Blood loss and perioperative transfusions related to surgery for spinal tumors. Relevance of tranexamic acid

Damade, Camille; Tesson, Gaëtan; Gilard, V.; Vigny, S.; Foulongne, E.; Gauthé, Rémi; Ould-Slimane, Mourad

doi:10.1016/j.neuchi.2019.05.003

Cited by 16 publications

(21 citation statements)

References 35 publications

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“…36 Due to the increased overall perioperative risk associated with ABTs in spine surgery, as well as the intraoperative anesthesiological challenges in fluid and coagulation management, various strategies have aimed to decrease intraoperative blood loss in oncological spine surgery. 37 The literature shows that preoperative embolization 38,39 and use of antifibrinolytic agents, 40,41 or even rare invasive approaches, such as aortic balloon occlusion, 42,43 applied to decrease intraoperative blood loss. For adaptation of the surgical strategy by using minimally invasive or staged surgical approaches, embolization is the preoperative procedure that is most widely used at high-volume oncological spine centers, and a large retrospective review by Nair et al demonstrated that preoperative embolization can be safely applied.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative blood loss in oncological spine surgery

Mohme¹,

Mende²,

Pantel³

et al. 2021

Neurosurgical Focus

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OBJECTIVE Intraoperative blood loss in patients undergoing oncological spine surgery poses a major challenge for vulnerable patients. The goal of this study was to assess how the surgical procedure, tumor type, and tumor anatomy, as well as anesthesiological parameters, affect intraoperative blood loss in oncological spine surgery and to use this information to generate a short preoperative checklist for spine surgeons and anesthesiologists to identify patients at risk for increased intraoperative blood loss. METHODS The authors performed a retrospective analysis of 430 oncological patients who underwent spine surgery between 2013 and 2018 at the university medical spine center. Enrolled patients had metastatic tumor of the spine requiring surgical decompression of neural structures and/or stabilization including tumor biopsy using an open, percutaneous, and/or combined dorsoventral approach. Patients requiring vertebro- and kyphoplasty or biopsy only were excluded. Statistical analyses performed included a multiple linear regression analysis. RESULTS The mean intraoperative blood loss in the study patient cohort was 1176 ± 1209 ml. In total, 33.8% of patients received intraoperative red blood cell transfusions. The statistical analyses showed that tumor histology indicating myeloma, operative procedure length, epidural spinal cord compression (ESCC) score, tumor localization, BMI, and surgical strategy were significantly associated with increased intraoperative blood loss or risk of needing allogeneic blood transfusions. Anesthesiological parameters such as the American Society of Anesthesiologists (ASA) Physical Status classification score were not associated with blood loss. Multiple linear regression analysis demonstrated good predictive value (r = 0.437) for a five-item preoperative checklist to identify patients at risk for high intraoperative blood loss. CONCLUSIONS The analyses performed in this study demonstrated key factors affecting intraoperative blood loss and showed that a simple preoperative checklist including these factors can be used to identify patients undergoing surgery for metastatic spine tumors who are at risk for increased intraoperative blood loss.

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Section: Discussionmentioning

confidence: 99%

Intraoperative blood loss in oncological spine surgery

Mohme¹,

Mende²,

Pantel³

et al. 2021

Neurosurgical Focus

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“…As has been proven, TXA has the direct efficacy on reducing blood loss in many diseases (14,23). Certainly, there exist a large amount of research exploring the mechanism or clinical function of TXA in the ICH (24,25). They have estimated the efficacy and safety of TXA from different aspects, such as the systematic review conducted by Hu et al (26).…”

Section: Discussionmentioning

confidence: 99%

The Function of Tranexamic Acid to Prevent Hematoma Expansion After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis From Randomized Controlled Trials

et al. 2021

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Objectives: The clinical results caused by spontaneous intracerebral hemorrhage (ICH) are disastrous to most patient. As tranexamic acid (TXA) has been proved to decrease the influence of ICH, we conducted this research to explore the function of TXA for the prognosis of ICH compared with placebo.Methods: We searched MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov for randomized controlled trials (RCTs) that were performed to evaluate TXA vs. placebo for ICH up to February 2021. The data were assessed by Review Manager 5.3 software. The risk ratio (RR) and mean difference were analyzed using dichotomous outcomes and continuous outcomes, respectively, with a fixed effect model.Results: We collected 2,479 patients from four RCTs. Then, we took the change of hematoma volume, modified Rankin Scale (mRS), and adverse events as evaluation standard of the treatment for ICH. Through statistical analysis, we found that there is no obvious hematoma expansion effect after the application of TXA (RR = 1.05), and we proceeded the quantitative analysis of percentage change in hematoma volume from baseline, indicating that TXA could inhibit the expansion of hematoma volume (RR = −2.02) compared with placebo. However, according to the outcomes of mRS (0–1, RR = 1.04; 0–2, RR = 0.96), TXA cannot improve neurological functional prognosis. As for the security outcomes—mortality (RR = 1.02), thromboembolic events (RR = 0.99), neurological deterioration (RR = 0.92), infection (RR = 0.86), and craniotomy (RR = 0.41), there seems exist no statistical difference between TXA and placebo.Conclusions: TXA has an advantage in the aspect of preventing hematoma expansion compared with placebo for ICH, but cannot illustrate the efficacy of TXA in improving neurological functional prognosis, which still needs more researches with large sample sizes. Moreover, for safety, we did not find obvious statistical difference between TXA and placebo.

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“…The studies including patients with liver, prostate and gynecological cancer found a reduction in blood transfusion requirements during and after surgery in the TXA arms [36][37][38][39][40][41]. In contrast, antifibrinolytics did not influence bleeding outcomes in major orthopedic cancer surgery or in oncologic spinal canal, head and neck and neurosurgeries [42][43][44][45].…”

Section: Solid Tumorsmentioning

confidence: 99%

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Leader

Hofstetter

Spectre

2021

JCM

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Cancer patients have varying incidence, depth and duration of thrombocytopenia. The mainstay of managing severe chemotherapy-induced thrombocytopenia (CIT) in cancer is the use of platelet transfusions. While prophylactic platelet transfusions reduce the bleeding rate, multiple unmet needs remain, such as high residual rates of bleeding, and anticancer treatment dose reductions/delays. Accordingly, the following promising results in other settings, antifibrinolytic drugs have been evaluated for prevention and treatment of bleeding in patients with hematological malignancies and solid tumors. In addition, Thrombopoeitin receptor agonists have been studied for two major implications in cancer: treatment of severe thrombocytopenia associated with myelodysplastic syndrome and acute myeloid leukemia; primary and secondary prevention of CIT in solid tumors in order to maintain dose density and intensity of anti-cancer treatment. Furthermore, thrombocytopenic cancer patients are often prescribed antithrombotic medication for indications arising prior or post cancer diagnosis. Balancing the bleeding and thrombotic risks in such patients represents a unique clinical challenge. This review focuses upon non-transfusion-based approaches to managing thrombocytopenia and the associated bleeding risk in cancer, and also addresses the management of antithrombotic therapy in thrombocytopenic cancer patients.

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Blood loss and perioperative transfusions related to surgery for spinal tumors. Relevance of tranexamic acid

Cited by 16 publications

References 35 publications

Intraoperative blood loss in oncological spine surgery

Intraoperative blood loss in oncological spine surgery

The Function of Tranexamic Acid to Prevent Hematoma Expansion After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis From Randomized Controlled Trials

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

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