The Effect of Tranexamic Acid on Operative and Postoperative Blood Loss in Transforaminal Lumbar Interbody Fusions

Kanhere, Arun; Lambrechts, Mark J.; Issa, Tariq Z.; Karamian, Brian A.; Hendow, Chelsea J.; Reddy, Yashas C.; Slota, Paul J.; D’Antonio, Nicholas D.; Kaye, I. David; Canseco, José A.; Woods, Barrett I.; Hilibrand, Alan S.; Kepler, Christopher K.; Vaccaro, Alexander R.; Schroeder, Gregory D.

doi:10.1016/j.wneu.2022.07.020

Cited by 3 publications

(14 citation statements)

References 56 publications

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“…These included one meeting ( 15 ), two registered studies without results ( 16 , 17 ), one study performed on posterior lumbar interbody fusion ( 18 ), two studies that were unable to extract data from patients with TLIF ( 19 , 20 ), one study that did not use tranexamic acid ( 21 ), and one study that compared oral tranexamic acid with intravenous use ( 22 ). Finally, five trials with three RCT studies and two retrospective studies, totaling 984 patients, were included in our study ( 10 , 11 , 12 , 23 , 24 ). The literature screening process is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“… Study Country Date range Design No. of subjects Age (years) TXA Control TXA Control He et al ( 11 ) China July 2018–February 2019 RCT 20 20 57.95 ± 12.44 57.9 ± 11.76 Kanhere et al ( 10 ) USA January 2017–July 2021 Cohort study 183 315 59.3 ± 11.7 61.4 ± 10.6 Mallepally et al ( 23 ) India November 2017–October 2018 Case controlled 175 75 55.8 ± 13.0 55.3 ± 12.8 Wang et al ( 12 ) China March 2014–December 2016 RCT 39 41 41.2 ± 10.3 42.5 ± 9.5 Zhang et al ( 24 ) ...…”

Section: Resultsmentioning

confidence: 99%

“…Five studies included IBL as the primary outcome ( 10 , 11 , 12 , 23 , 24 ). Three RCT studies and two retrospective studies were included ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…before skin incision + 6–8 mg/kg/h i.v. during the surgery IBL, total postoperative drainage, time for drainage removal, hospital stay after surgery, hematological parameters, blood transfusion, complication Kanhere et al ( 10 ) NOS (8) Degenerative conditions 10 mg/kg i.v. before skin incision Length of stay, 90-day readmissions, estimated blood loss, pre- and postoperative hemoglobin, operative length, transfusion requirement, and drain output per day.…”

Section: Resultsmentioning

confidence: 99%

“…Compared with traditional fusion surgery, there is less damage to soft tissues, less surgical trauma, and less IBL. Kanhere et al found that intravenous tranexamic acid had no effect on IBL ( 10 ). However, other studies have found that preoperative tranexamic acid reduces IBL during TLIF ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

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The efficacy and safety of tranexamic acid in transforaminal lumbar interbody fusion: a systematic review and meta-analysis

Luo,

Yan,

Ren

et al. 2023

EFORT Open Reviews

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Purpose This meta-analysis aimed to assess the efficacy and safety of tranexamic acid (TXA) in transforaminal lumbar interbody fusion (TLIF), focusing on its impact on intraoperative blood loss and related outcomes. Methods The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed, EMBASE, Medline, and Cochrane Library databases to identify all literature related with TXA and TLIF. Finally, five trials ultimately meeting the inclusion criteria. Continuous variables were analyzed using mean difference and categorical variables were analyzed using Peto odds ratio, via random effects models. Results The meta-analysis revealed a significant reduction in intraoperative blood loss associated with TXA use during TLIF, as confirmed by the RCTs. However, the impact of TXA on other outcomes, such as postoperative drainage volume, total blood loss, and length of hospital stay, remains inconclusive due to limited data. No severe complications related to TXA use were reported, providing preliminary evidence of its safety in TLIF. Conclusion TXA appears to effectively reduce intraoperative blood loss in TLIF, based on the available RCT evidence. However, further research is needed to provide a comprehensive assessment of TXA’s overall impact on various outcomes in this context. This meta-analysis underscores the importance of ongoing investigation to establish the full potential and safety profile of TXA in TLIF procedures.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Five studies included IBL as the primary outcome ( 10 , 11 , 12 , 23 , 24 ). Three RCT studies and two retrospective studies were included ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The efficacy and safety of tranexamic acid in transforaminal lumbar interbody fusion: a systematic review and meta-analysis

