Topical use of tranexamic acid can effectively decrease hidden blood loss during posterior lumbar spinal fusion surgery

Abstract

In spinal fusion surgery, total blood loss (TBL) is composed of visible blood loss from the surgical field and wound drainage, and hidden blood loss (HBL). Until now, no published studies exist reporting the effect of topical use of tranexamic acid (tTXA) on HBL in patients undergoing posterior lumbar spinal fusion surgery. This study aimed to explore the effect of tTXA on HBL during primary posterior lumbar spinal fusion surgery. Between September 2014 and September 2016, 100 adult patients (age > 18 years) with lumbar disc herniation or lumbar spinal stenosis undergoing primary posterior lumbar instrumented spinal fusions at 1 institution were divided into tTXA and control groups. The primary outcome was HBL. Secondary outcomes include TBL, intraoperative blood loss (IBL), postoperative blood loss (PBL), hemoglobin (HGB) levels on preoperative (Pre-op) and postoperatively (days 1–3, POD1, POD2, POD3, respectively), and amount of allogeneic blood transfusion. Complications occurring perioperatively until hospitalization discharge were also collected. In the tTXA group (n = 50 patients), wound surface was soaked with TXA (1 g in 100 mL saline solution) for 5 minutes before wound closure. For the control group (n = 50 patients), wound surface was soaked with the same volume of normal saline. There were no significant differences in demographics, surgical traits between the 2 groups. There were no significant differences in IBL or perioperative blood transfusion requirements between the 2 groups. However, in the tTXA group, TBL, PBL, and HBL were significantly lower than those in the control group (550 ± 268 vs 833 ± 298 mL, 53.5 ± 43.9 vs 136.7 ± 87.9 mL, 356.7 ± 254.8 vs 501.1 ± 216.9 mL, P < .001, respectively). HGB levels were significantly higher in the tTXA group (P < .001) on POD1 and had a slower decline on POD2 and POD3 than the control group. No complications associated with TXA were observed. From these data, we conclude that tTXA can effectively reduce HBL, without significant complications in adult patients undergoing posterior lumbar spinal fusion surgery.

Topical Injection of Tranexamic Acid via a Drain Plus Drain‐Clamping to Reduce Blood Loss in Degenerative Lumbar Scoliosis Surgery

“…Xu et al 26 reported that no patient developed adverse reactions attributable to the topical administration of TXA and there were no differences in any of the parameters representing wound problems or readmissions within 30 days from discharge between patients with the topical use of TXA and patients in the control group. Similarly, Ren et al 27 reported that topical use of tranexamic acid can effectively decrease hidden blood loss, without significant complications in adult patients undergoing posterior lumbar spinal fusion surgery. The results of the present study also indicate no statistically significant differences for wound complications between the two cohorts.…”

The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis

“…No additional studies were obtained after the reference review. Ultimately, three RCT [ 11 , 15 , 16 ] and one non-RCT [ 12 ] were eligible for data extraction and meta-analysis. The search process is shown in Fig.…”

“…Topical application of TXA would decrease systemic absorption and result in lower risk of adverse reactions. Recently, several studies [ 10 – 12 ] have reported topical application of TXA in spinal surgery. However, there is still no consensus whether to use topical application of TXA during spinal surgery or not.…”

Prediction of Hidden Blood Loss During Posterior Spinal Surgery

“…These results indicated HBL is commonly occurred in the perioperative period of posterior spinal The underlying mechanism for HBL remains elusive. [10][11][12] To our knowledge, there are many reports about the mechanisms of HBL only focusing on joint surgery, but few reports have mentioned spinal surgery. Therefore, we carried out this study to investi- March 2019 CHINESE MEDICAL SCIENCES JOURNAL 42 cells.…”