Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion

Li, Jianjiang; Wang, Long; Bai, Tao; Liu, Yanlu; Huang, Yifei

doi:10.1186/s13018-020-01758-8

Cited by 15 publications

(24 citation statements)

References 31 publications

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“…Based on the outcomes of pool of 5 studies, the most important finding of this meta-analysis was that the administration of TXA could significantly reduce total blood loss (MD = − 239.60, 95% CI − 332.74 to − 146.46, P < 0.00001) and wound complications (RR = 0.34, 95% CI 0.12 to 0.97, P = 0.04). This is consistent with the evidence that TXA can also reduce total blood loss in arthroplasty, spine, and other orthopedic surgeries [ 13 , 23 , 24 ]. Indeed, blood loss is inevitable when the medullary cavity is exposed during the tibial osteotomy.…”

Section: Discussionsupporting

confidence: 90%

The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis

Chen

et al. 2021

J Orthop Surg Res

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Objective The present meta-analysis was conducted to evaluate the efficacy and safety of the application of tranexamic acid (TXA) in patients undergoing high tibial osteotomy (HTO). Methods PubMed (MEDLINE), EMBASE, and Cochrane Library were systematically searched for relevant literature from inception until 1 February 2021. A combined searching strategy of subject words and random words was adopted. After testing for potential publication bias and/or heterogeneity, we aggregated variables by using the random-effect model. The primary comparison outcome measures were total blood loss, hemoglobin decrease, drain output, wound complications, thrombotic events, and blood transfusion rate of the TXA group versus control. The meta-analysis was performed using the RevMan 5.3 software. Results A total of 5 studies were included involving 532 patients. The results showed that there were significant differences in the two groups concerning total blood loss (95% confidence interval [CI] − 332.74 to − 146.46, P < 0.00001), hemoglobin decrease on postoperative day (POD) 1, 2, and 5 (POD 1 95% CI − 1.34 to − 0.63, P < 0.00001; POD 2 95% CI − 1.07 to − 0.68, P < 0.00001; POD 5 95% CI − 1.46 to − 0.84, P < 0.00001), drain output (POD total 95% CI − 195.86 to − 69.41, P < 0.00001) and wound complications (RR = 0.34, 95% CI 0.12 to 0.97, P = 0.04). Nonsignificant differences were found in the incidence of thromboembolic events (RR = 0.46, 95% CI 0.09 to 2.41, P = 0.36) and blood transfusion rate (RR = 0.25, 95% CI 0.03 to 2.27, P = 0.22). Conclusions This meta-analysis of the available evidence demonstrated that TXA could reduce total blood loss, hemoglobin decrease, drain output, and wound complications without increasing the incidence of thromboembolic events in patients undergoing HTO. But there is no obvious evidence that TXA could reduce blood transfusion rates. Further studies, including more large-scale and well-designed randomized controlled trials, are warranted to assess the efficacy and safety issues of routine TXA use in HTO patients.

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Section: Discussionsupporting

confidence: 90%

The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis

Chen

et al. 2021

J Orthop Surg Res

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“…It, as a synthetic antifibrinolytic drug, can reduce surgical bleeding by inhibiting fibrinolysis and stabilizing blood clots (8). Studies have reported that intravenous (iv)TXA can effectively reduce perioperative blood loss in PLIF (9)(10)(11)(12). Red blood cell (RBC), hemoglobin (HB) and hematocrit (HCT) are commonly used clinical indicators to monitor the course of anemia.…”

Section: Introductionmentioning

confidence: 99%

RBC, HB, HCT, CRP, and ESR at different postoperative periods after the application of intravenous unit dose transient acid in PLIF: A case control study

Hao¹,

Wang²,

Yue

et al. 2023

Front. Surg.

