This study will evaluate whether tranexamic acid (TXA), a medication used to reduce bleeding, is effective and safe in children undergoing surgery for idiopathic scoliosis. Significant blood loss is common during this type of surgery and often requires blood transfusions.

Participants will be randomly assigned to one of three groups: (1) TXA given as an intravenous bolus followed by continuous infusion, (2) TXA given as two intravenous bolus doses, or (3) placebo (saline). Neither the patients nor the medical team will know which treatment is given.

The main goal is to compare how much blood is lost during and after surgery and whether TXA reduces the need for blood transfusions. The study will also assess safety, including the risk of side effects such as seizures or blood clots.

Patients will be followed for up to 30 days after 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

Individual participant data (IPD) underlying the results reported in this study, after de-identification, will be shared. This includes demographic data, perioperative variables, laboratory results, and outcome measures. Supporting documents such as the study protocol and statistical analysis plan will also be available.

Data will be available beginning 6 months after publication of the primary results and ending 5 years after publication.

Data will be shared with researchers who provide a methodologically sound proposal. Proposals should be directed to the principal investigator. Data access will be granted following approval by the study investigators and after signing a data access agreement.