Two Doses of Tranexamic Acid Reduce Blood Loss in Primary Posterior Lumbar Fusion Surgery

Abstract

Purpose: Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to reduce perioperative blood loss and blood transfusion, but the dosage and efficacy of TXA in posterior lumbar spinal surgery are not fully clear. The aim of this study was to investigate the efficacy and safety of TXA and to determine whether 2 doses of TXA could reduce the blood loss in primary single-segment or double-segment posterior lumbar fusion surgery. Materials and Methods: A total of 150 patients with lumbar degenerative disease undergoing posterior lumbar interbody fusion surgery between October 2017 and February 2019 were randomized to 3 groups. Group A was treated with 0.9% normal saline solution without TXA, group B was treated with a 15 mg/kg loading dose intravenous infusion 30 minutes before surgery, and group C was treated with a 15 mg/kg loading dose intravenous infusion 30 minutes before surgery; then, the same dose was administered again 3 hours later. The assessed outcomes were the operation time, the total blood loss, the hidden blood loss, postoperative drainage, blood transfusions, incidence of venous thromboembolism, and incision infection. Results: The total blood loss, the hidden blood loss, and postoperative drainage were the lowest in group C. The amount of intraoperative blood loss was similar among the 3 groups. The hemoglobin and hematocrit values of the third postoperative day were the highest in group C. No significant differences in the incidence of complications and adverse events from TXA use were observed among the 3 groups. The use of TXA, the operation time, and the number of fusion segments were identified as risk factors related to total blood loss. Conclusion: Two doses of TXA significantly reduced the total blood loss, the hidden blood loss and postoperative drainage, and decreased hemoglobin and hematocrit drop in patients undergoing posterior lumbar fusion without increasing the risk of complications.

Hidden blood loss of minimally invasive hybrid lumbar interbody fusion: an analysis of influencing factors

“…Tranexamic acid, a frequently used haemostatic drug in orthopedic surgery, has been widely employed in spinal surgery to reduce intraoperative bleeding and hidden blood loss with the absence of thrombo-embolic events [ 27 , 28 ]. The current study focuses on the use of tranexamic acid in posterior spinal fusion, mainly by intravenous drip and topical application; Zhinan Ren [ 29 ] applied a topical tranexamic acid dip (1 g tranexamic acid in 100 mL saline solution) for 5 minutes before wound closure and showed a significant reduction in postoperative invisible blood loss, similar to the findings of Shi [ 30 ] et al On the other hand, Zhu [ 31 ] advocated one intravenous dose of tranexamic acid 30 min before surgery and one dose 3 h after the start of surgery, while Zheng [ 32 ] suggested a combination of intravenous drip and topical application to reduce intraoperative bleeding. This study also showed that tranexamic acid does not increase the risk of thrombosis and does not have a serious impact on the patient’s liver or kidney function.…”

Safety and Efficacy of Tranexamic Acid in Spinal Surgery: A Systematic Review and Meta-Analysis

“…Thirteen trials with 1,213 participants were eligible for inclusion in the metaanalysis [13][14][15][16][17][18][19][20][21][22][23][24][25] (Figure 1).…”

Comparative efficacy and safety of different hemostatic medications during spinal surgery: A network meta-analysis

“…[15] The action mechanism of TXA and EACA is similar as competes to saturate the lysine binding site of plasminogen. [16] The fibrinolysis inhibitor AP inactivates free plasmin to inhibit fibrinolysis. Several studies and meta-analyses have identified antifibrinolytics as an effective method of hemostasis during spinal surgery.…”