Marijuana Use is Not a Contraindication for Tranexamic Acid Utilization in Lumbar Spine Surgery

Abstract

Study Design Retrospective cohort study Objective The purpose of this study was to evaluate safety in lumbar spinal fusion with tranexamic acid (TXA) utilization in patients using marijuana. Methods This was a retrospective cohort study involving a single surgeon’s cases of 1 to 4 level lumbar fusion procedures. Two hundred and ninety-four patients were followed for ninety days post-operatively. Consecutive patients were self-reported for daily marijuana use (n = 146) and compared to a similar cohort of patients who denied usage of marijuana (n = 146). Outcomes were collected, which included length of stay (LOS), estimated blood loss (EBL), post-operative myocardial infarction, seizures, deep venous thrombosis, pulmonary embolus, death, readmission, need for further surgery, infection, anaphylaxis, acute renal injury, and need for blood product transfusion. Results Patients in the marijuana usage cohort had similar age (58.9 years ±12.9 vs 58.7 years ±14.8, P = .903) and distribution of levels fused ( P = .431) compared to the non-usage cohort. Thromboembolic events were rare in both groups (marijuana usage: 1 vs non-usage: 2). Compared to the non-usage cohort, the marijuana usage cohort had a similar average EBL (329.9 ± 298.5 mL vs 374.5 ± 363.8 mL; P = .254). Multivariate regression modeling demonstrated that neither EBL (OR 1.27, 95% CI 0.64-2.49) nor need for transfusion (OR 1.56, 95% CI 0.43-5.72) varied between cohorts. The non-usage cohort had twice the risk of prolonged LOS compared to the marijuana usage cohort (OR 2.05, 95% CI 1.15-3.63). Conclusion Marijuana use should not be considered a contraindication for TXA utilization in lumbar spine surgery.

Unlocking the Healing Potential

“…What work there has been thus far has been minimal and has not given any definitive answers 51 , thus calling for larger future studies with the hopes of future clinical applications (Table II). Overall, the variable results have shown cannabinoids to possibly increase the risk of reoperation 52,53 , both decrease mortality and increase risk of complications 54,55 , both increase and decrease postoperative opioid use 56,57 , increase and decrease length of hospital stay for spine surgery 55,58,59 , and both increase 60 and reduce pain in patients with general spinal pathology, likely due to overall reductions in postoperative pain 61-63 . However, the evidence remains contradictory regarding cannabinoids and their ability to treat postoperative pain after spinal cord injuries as shown by a recently published meta-analysis 60 .…”