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J Neurol Surg A Cent Eur Neurosurg 2022; 83(01): 046-051
DOI: 10.1055/s-0041-1731751
Original Article

The Efficiency of Simultaneous Systemic and Topical Use of Tranexamic Acid in Spinal Fusion Surgery

Uzay Erdogan
1   Department of Neurosurgery, University of Health Sciences, Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
,
Seckin Sari
2   Department of Orthopedics, Sportoteam Sport and Spine Center, Istanbul, Turkey
,
Ahmet Akbas
3   Department of Neurosurgery, Istanbul Taksim Training and Research Hospital, Istanbul, Turkey
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Abstract

Background and Aim Multilevel posterior spinal fusion surgery in adults is associated with significant intra- and postoperative blood loss. Tranexamic acid (TXA) is an antifibrinolytic agent for reducing blood loss and allogenic blood transfusion. The purpose of this study was to evaluate the efficiency of TXA in reducing blood loss and improving hematologic parameters in adult patients undergoing posterior thoracic/lumbar instrumented spinal fusion surgery.

Patients and Methods This is a retrospective observational study comparing the intra- and postoperative hemodynamic findings of two groups treated with and without TXA. The study included 112 adult patients receiving elective posterior thoracic/lumbar instrumented spinal fusion surgery. The patients were evaluated in terms of age, gender, type of surgery, intraoperative blood loss, pre- and postoperative hemoglobin (Hb) and hematocrit values, postoperative systemic anticoagulant use, intra- and postoperative use of blood products, and the volume of the drainage fluid as an indicator of postoperative blood loss. The TXA group received preoperative 10 mg/kg intravenous TXA, another dose of 10 mg/kg/h in isotonic solution during the operation, and local administration of TXA before the closure of the surgical site (1g in patients undergoing surgery in ≤3 segments, and 2g in patients undergoing surgery in ≥4 segment group).

Results Intra- and postoperative blood loss and need for transfusion were significantly lower in the TXA group. Fifty-three of 112 patients required intra- and postoperative transfusion, and postoperative anticoagulants were given to 25/112 patients. The postoperative Hb level was lower, and the difference of pre- and postoperative Hb values was higher in the non-TXA group (not significant).

Conclusion Simultaneous systemic and topical application of TXA is a safe and efficient blood conservation strategy for adult patients undergoing major multilevel spinal surgery.

Keywords

tranexamic acid - spine - multilevel spinal surgery - spinal fusion - blood loss - transfusion


