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
