Tranexamic acid reduces perioperative blood loss of posterior lumbar surgery for stenosis or spondylolisthesis

Shi, Houyin; Ou, Yunsheng; Jiang, Dianming; Quan, Zhengxue; Zhao, Zhigang; Zhu, Yong

doi:10.1097/md.0000000000005718

Cited by 47 publications

(41 citation statements)

References 29 publications

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“…The intravenous application of TXA has been confirmed as effectively decreasing blood loss and transfusion requirement in spinal surgery [ 6 , 7 ]. Recently, topical TXA is widely established in hip and knee arthroplasty and successfully reduced postoperative blood loss and blood transfusion requirements [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Tranexamic acid (TXA), an antifibrinolytic drug, competitively blocks the lysine-binding site of plasminogen and has been used to reduce blood loss in spine surgery for many years [ 5 ]. Various studies have reported that intravenous application of TXA reduces blood loss and allogenic blood transfusions in spinal surgery without increasing related complications [ 6 – 8 ]. In theory, there remains an unresolved concern about the potential thrombogenicity of intravenous TXA [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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BackgroundWe conducted a meta-analysis from randomized controlled trials (RCTs) and non-RCTs to assess the efficacy and safety of tranexamic acid (TXA) in spine surgery.MethodsPotentially relevant academic articles were identified from the Cochrane Library, MEDLINE (1966–2017.11), PubMed (1966–2017.11), Embase (1980–2017.11), and ScienceDirect (1985–2017.11). Secondary sources were identified from the references of the included literature. The pooled data were analyzed using RevMan 5.1.ResultsThree RCTs and one non-RCT met the inclusion criteria. There were significant differences in total blood loss (MD = − 267.53, 95% CI − 373.04 to − 106.02, P < 0.00001), drainage volume (MD = − 157.00, 95% CI − 191.17 to − 122.84, P < 0.00001), postoperative hemoglobin level (MD = 0.95, 95% CI 0.44 to 1.47, P = 0.0003), and length of hospital stay (MD = − 1.42, 95% CI − 1.92 to − 0.93, P < 0.00001). No significant differences were found regarding transfusion requirement, deep vein thrombosis (DVT), pulmonary embolism (PE), wound hematoma, and infection between the two groups.ConclusionsThe present meta-analysis indicated that the topical application of TXA in spinal surgery decreases the total blood loss and drainage volume and preserves higher postoperative hemoglobin level without increasing the risk of DVT infection, hematoma, DVT, and PE.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…As for TXA, Shi performed a prospective, randomized, double-blind, placebo-controlled study, in which the eligible patients were randomized to receive either a bolus dose of 30 mg/kg intravenous TXA, a maintenance dosage of 2 mg/kg/h TXA, or an equivalent volume of normal saline. The result showed that the blood transfusion rates did not vary significantly [ 17 ]. In our study, the amount of allogeneic blood transfusion of experimental groups was only 1/4 of the control group; meanwhile, there were no differences between collagen sponge group and topical TXA group.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial on the effects of collagen sponge and topical tranexamic acid in posterior spinal fusion surgeries

Zhuang

Zheng

et al. 2017

J Orthop Surg Res

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BackgroundThis is a randomized controlled trial research to assess the hemostatic efficacy of gelatin sponge, collagen sponge, and topical use of tranexamic acid (TXA) on postoperative blood loss in posterior spinal fusion surgeries.MethodsWe recruited patients with spinal degenerative diseases into the study from November 2013 to October 2016. All the participants were assigned to 3 groups using a simple, equal-probability randomization scheme: group A is a control group utilizing gelatin sponge, while groups B and C are experimental groups, applying collagen hemostatic sponge and topical TXA respectively. Postoperative blood loss, rates of transfusion, and hospitalization were compared among the 3 groups.ResultsIn our study, the volume of drainage and blood content in drainage on the first postoperative day (POD 1) of patients in the experimental groups were significantly less than those in the control group, as well as rates of transfusion and postoperative hospitalization (P < 0.05). When compared with the control group, the volume of drainage decreased by 22.7% in group B and 56.2% in group C, while the blood content in drainage decreased by 28.8 and 75% respectively.ConclusionsIn this study, collagen and topical use of TXA have both proven to be effective and safe for patients undergoing posterior spinal fusion surgeries, while TXA has exhibited better efficacy. The total amount of perioperative blood loss reduced significantly without increasing incidence of related complications.Trial registrationA randomized controlled trial for effects of collagen sponge and topical tranexamic acid in posterior lumbar fusion surgeries. ChiCTR-IIR-17010785.

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“…However, intravenous TXA may have potentially adverse effects on patients, including DVT, PE, and myocardial infarction [18,19]. Intravenous TXA is usually avoided in patients with a previous history of myocardial infarction, DVT/ PE, stroke, and seizure disorders [20][21][22][23]. In addition, some research teams had published different conclusions.…”

Section: Postoperative Aptt (Seconds)mentioning

confidence: 99%

Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity Spine Surgery: A Meta-Analysis

Xiong

Liu

et al. 2020

BioMed Research International

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Objective. Tranexamic acid (TXA), an antifibrinolytic agent, interferes with fibrinolysis and has been used for many years to reduce blood loss during spine surgery. The purpose of our meta-analysis was to compare the effect of intravenous versus topical administration of TXA in patients undergoing nondeformity spine surgery. Methods. We searched multiple databases, including PubMed, Embase, the Cochrane library, CNKI, WanFang database, and VIP to find studies that met the inclusion criteria. A meta-analysis was performed according to the guidelines of the Cochrane Reviewer’s Handbook. Results. Eight randomized controlled trials (RCTs) were identified, including 660 patients. The surgical methods used in the included studies were nondeformity spine surgery. No significant differences were found in the two groups regarding total blood loss, intraoperative blood loss, hidden blood loss, hematocrit, hemoglobin, fibrinogen, postoperative prothrombin time (PT), postoperative activated partial thromboplastin time (APTT), drainage volume, and blood transfusion rate. There were statistically significant differences in the two groups in terms of preoperative PT (MD = −0.39, 95% CI: [−0.63, −0.15], P=0.002) and preoperative APTT (MD = 1.12, 95% CI: [0.57, 1.68], P<0.0001). Conclusion. During nondeformity spine surgery, intravenous administration of TXA did not have a significant effect on the decrease of blood loss and blood transfusion rate compared with the topical group. According to the pooled analysis of PT and APTT, intravenous and topical application of TXA may have different effects on the coagulation pathway. More high-quality RCTs are needed to explore the optimal dosage, method, timing in the future in order to recommend TXA widespread use in spine surgery.

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Tranexamic acid reduces perioperative blood loss of posterior lumbar surgery for stenosis or spondylolisthesis

Cited by 47 publications

References 29 publications

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

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

A randomized controlled trial on the effects of collagen sponge and topical tranexamic acid in posterior spinal fusion surgeries

Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity Spine Surgery: A Meta-Analysis

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