Use of Topical Tranexamic Acid to Reduce Blood Loss in Single-Level Transforaminal Lumbar Interbody Fusion

Abstract

To evaluate the efficacy and cost-effectiveness of topically applied tranexamic acid (TXA) during different phases of spine surgery. Overview of Literature: Perioperative blood loss is the leading cause of postoperative anemia associated with prolonged stays in hospital and long recovery times. The direct and indirect costs involved pose a significant economic challenge in developing countries. There is no consensus for topical use of tranexamic acid in spine sur gery. Methods: Patients requiring a single-level TLIF were divided into 2 groups. In the TXA group (n=75), the wound surface was soaked with TXA (1 g in 100 mL saline solution) for 3 minutes after exposure, after decompression, and before wound closure, and in the control group (n=175) using only saline. Intraoperative blood loss drain volume was recorded on each of the first 2 days immediately after surgery. An estimated cost analysis was made on the basis of the length of hospital stay and the blood transfusion. Results: IBL for the control group was 783.33±332.71 mL and for intervention group 410.57±189.72 mL (p<0.001). The operative time for control group was 3.24±0.38 hours and for intervention group 2.99±0.79 hours (p<0.695). Hemovac drainage on days 1 and 2 for control group was 167.10±53.83 mL and 99.33±37.5 mL, respectively, and for intervention group 107.03±44.37 mL and 53.38±21.99 mL, respectively (p<0.001). The length of stay was significantly shorter in the intervention group (4.8±1.1 days) compared to control group (7.0±2.3 days). The cost of treatment in the intervention group was US dollar (USD) 4,552.57±1,222.6 compared with that in the control group USD 6,529.9±1,505.04. Conclusions: Topical TXA is a viable, cost-effective method of decreasing perioperative blood loss in major spine surgery with fewer overall complications than other methods. Further studies are required to find the ideal dosage and timing.

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

“…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.…”

“… 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 ) ...…”

Adjunctive Topical Tranexamic Acid for Blood Salvage Does Not Reduce Postoperative Blood Loss Compared with Placebo in Patients Who Undergo Palliative Decompressive Spinal Metastasis Surgery

“…In our perspective, the amount of postoperative drainage was not an acceptable representative of postoperative blood loss, since many uncontrollable factors such as serous content, remaining irrigated saline from the operative field, and measurement errors interfered, possibly underestimating ''Hidden blood loss,'' 27,29,30 occurring from hemolysis, extravasation into the tissues, and residual blood in a dead space. A report by Mallepally et al 31 claimed the benefit of tTXA in decreasing perioperative blood loss. Nonetheless, they applied this intervention just before closing the wound, possibly causing a poor causal relation to their outcome, which was intraoperative blood loss.…”

Comparison of efficacy of tranexamic acid irrigation versus intravenous injection for preventing blood loss in percutaneous nephrolithotomy

“…11 Local administration of tranexamic acid has been shown to reduce blood loss effectively in some surgeries such as cardiac surgery, oral surgery, dental surgery, knee arthroplasty, endoscopic sinus surgery and open prostate surgery. 12–18 A study from northern India by Bansal and Arora 10 evaluated the efficacy and safety of 0.1% tranexamic acid in irrigation fluid in reducing blood loss during PCNL. 0.1% tranexamic acid in irrigation fluid has been found to be safe to significantly reduce perioperative blood loss during PCNL.…”