Acute normovolemic hemodilution in combination with tranexamic acid is an effective strategy for blood management in lumbar spinal fusion surgery

Li, Yang; Yan, Zhang; Fang, Xiutong

doi:10.1186/s13018-022-02950-8

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…In a multi institutional retrospective study by Rhee P et al of all trauma patients who received an autologous whole blood transfusion from the patient's hemothorax, which was collected from the chest tubes and anticoagulated with citrate phosphorus dextrose, significantly lower packed red blood cell and platelets transfusion were required 13 . ANH when combined with an antifibrinolytic agent, such as tranexamic acid (which we used in our study) assists in hemostasis 20 . Not surprisingly an enhanced hemostasis also decreased the need for allogeneic blood transfusions .…”

Section: Discussionmentioning

confidence: 99%

Acute Normovolemic Hemodilution (ANH) impacts postoperative coagulation profile and bleeding in Adult Cardiac Surgery

Shahbaz Ahmad Khilji,

Muhammad Fahad Ghaffar

2024

Proceedings S.Z.M.C

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Introduction: The coagulation profile of cardiac surgery patients is impacted by pro-inflammatory effects caused by procedures involving cardiopulmonary bypass. In order to counteract these effects, pharmacological therapies and allogeneic blood transfusions are required. The strategy of Acute normovolemic hemodilution also known as “intraoperative autologous donation” is also a viable option to address these negative effects. The theoretical basis for ANH is that the removed blood of a patient’s own self is shielded from the inflammatory response of blood cells to the bypass circuit. ANH is an infrequently practiced strategy at various cardiac surgery institutes within Pakistan to enhance coagulation profile, decrease the need for blood transfusions despite being an established approach abroad. Aims and Objectives: The objective of our study is to compare the effect of ANH on patients undergoing adult cardiac surgery in a sample group versus a control group with the primary endpoint of postoperative drain output as a measure of effectiveness of blood coagulation profile. Blood coagulation profiles were also compared between the two groups as secondary variables. Place and Duration of study: The study was conducted at the Faisalabad Institute of Cardiology from December 21st, 2023 to February 13th, 2024. Material and Methods: A randomized controlled trial involving 60 patients over the age of 12 years who were to undergo adult cardiac surgery was conducted. An online research randomizer software randomly selected them into two equal groups, sample and control (n=30). The ANH volume retrieved from the patient's central vein in the sample group was used to fill the CPD blood transfusion bags after administering anesthesia. After the patients in both groups were weaned off CPB and protamine administered to neutralize heparin, ANH blood was infused back into the patients in the sample group whereas the control group received allogenic blood only. Chi square test was applied to all qualitative variables and Independent Samples t-test for all quantitative variables. The results were analyzed using SPSS version 25, and a p-value ? 0.05 was considered statistically significant. Results: Hemoglobin (12.9±0.90 g/dL in ANH and 11.8±1.00 g/dL in non-ANH) and aPTT levels (34.2±6.06 seconds in ANH and 54.2±10.95 seconds in non-ANH) were statistically significant (p-value <0.01). In the ANH group, the mean value (623.3±86.28 mL) of postoperative drain output significantly decreased by approximately 220mL compared to the non-ANH group (842.3±99.26 mL) (p-value <0.01). Conclusion: ANH positively conserves most of the coagulation profile parameters. It assists in reducing postoperative bleeding and the volume of allogeneic blood required perioperatively in cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Acute Normovolemic Hemodilution (ANH) impacts postoperative coagulation profile and bleeding in Adult Cardiac Surgery

Shahbaz Ahmad Khilji,

Muhammad Fahad Ghaffar

2024

Proceedings S.Z.M.C

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“…Researchers also reported that TXA has showed better efficacy. A combination of TXA and acute normovolemic hemodilution might be an successful plan for reducing blood loss in patients undergoing lumbar spinal fusion surgery [ 16 ]. We organized this study by predicting that TXA can prevent the development of fibrosis by reducing bleeding into the epidural space.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore there are some clinical precautions and contraindications to intravenous use of TXA, such as a previous thromboembolic event, active intravascular clotting, subarachnoidal hemorrhage, and renal failure. Numerous studies submit that the administeration of intravenous TXA is successful for reducing surgical bleeding without an obvious increase in the risk of pulmonary embolism or thromboembolic complication in selected patients [ 16 , 31 , 32 ]. However, the side effects of the drug used in major surgeries such as spinal surgery should not be ignored.…”

Section: Discussionmentioning

confidence: 99%

“…TXA can be administered orally, intravenously, and topically, it was seen that the most common method of administration intravenously in the literature. There is no consensus on the method of administration and dosage [ 3 , 10 , 16 , 30 , 33 ]. Although there are many studies on TXA in the literature, to our knowledge no study to date has examined experimentally the effect of both topical and systemic TXA application in the formation of epidural fibrosis.…”

Section: Introductionmentioning

confidence: 99%

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Is Tranexamic Acid an Effective Prevention in the Formation of Epidural Fibrosis? Histological Evaluation in the Rats