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BackgroundTranexamic acid (TXA) has been used in posterior lumbar interbody fusion (PLIF) and reduces blood loss. However, it has not been reported whether it will continue to affect postoperative red blood cells (RBC), hemoglobin (HB), hematocrit (HCT), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The purpose of this study was to observed the above indicators at different time after PLIF with unit dose intravenous (iv) TXA.MethodsThe data of 44 patients treated by single-segment PLIF from 2020.11 to 2022.3 were retrospectively analyzed. Observation group was given a unit dose of ivTXA (1 g/100 mL) 15 min before skin incision after general anesthesia. Patients without TXA were recorded as control group. Main observation indicators include RBC, HB, HCT, CRP and ESR on the 1st, 4th, 7th and last tested day after surgery. Secondary observation indicators include postoperative activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT), and fibrinogen (FIB); and operation time, intraoperative blood loss, postoperative drainage volume, incision healing, postoperative deep vein thrombosis and postoperative hospital stay.ResultsThe operation was successfully completed without related complications. At term of main observation indicators, RBC, HB and HCT remained relatively stable, while CRP and ESR fluctuated to some extent after PLIF. The RBC, HB and HCT in the observation group were higher than those in the control group with statistically significant (p < 0.05). Except the CRP of 7th postoperative day of the observation group was significantly lower than that of the control group (p < 0.05), there was no difference in other CRP and ESR between the two groups (p > 0.05). At term of secondary observation indicators, the intraoperative blood loss and postoperative drainage volume of the observation group were lower than those of the control group with statistically significant (p < 0.05). There was no significant difference in postoperative APTT, PT, TT, FIB, and operation time and postoperative hospital stay between the two groups (p > 0.05).ConclusionThe application of unit dose of ivTXA in PLIF can safely and effectively reduce blood loss. Meanwhile, it can also maintain higher RBC, HB, HCT levels without disturbing CRP and ESR levels after surgery.

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“…On the one hand, spine surgeon should consider the effect of PLIF, and on the other hand, consider how to reduce perioperative blood loss 13 . Many scholars have www.nature.com/scientificreports/ studied that intravenous TXA can safely and effectively reduce perioperative blood loss in PILF patients [5][6][7][8] . There are various options for using TXA during the perioperative period of spinal surgery, such as oral medication, local medication, intravenous medication, etc.…”

Section: Discussionmentioning

confidence: 99%

“…Tranexamic acid (TXA) is a synthetic derivative of lysine, a synthetic anti fibrinolytic drug that could reduce surgical bleeding by inhibiting fibrinolysis and stabilizing blood clots 4 . Many studies have shown that intravenous TXA can effectively reduce perioperative blood loss in PLIF 5 – 8 . Meanwhile, in our previous studies, we confirmed that preoperative intravenous unit dose TXA in PLIF can safely and effectively reduce intraoperative and postoperative blood loss without affecting postoperative coagulation function indicators 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

The effect of preoperative use of anticoagulants on the hemostatic effect of intravenous application of tranexamic acid in PLIF: a case control study

Hao,

Li,

Luo

et al. 2024

Sci Rep

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Intravenous application of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF) can effectively reduce blood loss without affecting coagulation function. However, it has not been reported whether preoperative use of anticoagulants may affect the efficacy of TXA in PLIF. The purpose of this study is to observe the effect of preoperative use of anticoagulants on coagulation indicators and blood loss after PLIF receiving intravenous unit dose TXA. A retrospective analysis was conducted on data from 53 patients with PLIF between 2020.11 and 2022.9, who received intravenous application of a unit dose of TXA (1 g/100 mL) 15 min before the skin incision after general anesthesia. Those who used anticoagulants within one week before surgery were recorded as the observation group, while those who did not use anticoagulants were recorded as the control group. The main observation indicators include surgical time, intraoperative blood loss, postoperative drainage volume, blood transfusion, and red blood cell (RBC), hemoglobin (HB), and hematocrit (HCT) measured on the 1st, 4th, 7th, and last-test postoperative days. Secondary observation indicators included postoperative incision healing, deep vein thrombosis of lower limbs, postoperative hospital stay, and activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), and platelets (PLT) on the 1st and 4th days after surgery. The operation was successfully completed in both groups, the incision healed well after operation, and no lower limb deep vein thrombosis occurred. There was no significant difference in surgical time, intraoperative blood loss, postoperative drainage volume, and blood transfusion between the two groups (p > 0.05). There was no significant difference in the RBC, HB, and HCT measured on the 1st, 4th, 7th, and last-test postoperative days between the two groups (p > 0.05). There was no statistically significant difference in APTT, PT, TT, FIB and PLT between the two groups on the 1st and 4th postoperative days (p > 0.05). There was no significant difference in postoperative hospital stay between the two groups (p > 0.05). The use of anticoagulants within one week before surgery does not affect the hemostatic effect of intravenous unit dose TXA in PLIF.

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Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion

Cited by 15 publications

References 31 publications

The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis

The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis

RBC, HB, HCT, CRP, and ESR at different postoperative periods after the application of intravenous unit dose transient acid in PLIF: A case control study

The effect of preoperative use of anticoagulants on the hemostatic effect of intravenous application of tranexamic acid in PLIF: a case control study

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