of the study was to evaluate the effectiveness of the use of tranexamic acid in the prevention of intraoperative hemorrhagic complications in geriatric patients with bioply transurethral resection of the prostate (BTURP). The patients were divided into 2 groups by the envelope method. Patients of the first group (control group, n=42) did not receive tranexamic acid infusion. Patients of the second group (main group, n=42) received pre-intraoperative infusion of tranexamic acid at a dose of 2 mg/kg. All patients underwent BTURP on endoscopic equipment according to the standard technique under spinal anesthesia. The groups were compared according to the following criteria: the volume of intraoperative blood loss, the level of erythrocytes, platelets and hemoglobin, indicators of hemostasis, thromboelastography before and after surgery. It was established that the perioperative use of tranexamic acid allowed to significantly reduce the volume of blood loss in BTURP. The method of thromboelastography, due to quantitative and qualitative characteristics, is able to assess how the effectiveness of the use of a fibrinolysis inhibitor is achieved.

A prospective randomized controlled trial of Q-switched Nd:YAG laser with topical 3% tranexamic acid (TA) versus microneedling with topical 3% tranexamic acid (TA) in treatment of melasma.

INTRODUCTION: Treatment of melasma is challenging. Topical TA has shown promising results as an adjuvant, when combined with microneedling or QS Nd:YAG laser. The efficacy of both combinations has been demonstrated but the efficacy between these two combinations has never been compared. AIM AND OBJECTIVES: To compare the efficacy and side effects of microneedling and QS Nd:YAG laser when combined with topical 3% TA gel. MATERIALS AND METHODS: 60 patients were randomized into 2 groups. Group A received Nd:YAG laser sessions monthly with daily 3% TA gel while Group B underwent microneedling monthly with daily 3% TA gel. A total of 5 sessions were given with follow-up after 2 months. Evaluation using modified Melasma Area and Severity Index (mMASI), Patient satisfaction score, and photography was done at baseline, 3rd session, 5th session, and final follow-up. RESULTS: Mean fall in mMASI at follow-up in Group A was 5.12 ± 2.66 to 2.33 ± 1.33 and Group B was 4.60 ± 2.38 to 1.88 ± 1.08 (p < 0.001). Patient satisfaction score was not significantly different. Side effects of both interventions included erythema, pain, and burning sensation. CONCLUSION: Our study shows equal efficacy of microneedling and QS Nd:YAG laser when combined with topical 3% TA gel in treating melasma without serious side effects. Microneedling has more downtime and maybe less preferable as a lunchtime procedure.

Microneedling as an adjuvant to topical therapies for melasma: A systematic review and meta-analysis.

BACKGROUND: Microneedling as an adjuvant to topical medications has shown promising but variable results in the treatment of melasma. OBJECTIVE: To conduct a systematic review and meta-analysis on the efficacy of microneedling as an adjuvant to topical therapies for the treatment of melasma. METHODS: This study followed PRISMA guidelines. All comparative, prospective studies on the use of topical interventions with microneedling for the treatment of melasma were included. Studies involving radiofrequency microneedling were excluded. RESULTS: Twelve eligible studies comprising 459 patients from 7 different countries were included. Topical therapies included topical tranexamic acid, vitamin C, platelet-rich plasma, non-hydroquinone-based depigmentation serums, and hydroquinone-based depigmenting agents. Topical therapy with microneedling improved melasma severity with a large effect (standardized mean difference >0.8) beyond 8 weeks, with best results seen at 12 weeks. Compared to topical therapy alone, topical therapy with microneedling resulted in an additional improvement in melasma severity with a moderate effect at 8 weeks and a large effect at 12-16 weeks. Microneedling was well tolerated across studies, with no serious adverse events reported. LIMITATIONS: Heterogeneity in study designs did not allow for a comparison of the efficacy of various topical therapies with microneedling. CONCLUSION: Microneedling is useful adjuvant to topical therapies for the treatment of melasma.