Publication History

Received: 08 September 2020

Accepted: 29 December 2020

Article published online:
18 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Elgafy H, Bransford RJ, McGuire RA, Dettori JR, Fischer D. Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion surgery?. Spine 2010; 35 (09) S47-S56
    CrossrefPubMedGoogle Scholar
  • 2 Sokolowski MJ, Garvey TA, Perl II J. et al. Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine 2008; 33 (01) 108-113
    CrossrefPubMedGoogle Scholar
  • 3 Urban MK, Beckman J, Gordon M, Urquhart B, Boachie-Adjei O. The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery. Spine 2001; 26 (10) 1152-1156
    CrossrefPubMedGoogle Scholar
  • 4 Mosaad AA, Mohamed H, Elsayed MA. et al. A comparative study between prophylactic high dose of tranexamic acid and low does tranexamic acid in reducing perioperative blood loss in spine surgery. Journal of Clinical Anesthesia and Pain Medicine 2017; 1 (01) 3
    PubMedGoogle Scholar
  • 5 Choi HY, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Effectiveness and safety of tranexamic acid in spinal deformity surgery. J Korean Neurosurg Soc 2017; 60 (01) 75-81
    CrossrefPubMedGoogle Scholar
  • 6 Winter SF, Santaguida C, Wong J, Fehlings MG. Systemic and topical use of tranexamic acid in spinal surgery: a systematic review. Global Spine J 2016; 6 (03) 284-295
    CrossrefPubMedGoogle Scholar
  • 7 Andersson L, Nilsson IM, Niléhn JE, Hedner U, Granstrand B, Melander B. Experimental and clinical studies on AMCA, the antifibrinolytically active isomer of p-aminomethyl cyclohexane carboxylic acid. Scand J Haematol 1965; 2 (03) 230-247
    CrossrefPubMedGoogle Scholar
  • 8 Kim KT, Kim CK, Kim YC. et al. The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study. Eur Spine J 2017; 26 (11) 2851-2857
    CrossrefPubMedGoogle Scholar
  • 9 Luo W, Sun RX, Jiang H, Ma XL. The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis. J Orthop Surg Res 2018; 13 (01) 96
    CrossrefPubMedGoogle Scholar
  • 10 Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology 1983; 58 (03) 277-280
    CrossrefPubMedGoogle Scholar
  • 11 Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery 1962; 51 (02) 224-232
    PubMedGoogle Scholar
  • 12 Smorgick Y, Baker KC, Bachison CC, Herkowitz HN, Montgomery DM, Fischgrund JS. Hidden blood loss during posterior spine fusion surgery. Spine J 2013; 13 (08) 877-881
    CrossrefPubMedGoogle Scholar
  • 13 Wong J, Abrishami A, El Beheiry H. et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 2010; 92 (15) 2503-2513
    CrossrefPubMedGoogle Scholar
  • 14 Henry DA, Carless PA, Moxey AJ. et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2011; 3: CD001886
    PubMedGoogle Scholar
  • 15 Neilipovitz DT. Tranexamic acid for major spinal surgery. Eur Spine J 2004; 13 (Suppl. 01) S62-S65
    CrossrefPubMedGoogle Scholar
  • 16 Colomina MJ, Koo M, Basora M, Pizones J, Mora L, Bagó J. Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial. Br J Anaesth 2017; 118 (03) 380-390
    CrossrefPubMedGoogle Scholar
  • 17 Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012; 344: e3054
    Google Scholar
  • 18 Walterscheid Z, O'Neill C, Carmouche J. Tranexamic acid in adult elective orthopaedic and complex spinal surgery: a review. Surg Rehabil 2017; 1: 1-4
    CrossrefPubMedGoogle Scholar
  • 19 Willner D, Spennati V, Stohl S, Tosti G, Aloisio S, Bilotta F. Spine surgery and blood loss: systematic review of clinical evidence. Anesth Analg 2016; 123 (05) 1307-1315
    CrossrefPubMedGoogle Scholar
  • 20 Shi H, Ou Y, Jiang D, Quan Z, Zhao Z, Zhu Y. Tranexamic acid reduces perioperative blood loss of posterior lumbar surgery for stenosis or spondylolisthesis: a randomized trial. Medicine (Baltimore) 2017; 96 (01) e5718
    CrossrefPubMedGoogle Scholar
  • 21 Cheriyan T, Maier II SP, Bianco K. et al. Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis. Spine J 2015; 15 (04) 752-761
    CrossrefPubMedGoogle Scholar
  • 22 Salam A, King C, Orhan O, Mak V. The great deception: tranexamic acid and extensive pulmonary emboli. BMJ Case Rep 2013; 2013: bcr2012007808
    CrossrefPubMedGoogle Scholar
  • 23 Parthvi R, Mehra S. Risk of pulmonary embolism due to tranexamic acid: a case study. Am J Ther 2018; 25 (04) e512-e514
    CrossrefPubMedGoogle Scholar
  • 24 Zhang L, Li Y, Liu D. et al. Combined use of tranexamic acid and rivaroxaban in posterior lumbar interbody fusion safely reduces blood loss and transfusion rates without increasing the risk of thrombosis: a prospective, stratified, randomized, controlled trial. Int Orthop 2020; 44 (10) 2079-2087
    CrossrefPubMedGoogle Scholar
  • 25 Lecker I, Wang DS, Romaschin AD, Peterson M, Mazer CD, Orser BA. Tranexamic acid concentrations associated with human seizures inhibit glycine receptors. J Clin Invest 2012; 122 (12) 4654-4666
    CrossrefPubMedGoogle Scholar