Efficacy and Safety of Prophylactic Large Dose of Tranexamic Acid in Spine Surgery

Elwatidy, Sherif; Jamjoom, Zain Alabedeen B.; Elgamal, Essam A.; Zakaria, Amro; Turkistani, Ahmed; Eldawlatly, Abdelazeem

doi:10.1097/brs.0b013e318188b9c5

Cited by 196 publications

(158 citation statements)

References 19 publications

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“…4 The same reasoning would apply to TXA use in cervical surgery. Elwatidy and colleagues 19 and Tsutsumimoto and colleagues 20 failed to demonstrate efficacy of TXA in cervical 30 procedures, which is not surprising considering that patients with intraoperative bleeding volumes of less than 100 mL were included. Our results show that the larger the number of levels fused and the longer the duration of surgery, the more effective was TXA administration, coinciding with the findings of Peters 35 and colleagues.…”

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confidence: 98%

“…10 Initial data supporting its effectiveness were from retrospective case series or heterogeneous cohort studies. [9][10][11][12][13][14][15] Subsequently, various prospective clinical trials analysed the performance of TXA in adolescents [16][17][18] and adults [19][20][21][22][23][24] undergoing several types of surgery of varying complexity, with divergent results. The 15 first meta-analysis on TXA use in spine surgery, published in 2008, 25 did not offer a clearly favourable recommendation because of the poor methodological quality of the studies included.…”

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confidence: 99%

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Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

Colomina

Koo

Basora

et al. 2017

British Journal of Anaesthesia

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Abstract15 Background. Perioperative tranexamic AQ5 acid (TXA) use can reduce bleeding and transfusion requirements in several types of surgery, but level I evidence proving its effectiveness in major spine surgery is lacking. This study was designed to investigate the hypothesis that TXA reduces perioperative blood loss and transfusion requirements in patients undergoing major spine procedures. Methods. We conducted a multicentre, prospective, randomized double-blind clinical trial, comparing TXA with placebo in 20 posterior instrumented spine surgery. Efficacy was determined based on the total number of blood units transfused and the perioperative blood loss. Other variables such as the characteristics of surgery, length of hospital stay, and complications were also analysed. Results. Ninety-five patients undergoing posterior instrumented spine surgery (fusion of >3 segments) were enrolled and randomized: 44 received TXA (TXA group) and 51 received placebo (controls). The groups were comparable for duration of 25 surgery, number of levels fused, and length of hospitalization. Transfusion was not required in 48% of subjects receiving TXA compared with 33% of controls (P ¼ 0.05). Mean number of blood units transfused was 0.85 in the TXA group and 1.42 with placebo (P ¼ 0.06). TXA resulted in a significant decrease in intraoperative bleeding (P ¼ 0.01) and total bleeding (P ¼ 0.01) relative to placebo. The incidence of adverse events was similar in the two groups. Conclusions. TXA did not significantly reduce transfusion requirements, but significantly reduced perioperative blood loss 30 in adults undergoing major spinal surgery.Clinical trial registration. NCT01136590.

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Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

Colomina

Koo

Basora

et al. 2017

British Journal of Anaesthesia

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“…18 It reduces transfusionrelated complications and operative expenses. 19 Administration of 20 mg/kg of tranexamic acid at induction of surgery is effective in reducing the haemoglobin decrease following TKR. 20 Oxygen helps rehabilitation in the immediate postoperative days, 21 and hence oxygen was given to all our patients for the first 2 days after surgery.…”

Section: Vol 21 No 1 April 2013mentioning

confidence: 99%

Simultaneous Bilateral Total Knee Replacement: A Prospective Study of 150 Patients

Jain¹,

Wasnik²,

Mittal³

et al. 2013

J Orthop Surg (Hong Kong)

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Purpose. To evaluate the safety of simultaneous bilateral total knee replacement (TKR). Methods. 124 women and 26 men (mean age, 66 years) underwent simultaneous bilateral TKR for tricompartmental osteoarthritis using a posterior-stabilised, high-flexion implant. All patients underwent dobutamine stress echocardiography for detection of any silent cardiac comorbidity by a cardiologist. None had any adverse effect after testing. Five patients had positive outcome and underwent coronary angiography to detect any significant coronary blockage. Functional outcome was evaluated using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Tranexamic acid was given intravenously to reduce peri-operative blood loss. Femoral blocks and patient-controlled analgesia were used to facilitate early recovery. Aggressive physiotherapy was allowed. Patients were followed up at months 3, 6, and 12, and yearly thereafter. Results. At the 2-year follow-up, the mean range of motion improved from 95° to 129° (p=0.032), the mean KSS from 120 to 158 (p<0.001), and the WOMAC from 51 to 88 (p=0.002). One patient developed patellar crepitus at week 6, which resolved with conservative treatment. Another patient developed infection in both knees at month 6. Despite salvage procedures, infection recurred after 3 months and the patient underwent bilateral arthrodesis. No patient developed deep vein thrombosis or pulmonary embolism, myocardial infarction, atrial fibrillation, or other cardiac event. Conclusion. Simultaneous bilateral TKR is safe for properly selected patients.

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“…Tranexamic acid (TXA) has shown a definite benefit in both arthroplasty and spinal surgery at reducing blood loss and the need for a transfusion [4,[11][12][13][14][15][16][17]. A placebo-controlled study in pediatric patients undergoing scoliosis surgery found that TXA reduced blood loss by 41% [15].…”

Section: Introductionmentioning

confidence: 99%

The pattern of blood loss in adolescent idiopathic scoliosis

Popta¹,

Stephenson²,

Patel³

et al. 2014

The Spine Journal

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Efficacy and Safety of Prophylactic Large Dose of Tranexamic Acid in Spine Surgery

Cited by 196 publications

References 19 publications

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

Simultaneous Bilateral Total Knee Replacement: A Prospective Study of 150 Patients

The pattern of blood loss in adolescent idiopathic scoliosis

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