Feasibility of oral tranexamic acid for vitiligo patients with melasma.

Melasma and vitiligo are both common pigmentary disorders, and the treatment is challenging. Oral tranexamic acid (TA) is effective for refractory melasma; however, the feasibility of TA in vitiligo patients with melasma was not studied. To evaluate the treatment outcomes and adverse effects of oral TA in vitiligo patients with melasma. We conducted a retrospective analysis of vitiligo patients who received oral TA for melasma in a tertiary dermatologic center from January 2017 to August 2020. We enrolled 32 patients with concomitant vitiligo and melasma on the face. The mean duration of the improvement of melasma that patients reported is around 1.64 months of treatment. The first sign of repigmentation of the vitiligo lesions occurred at 1 month of treatment. 84.38% of the patients achieved a mild to good degree of improvement of melasma (0%-75% improvement), whereas 81.25% of the patients achieved a moderate to excellent degree of improvement of vitiligo (25%-100% improvement) via physician global assessments. No significant adverse event was noted. No patients experience vitiligo disease deterioration during TA treatment. Oral TA may be a feasible option for melasma in vitiligo patients.

Clinical evaluation of efficacy and tolerability of cysteamine 5% cream in comparison with tranexamic acid mesotherapy in subjects with melasma: a single-blind, randomized clinical trial study.

This study was aimed at evaluating the efficacy of Tranexamic Acid (TA) mesotherapy versus cysteamine 5% cream in the treatment of melasma. This single-blind, randomized clinical trial was conducted among 54 subjects between 2018 and 2019. Cysteamine 5% cream group was instructed to apply the cream on the melasma lesions 30 min before bed for 4 consecutive months. Conversely, 0.05 mL (4 mg/mL) TA mesotherapy was performed by a physician every 4 weeks until 2 months. The severity of melasma was evaluated using both Dermacatch® device and the modified Melasma Area Severity Index (mMASI). The most remarkable improvement rate was observed in the TA group at the third visit based on mMASI and Dermacatch® values at 47% and 15% in turn. The mMASI scores were substantially improved in both groups at the second visit (cysteamine vs TA 8.48 ± 2.34 and 7.03 ± 3.19; P = 0.359) and third visit (cysteamine vs TA 6.32 ± 2.11 and 5.52 ± 2.55; P = 0.952) as compared to baseline (cysteamine vs TA: 11.68 ± 2.70 and 10.43 ± 2.69). Dermacatch® values were significantly declined at the second and third visits (cysteamine vs TA 42.54 ± 12.84 and 38.75 ± 9.80, P = 0.365; 40.74 ± 12.61 and 36.17 ± 10.3, P = 0.123, respectively) compared with baseline (cysteamine vs TA 45.76 ± 13.41 and 42.41 ± 10.48), although the improvement rates between two groups were not significantly different. Findings suggest that none of the cysteamine and TA mesotherapy treatments measured by both mMASI and Dermacatch® methods have substantial advantages over the other; however, complications are less in the cysteamine than the TA mesotherapy group.

The Vascular Component of Melasma: A Systematic Review of Laboratory, Diagnostic, and Therapeutic Evidence.

BACKGROUND: Melasma is a common acquired disorder of hyperpigmentation, classically manifesting as symmetric brown patches on the face. Although the exact pathogenesis is not fully understood, vascular abnormalities have been implicated in melasma. OBJECTIVE: To evaluate the laboratory and clinical evidence regarding the safety and efficacy of antivascular agents for the treatment of melasma. METHODS: A systematic review of PubMed, EMBASE, and Cochrane was conducted on May 13, 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Original research articles investigating the role of vascularity and/or evaluating the use of antivascular therapeutics in melasma were included. Clinical recommendations were based on the American College of Physicians guidelines. RESULTS: A total of 34 original research articles as follows were identified: 4 laboratory studies, 15 diagnostic studies, and 15 therapeutic studies. CONCLUSION: There is promising evidence supporting the use of tranexamic acid and laser/light therapies to treat the vascular component of melasma, and more rigorous clinical trials are needed to validate their efficacy. Clinicians may consider treatment with one or more antivascular therapeutics in patients with melasma. Further research is warranted to characterize the role of cutaneous vascularization in melasma and may provide insights for novel therapies.