Luo,

Yan,

Ren

et al. 2023

EFORT Open Reviews

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Exploratory Randomised Trial of Tranexamic Acid to Decrease Postoperative Delirium in Adults Undergoing Lumbar Fusion: A trial stopped early

Hindman,

Olinger,

Woodroffe

et al. 2024

Preprint

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Background: Postoperative delirium may be mediated by perioperative systemic- and neuro-inflammation. By inhibiting the pro-inflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA, adding measures of postoperative delirium, cognitive function, systemic cytokines, and astrocyte activation. Methods: Adults undergoing elective posterior lumbar fusion randomly received intraoperative intravenous TXA (n=43: 10 mg kg-1 loading dose, 2 mg kg-1 h-1 infusion) or Placebo (n=40). Blood was collected pre- and at 24 h post-operatively (n=32) for biomarkers of systemic inflammation (cytokines) and astrocyte activation (S100B). Participants had twice daily delirium assessments using the 3-minute diagnostic interview for Confusion Assessment Method (n=65). Participants underwent 4 measures of cognitive function preoperatively and during post-discharge follow-up. Results: Delirium incidence in the TXA group (7/32=22%) was not significantly less than in the Placebo group (11/33=33%); P=0.408, absolute difference=11%, relative difference=33%, effect size = -0.258 (95% CI -0.744 to 0.229). In the Placebo group (n=16), delirium severity was associated with the number of instrumented vertebral levels (P=0.001) and with postoperative interleukin -8 and -10 concentrations (P=0.00008 and P=0.005, respectively) and these associations were not significantly modified by TXA. In the Placebo group, delirium severity was associated with S100B concentration (P=0.0009) and the strength of the association was decreased by TXA (P=0.002). Conclusions: A potential 33% relative decrease in postoperative delirium incidence justifies an adequately powered clinical trial to determine if intraoperative TXA decreases delirium in adults undergoing lumbar fusion.

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The Optimal Dosing and Timing of Tranexamic Acid in Reducing Perioperative Bleeding and Transfusion Requirements in Vascular Surgery Patients: A Systematic Review

Turaga

2023

Cureus

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Tranexamic acid (TXA) has been widely investigated as an antifibrinolytic agent to minimize perioperative bleeding and transfusion requirements in various surgical settings. This systematic review aims to assess the optimal dosing and timing of TXA administration for reducing perioperative bleeding and transfusion requirements, specifically in vascular surgery patients. A comprehensive search was conducted using multiple databases, and relevant articles were selected based on predefined inclusion criteria. A total of 20 studies were identified and analyzed, including randomized controlled trials (RCTs), systematic reviews, and meta-analyses. Findings from these studies were synthesized to provide a comprehensive overview of the evidence regarding the use of TXA in vascular surgery.

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The Effect of Tranexamic Acid on Operative and Postoperative Blood Loss in Transforaminal Lumbar Interbody Fusions

Cited by 3 publications

References 56 publications

The efficacy and safety of tranexamic acid in transforaminal lumbar interbody fusion: a systematic review and meta-analysis

The efficacy and safety of tranexamic acid in transforaminal lumbar interbody fusion: a systematic review and meta-analysis

Exploratory Randomised Trial of Tranexamic Acid to Decrease Postoperative Delirium in Adults Undergoing Lumbar Fusion: A trial stopped early

The Optimal Dosing and Timing of Tranexamic Acid in Reducing Perioperative Bleeding and Transfusion Requirements in Vascular Surgery Patients: A Systematic Review

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