Antifibrinolytic Therapy in Complex Spine Surgery: A Case-Control Study Comparing Aprotinin and Tranexamic Acid

Abstract

A case-control study was performed to determine the impact of aprotinin or tranexamic acid use on reducing intraoperative blood loss and transfusion needs in complex spine surgery. Sixty-nine patients undergoing complex spine surgery received aprotinin or tranexamic acid. The aprotinin group contained 30 patients (8 men and 22 women) and the tranexamic acid group 39 patients (11 men and 28 women). The following variables were recorded: duration of surgery, number of levels fused, intraoperative and total blood loss, and number of blood units transfused (autologous and allogenic). In addition, various parameters related to blood loss in this type of surgery were calculated. The groups differed with regard to duration of surgery (aprotinin 662 min vs tranexamic acid 448 min, PϽ.001) and number of levels fused (aprotinin 11.2 vs tranexamic acid 7.6, Pϭ.004). There were no signifi cant differences in intraoperative blood loss (aprotinin 2118 mL vs tranexamic acid 1608 mL, Pϭ.066) or total blood loss (aprotinin 3312 mL vs tranexamic acid 2627 mL, Pϭ.056). Statistical differences were found for the number of autologous blood units transfused (aprotinin 2.2 vs tranexamic acid 1.3 Pϭ.047) and total units transfused (aprotinin 4.1 vs tranexamic acid 2.6, Pϭ.008). Blood loss per hour of surgery, transfused units per level fused and transfused units per hour of surgery were similar in the 2 groups. Signifi cant differences were found for intraoperative blood loss per fusion level (aprotinin 228 mL vs tranexamic acid 428, Pϭ.025) and total blood loss per fusion level (aprotinin 360 mL vs tranexamic acid 638 mL, Pϭ.01). Analysis of the applied geometric mean showed that aprotinin reduced total blood loss by 16.4% and total number of blood units transfused by 12.4% as compared to tranexamic acid, although statistical signifi cance was not reached. The type of antifi brinolytic used did not have a signifi cant impact on the main outcome variables of the study.

Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study

“…Therefore the total transfusion rate was 2.6. The authors found that the duration of surgery was the main predictive factor of total blood loss among the patients [ 23 ].…”

Systemic and Topical Use of Tranexamic Acid in Spinal Surgery: A Systematic Review

“…ivTXA has also been used for hemostasis in cervical spinal procedures and spinal tumor surgery 63 64 ; several RCTs have demonstrated its beneficial effects in overall complex spinal surgery procedures. 65 66 An RCT conducted by Elwatidy et al involving patients ( n = 64) undergoing different kinds of major, mostly multilevel, spinal surgery used a high-dose protocol (2 g loading dose for adults or 30 mg/kg for children, followed by a maintenance dose of 100 mg/h for adults or 1 mg/kg/h for children) of ivTXA, which was continuously administered up to 5 hours after the surgery. 65 Total blood loss in the treatment group was reduced by almost half, with a 48% reduction intraoperatively and 55% reduction in postoperative drain output.…”

Effect of intravenous tranexamic acid on perioperative bleeding and transfusion in spine surgery: systematic review and meta-analysis of randomized controlled trials

“…Most studies reported detailed information regarding the randomization techniques that were used, such as manual random number selection or computer-generated random number table; Xu et al [20] did not specify a randomization method. Allocation concealment was high in 4 studies [1,2,20,21] and low in the others. The studies by Taghaddomi et al [22] and Xu et al [20] were rated as unclear to blinding of the participants and the outcome assessor.…”