Tranexamic Acid for Melasma Treatment: A Split-Face Study.

BACKGROUND: Melasma is an acquired hyperpigmented skin disorder. Tranexamic acid (TXA) prevents ultraviolet radiation induced pigmentation in melasma through interfering with the plasminogen-plasmin pathway. OBJECTIVE: This study was conducted to evaluate the therapeutic effect and safety of TXA by intradermal injection versus TXA with microneedling for melasma treatment. METHODS: Fifty-six female patients with bilateral symmetrical melasma were recruited in a split-face study. All patients received an intradermal injection of TXA on one side of the face, and the other side received TXA with microneedling for 6 sessions at 2 weeks intervals. Clinical efficacy was assessed using a modified Melasma Area Severity Index (mMASI) score at the baseline and after treatment. Global photographs underwent blinded review by 2 dermatologists. Patient self-assessment and satisfaction were recorded. RESULTS: After the treatment, the mMASI score was significantly reduced compared with the baseline in both treated sides (p < .001). No significant difference between both treated sides (p > .05). Patient satisfaction was higher in the microneedling-treated side than the intradermal-injected side (p < .001). No significant adverse effects were observed in both treated sides. CONCLUSION: Intradermal injection and microneedling of TXA could be safe and effective in melasma treatment. Microneedling of TXA was significantly more satisfying to the patients.

Efficacy and safety of oral tranexamic acid as an adjuvant in Indian patients with melasma: a prospective, interventional, single-centre, triple-blind, randomized, placebo-control, parallel group study.

BACKGROUND: Melasma is a chronic recalcitrant pigmentary disorder whose treatment frustrates physician and patient alike. Tranexamic acid, a plasmin inhibitor, has demonstrated hypopigmenting properties. AIM: To compare safety and efficacy of combination of oral tranexamic acid (TXA) and topical fluocinolone-based combination cream (FbTC) with that of topical FbTC alone in melasma. METHOD: One hundred and eighty patients patients of facial melasma of either sex attending dermatology OPD were screened. Consenting 130 participants were randomized into two blinded groups with 65 patients in each group. Group A patients received oral tranexamic acid 250 mg and oral ranitidine 150 mg twice daily and applied a triple combination cream containing fluocinolone acetonide 0.01%, tretinoin 0.05% and hydroquinone 2% once daily, and Group B was asked to take placebo tablets (calcium lactate and multivitamin) and apply the cream only for 12 weeks. Response was evaluated using modified melasma area severity index (mMASI) and graded mMASI improvement at 4th, 8th and 12th weeks, and at 24th week for recurrence. Data were analysed using SPSS software. RESULTS: Results were analysed in 120 patients who completed the study with 61 and 59 patients in group A and B, respectively. Demographic profile was equally distributed in both the groups. In group A, 13.1% patients showed marked improvement (>75%) in mMASI as compared to group B (1.7%) at 4th week. By 12th week, 65.6% patients had marked improvement in group A in contrast to only 27.1% in group B. At 24th week, group A (65.6%) had sustained improvement as compared to group B (11.9%) despite stopping treatment; all of which were statistically significant. Recurrence observed was 18.03% in group A vs. 64.4% in group B at 24th week. CONCLUSION: Oral tranexamic acid is definitely a boon to the armamentarium of melasma management and should be used as an adjuvant to fluocinolone-based triple combination cream for a faster, sustained improvement and to prevent recurrence.

Melasma: A critical analysis of clinical trials investigating treatment modalities published in the past 10 years.