Çirçi¹,

Atıcı²,

Barış³

et al. 2023

J Korean Neurosurg Soc

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Objective : The present study aimed to determine the topical and systemic efficacy of tranexamic acid (TXA) on epidural fibrosis in a rat laminectomy model.Methods : Thirty-two 12-month-old adult Sprague-Dawley rats were used in this study. Each rat underwent bilateral laminectomy at the L1 and L2 vertebral levels. Rats were divided into four groups : in group I (control group, n=8), a laminectomy was performed and saline solution was applied into the surgical space. In group II (topical group, n=8), laminectomy was performed and 30 mg/ kg TXA was applied to the surgical site before skin closure. In group III (systemic group, n=8), 30 mg/kg TXA was administered intravenously via the tail vein in the same session as the surgical procedure. In group IV (topical and systemic group, n=8), TXA was administered 30 mg/kg both topical and intravenous. The rats were sacrificed at 4 weeks postoperatively. Masson’s trichrome and hematoxylin and eosin were used to assess acute inflammatory cells, chronic inflammatory cells, vascular proliferation, and epidural fibrosis.Results : Epidural fibrosis, acute inflammation, chronic inflammation, and sum histologic score value were significantly lower in the systemic TXA group, systemic and topical TXA groups than in the control group (<i>p</i><0.05). In addion, the sum histologic score was significantly lower in the topical TXA group than in the control group (<i>p</i><0.05).Conclusion : In this study, epidural fibrosis formation was prevented more by systemic application, but the topical application was found to be effective when compared to the control group. As a result, we recommend the systemic and topical use of TXA to prevent epidural fibrosis during spinal surgery.

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“…Accumulated evidence suggests that tranexamic acid (TXA) can competitively bind to lysine binding sites on plasmin and plasminogen to prevent their activation, thereby inhibiting the activity of the fibrinolytic system and stabilizing the structure of fibrin, reducing bleeding secondary to hyperfibrinolysis, and reducing the production of D-dimer (D-D) (Fig. 1 ) 8 , 9 . At the same time, TXA could also reduce the inflammatory response by inhibiting vascular permeability, allergic reactions, and the production of kinin and other active peptides in inflammatory lesions 10 – 12 .…”

Section: Introductionmentioning

confidence: 99%

The effect of perioperative sequential application of multiple doses of tranexamic acid on postoperative blood loss after PLIF: a prospective randomized controlled trial

Dong,

Tang,

Lei

et al. 2024

International Journal of Surgery

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Background: Tranexamic acid (TXA) has been utilized in spinal surgery to effectively reduce intraoperative blood loss (IBL) and allogeneic blood transfusion rates. However, the traditional TXA regimen might last the entire duration of hyperfibrinolysis caused by surgical trauma, resulting in its limited ability to reduce postoperative blood loss (PBL). Therefore, the aim of this study was to investigate the effectiveness of perioperative sequential administration of multiple doses of TXA in reducing PBL in patients who underwent posterior lumbar interbody fusion (PLIF). Methods: From February 2022 to June 2023, 231 patients who were diagnosed with lumbar degenerative disease and scheduled to undergo PLIF were prospectively enrolled in the present study. The patients were randomly divided into three groups. Moreover, all patients received an intravenous injection of TXA at a dose of 15 mg/kg 15 min before surgical skin incision. Patients in Group A received a placebo of normal saline after surgery, while patients in Group B received three additional intravenous injections of TXA at a dose of 15 mg/kg every 24 h. Patients in Group C received three additional intravenous injections of TXA at a dose of 15 mg/kg every 5 h. The primary outcome measure was PBL. In addition, this study assessed total blood loss (TBL), IBL, routine blood parameters, liver and kidney function, coagulation parameters, fibrinolysis indexes, inflammatory indicators, drainage tube removal time (DRT), length of hospital stay (LOS), blood transfusion rate, and incidence of complications for all subjects. Results: The PBL, TBL, DRT, and LOS of Group B and Group C were significantly lower than those of Group A (P<0.05). The level of D-dimer (D-D) in Group C was significantly lower than that in Group A on the first day after the operation (P=0.002), and that in Group B was significantly lower than that in Group A on the third day after the operation (P=0.003). The interleukin-6 levels between the three groups from 1-5 days after the operation were in the order of Group A > Group B > Group C. No serious complications were observed in any patient. The results of multiple stepwise linear regression analysis revealed that PBL was positively correlated with incision length, IBL, smoking history, history of hypertension, preoperative fibrinogen degradation product (FDP) level, and blood transfusion. It was negatively correlated with preoperative levels of fibrinogen (FIB), red blood cells (RBCs), blood urea nitrogen (BUN), and age. Compared to female patients, male patients had an increased risk of PBL. Finally, the incidence of PBL was predicted. Conclusions: Sequential application of multiple doses of TXA during the perioperative period could safely and effectively reduce PBL and TBL, shorten DRT and LOS, reduce postoperative D-D generation, and reduce the postoperative inflammatory response. In addition, this study provided a novel prediction model for PBL in patients undergoing PLIF.

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Acute normovolemic hemodilution in combination with tranexamic acid is an effective strategy for blood management in lumbar spinal fusion surgery

Cited by 6 publications

References 26 publications

Acute Normovolemic Hemodilution (ANH) impacts postoperative coagulation profile and bleeding in Adult Cardiac Surgery

Acute Normovolemic Hemodilution (ANH) impacts postoperative coagulation profile and bleeding in Adult Cardiac Surgery

Is Tranexamic Acid an Effective Prevention in the Formation of Epidural Fibrosis? Histological Evaluation in the Rats

The effect of perioperative sequential application of multiple doses of tranexamic acid on postoperative blood loss after PLIF: a prospective randomized controlled trial

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