The influence of topical use of tranexamic acid in reducing blood loss on early operation for thoracolumbar burst fracture: a randomized double-blinded controlled study

Abstract

Purpose To investigate the safety and efficacy of topical use of tranexamic acid (TXA) on early operation for thoracolumbar burst fracture (TBF). Methods Patients with acute TBF requiring early decompression were prospectively collected. The enrolled patients were randomly assigned to TXA and control group, in which wound surface was soaked with TXA or the same volume of normal saline for 5 min after wound incision, respectively. The total blood loss (TBL), intraoperative blood loss (IBL), postoperative blood loss (PBL), hemoglobin (HGB) levels on preoperatively (pre-op) and postoperatively, and amount of allogenic blood transfusion were recorded. Furthermore, the general information was also compared between groups. Results There were 39 and 37 patients enrolled in TXA and control group for final analysis. The demographics data showed no significant difference between groups (P > 0.05), but operation time and IBL were significantly decreased in TXA group (P < 0.05). Further analysis showed that HGB level was significantly higher in the TXA group at POD1, while the TBL and PBL were significantly less than those in the control group (P < 0.05), but similar to HBL (P > 0.05). The postoperative ambulation time, removal time of drainage tube, length of hospital stay, and blood transfusion rate were also significantly less in TXA group (P < 0.05). At the final follow-up, no neurological deteriorations and no TXA-related complications were observed in both groups. Conclusion This RCT first demonstrated that topical TXA usage after wound incision could effectively reduce IBL without increasing risk of complications, beneficial to enhanced recovery after early operation for TBF.

The Effect of Topical Tranexamic Acid on Intraoperative Blood Loss in Patients Undergoing Posterior Lumbar Laminectomy and Discectomy: A Randomized, Double-Blind, Controlled Trial Study

“…This finding emphasizes the key role of topical TXA in the reduction of blood loss during surgery; this can result in better visualization, less operation time, and a decrease in surgical complications. Our results are in agreement with the recent study, which demonstrated that topical TXA can decrease IBL in the surgical treatment of thoracic burst fracture [29].…”

Efficacy and Safety Profile of Tranexamic Acid in Traumatic Thoracolumbar Fracture Management: A Systematic Review and Meta-Analysis

“…24 Of these, 7 were prospective randomized trials, 1 was a retrospective cohort study, and 1 prospective observational study. [24][25][26][27][28][29][30][31][32] Combined, the total participant strength was 828 patients. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram is shown in Figure 1.…”

“…Total Blood Loss TBL was reported in 3 studies with a total of 4 groups. 28,29,31 A random effects model was used due to significant heterogeneity (I 2 = 96%, P < 0.00001). A significant effect was noted in terms of TBL (standard mean difference [SMD] = −2.54 [95% CI, −3.72, −1.37], P = 0.0001) (Figure 1).…”

“…IBL was reported in 6 studies with a total of 481 patients. 25,26,[28][29][30][31] Two studies used tTXA, and 4 studies used iTXA. As heterogeneity was significant (I 2 = 81%, P < 0.0001), random effects model was used.…”

“…PBL was reported by 6 studies with a total of 331 patients 25 . 26,28,[30][31][32] Random effects model was used (I 2 = 34%, P = 0.18). The overall effect of TXA on PBL was significant (SMD = −1.42 [95% CI, −1.72, −1.11], P < 0.00001) (Figure 6).…”