BACKGROUND: Melasma is an acquired disorder of facial pigmentation which is a treatment challenge. AIMS: The aim of this article is to critically appraise the clinical trial evidence for different treatment modalities for melasma, published in peer-reviewed journals in the past 10 years. PATIENTS/METHODS: The literature review was conducted using PubMed and MEDLINE. The search was performed in July 2019, and search parameters were limited to all English language articles published in the past 10 years only. RESULTS: Eighty-nine clinical trials were found. Four clinical trials investigated topical hydroquinone, supporting its safety and efficacy as first-line treatment. Twelve studies showed tranexamic acid as very promising. Nineteen studies assessed various novel oral, injectable, and topical treatments and highlight some new potential future treatments. Forty-two studies investigated laser and light treatment in melasma: LFQS laser is still one of the best options, especially in darker skin types. However, the picosecond laser has shown excellent results. Finally, 11 studies looked at peels. Overall, peels have not been shown to be superior to the use of topical therapy alone. CONCLUSION: Topical therapy with a HQ and retinoid-based product should be first line for a minimum of 3 months with the addition of oral tranexamic acid at 250 mg BD if no contraindication. Second-line treatment with lasers includes the LFQS Nd:YAG, picosecond laser, and the pulsed dye laser in lighter skin types. Third-line therapy would be the addition of chemical peels to the above treatments, with GA or TCA peels having the most evidence for effectiveness.

Comparing the efficacy of Myjet-assisted tranexamic acid and vitamin C in treating melasma: A split-face controlled trial.

BACKGROUND: Melasma is a benign and chronic hypermelanosis characterized by irregular light brown to dark brown patches of hyperpigmentation on the skin. Oral tranexamic acid (TA) or vitamin C (VC) supplementation has been one treatment choice. TA interferes with keratinocyte-melanocyte interactions, and VC functions by reducing melanin production resulting in skin rejuvenation and whitening. AIM: The aim of the present study was to compare the efficacy and safety of Myjet assisted transdermal injection of TA vs VC in the treatment of melasma. METHODS: In this split-face controlled trial, 17 patients were randomized to receive eight weekly transdermal injections of TA or VC via Myjet either on the right or the left side of their face. MASI was measured from each side of the face at the baseline, at the middle, and at the end of treatment. RESULTS: A reduction in MASI was observed for TA and VC separately (P value < 0.05). The difference in efficacy between TA and VC group was not statistically significant (P value 0.05). Both treatments were well tolerated, with no serious adverse events reported. CONCLUSION: Weekly TA or VC transdermal injections can be an effective treatment for melasma. Further studies are required to validate these findings.

Incidence of Thromboembolic Events in Oncology Patients Receiving Intraoperative Tranexamic Acid During Orthopedic Surgery: A Retrospective Review at a Comprehensive Cancer Center.

Despite an abundance of evidence, routine perioperative antifibrinolytics have been avoided in oncology patients due to concern of thrombosis when given to patients with a preexisting hypercoagulable state. We present a retrospective review of 104 patients with an oncologic diagnosis who received intraoperative tranexamic acid during orthopedic surgery. Overall, complication rates were low, including deep vein thrombosis (1.0%), pulmonary embolism (4.8%), stroke (0%), and myocardial infarction (0%). This preliminary evidence shows that antifibrinolytics such as tranexamic acid may be considered perioperatively in oncology patients without increased risk of thromboembolic events; however, further prospective trials are encouraged.

The Efficacy and Safety of Prophylactic Intravenous Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Posterior Lumbar Interbody Fusion.

OBJECTIVE: To investigate the efficacy and safety of a prophylactic intravenous administration of tranexamic acid (TXA) 30 minutes before skin incision on perioperative blood loss in patients treated with posterior lumbar interbody fusion (PLIF). METHODS: A total of 63 patients who underwent PLIF were recruited and divided into a TXA group (n = 26) and a control group (n = 37). Intraoperative blood loss, postoperative blood loss, duration of tube drainage, hospitalization time, blood transfusion rate, and incidence of complications were compared between the 2 groups. RESULTS: There were no significant differences in the demographic characteristics and laboratory results between the 2 groups. The intraoperative blood loss, 24-hour postoperative drainage volume, 24-hour postoperative hidden blood loss, perioperative overt blood loss, hospitalization time, and postoperative duration of tube drainage were significantly reduced in the TXA group compared with the control group. In addition, the perioperative blood transfusion rate was lower in the TXA group (7.7%) than in the control group (16.22%), but the difference was not statistically significant. During a 3-month follow-up period, no pulmonary embolism, liver failure, or renal dysfunction was observed in the 2 groups. Likewise, the incidence of deep venous thrombosis was not found in the TXA group compared with 1 case in the control group, hence the difference was not statistically significant. CONCLUSIONS: A prophylactic intravenous administration of TXA 30 minutes before skin incision effectively reduces the perioperative blood loss, duration of tube drainage, and hospitalization time, and it does not increase the risk of complications. However, TXA may not be able to decrease the rate of blood transfusion.

The new therapeutic choice of tranexamic acid solution in treatment of erythematotelangiectatic rosacea.

BACKGROUND: Erythematotelangiectatic rosasea is a common,chronic, relapsing disease characterized mainly by vascular components, for which many therapies may exist but with limited efficacy. OBJECTIVES: We decided to test the efficacy of tranexamic acid when applied topically on the affected areas.,Tranexamic acid is an antifibrinolytic,thus we considered it could be effective at this type of rosacea. METHODS: This is an unblinded study. We included 20 patients, having erythematotelangiectatic rosacea. All patients were women between 27 and 65 years-old. We divided the patients in two groups,the first group was treated only with tranexamic acid solution (Transamin inj/sol 500 mg/5 mL) infused wet dressing for 20 minutes, and the second group was treated with microneedling simultaneously with tranexamic acid solution topical application followed by tranexamic acid solution infused dressing therapy,every 15 days for four sessions. RESULTS: The improvement assecion was outlined according to the Investigator Global Assessment of Rosacea Severity Score (IGA-RSS) and the use of clinical photos and dermoscopy. All patients were improved in the end of the therapy. There was statistically significant improvement, 2 units IGA-RSS in the first group, whereas 3 units IGA-RSS in the second group. The improvement lasted more than four months. The tolerability of the use of tranexamic acid was also asessed. CONCLUSIONS: According to our results a new really promising simple, safe and cheap treatment option targeting mainly to the vascular net and the erythema of rosacea is proposed.

[Safety and efficacy of intravenous tranexamic acid in endoscopic transurethral resections in urology: Prospective randomized trial]. / Intérêt de l'acide tranexamique dans les résections endoscopiques urologiques : étude prospective randomisée.

BACKGROUND: Endoscopic urological procedures (transurethral resection of the prostate TURP/transurethral resection of bladder tumor TURBT) are not without risk of significant bleeding. This risk is due to the vascular nature of the tissues and their high levels of fibrinolytic enzymes in the tissues and urine. This study was conducted to evaluate the safety and efficacy of the antifibrinolytic agent tranexamic acid (TXA) in reducing blood loss in patients undergoing TURP/TURBT and transfusion requirement. METHODS: This study was a prospective, randomized, double-blind, placebo controlled clinical trial. One hundred and thirty-one patients of ASA physical status I or II, undergoing TURP (60 patients) or TURBT (71 patients) were randomly allocated to receive IV TXA: bolus of 10mg/kg at the induction of anesthesia followed by infusion of 1mg/kg/h intraoperatively and for 24h postoperatively or an equal volume of saline (control group). Blood loss was evaluated in terms of reduction in the serum hemoglobin level (delta Hb=Hb H24-Hb H0). RESULTS: There was no difference between two groups in terms of transfusion requirements and episodes of retention. TXA did not significantly reduce mean blood loss compared with placebo during TURP (1.37±0.69 vs. 1.72±1.23g/dL respectively, P=0.256) or TURBT (1.15±0.95 vs. 1.07±0.88g/dL; P=0.532). No thrombotic complications were noted in any patient. CONCLUSION: Tranexamic acid did not reduce transfusion requirements or perioperative blood loss in transurethral resection of the prostate or bladder tumor. LEVEL OF EVIDENCE: 4.

Effects of five treatment regimens on blood loss and blood transfusion in total knee arthroplasty: a preliminary study in China
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OBJECTIVE: Our study is aimed to explore effects of five treatment regimens on blood loss and blood transfusion rate in total knee arthroplasty (TKA) patients. METHODS: 191 TKA patients were divided into the rivaroxaban, nadroparin, and tranexamic acid groups (n = 37 each) as well as into the affected-limb-position and tourniquet group (n = 40 each). A 3-month follow-up after operation was needed for all patients. The total blood loss, hidden blood loss, and dominant blood loss were recorded, and hemoglobin and red blood cell changes, pain and knee swelling degrees, hospital for special surgery (HSS), and American knee society (KSS) knee scores were observed. RESULTS: When compared with the rivaroxaban, nadroparin, and tourniquet groups, TKA patients' dominant blood loss, hidden blood loss, total blood loss, rate and volume of blood transfusion in the tranexamic acid and affected-limb-position groups were significantly decreased. While 7 days after operation, the hemoglobin and red blood cells in the tranexamic acid and affected-limb-position groups were significantly increased. At 1 month and 3 months after operation, when compared with the rivaroxaban, nadroparin, and tourniquet groups, the HSS and KSS scores in the tranexamic acid and affected-limb-position groups were all increased. In comparison with the rivaroxaban, nadroparin, and tourniquet groups, the D-Dimers after operation in the tranexamic acid and affected-limb-position groups were significantly lower. CONCLUSION: These results demonstrated that for TKA patients, the tranexamic acid and affected-limb-position could obviously reduce the blood loss and blood transfusion rate.
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Are antifibrinolytics helpful in decreasing blood loss and transfusions during spinal fusion surgery in children with cerebral palsy scoliosis?

STUDY DESIGN: Therapeutic comparative study. OBJECTIVE: To evaluate the safety and efficacy of antifibrinolytic (AF) agents in reducing blood loss and transfusions during posterior spinal fusion (PSF) in children with cerebral palsy (CP) scoliosis. SUMMARY OF BACKGROUND DATA: Scoliosis surgery in CP children is associated with substantial blood loss. Few reports on the role of AFs exist. METHODS: A multicenter, retrospective review of a prospectively collected database of 84 consecutively enrolled patients with CF (age < 18 years) with spinal deformity who underwent PSF and instrumentation. The use of AFs, tranexamic acid (TXA), epsilon-aminocaproic acid (EACA), or none was based on the surgeon preference. Estimated blood loss (EBL), transfusion requirements, and length of stay were recorded. Analysis was performed with the independent-samples t test and 1-way analysis of variance with post hoc Bonferroni analysis. RESULTS: The average age at the time of surgery was 14.4 ± 2.6 years. The groups were well matched in preoperative major deformity, age, levels fused, and operating time. Forty-four patients received AFs (30 TXA and 14 EACA), and 40 received no antifibrinolytics (NAF). The EBL averaged 1684 mL for the AFs group and 2685 mL for the NAF group (P = 0.002). There was more cell salvage transfusion in the NAF group. No significant differences were found in total transfusion requirements. There was a trend for decreased hospital stay in the AFs group. No adverse effects were seen. On comparison of the 3 groups (NAF, TXA, and EACA), a significant difference was observed between the TXA and the other groups with respect to EBL and cell salvage transfusion. CONCLUSION: AFs significantly reduced intraoperative EBL associated with PSF, with no adverse effects; however, we could not demonstrate significant differences in total transfusion, except in cell salvage. TXA was more effective than EACA in decreasing the EBL and cell salvage transfusion.