Study DesignProspective, randomized controlled trial.PurposeTo evaluate the effect of topically applied tranexamic acid (TXA) on postoperative blood loss of neurologically intact patients with thoracolumbar spine trauma.Overview of LiteratureFew articles exist regarding the use of topical TXA for postoperative bleeding and blood transfusion in spinal surgery.MethodsA total of 57 patients were operated on with long-segment instrumented fusion without decompression. In 29 patients, a solution containing 1 g of TXA (20 mL) was applied to the site of surgery via a drain tube after the spinal fascia was closed, and then the drain was clamped for 2 hours. The 28 patients in the control group received the same volume of normal saline, and clamping was performed using the same technique. The groups were compared for postoperative packed red cells (PRC) transfusion rate and drainage volume.ResultsThe rate of postoperative PRC transfusion was significantly lower in the topical TXA group than in the control group (13.8% vs. 39.3%; relative risk, 0.35; 95% confidence interval, 0.13 to 0.97; p=0.03). The mean total drainage volume was significantly lower in the topical TXA group than in the control group (246.7±125 mL vs. 445.7±211.1 mL, p<0.01). No adverse events or complications were recorded in any patient during treatment over a mean follow-up period of 27.5 months.ConclusionsThe use of topically administered 1 g TXA in thoracic and lumbar spinal trauma cases effectively decreased postoperative transfusion requirements and minimized postoperative blood loss, as determined by the total drainage volume.
Purpose: There is limited literature regarding the topical use of tranexamic acid (TXA) to control postoperative bleeding during spinal deformity correction and fusion procedures, which often require blood transfusions. This study aimed to evaluate the effect of topical TXA on postoperative blood loss in patients undergoing deformity correction and posterior spinal fusion (PSF) surgeries. Methods: A retrospective study was conducted between January 2011 and April 2017 in 51 patients with adolescent idiopathic scoliosis who underwent long-segment PSF with hybrid thoracic-hook pedicle screw instrumentation or pedicle-screw-alone constructs. Twenty-five patients were assigned to receive topical TXA (1 g/20 mL), and the drain was clamped for 2 h. Twenty-six patients in the control group were treated with antifibrinolytic agents. Results: Median drainage blood loss, median day of drain removal, and median postoperative hospitalization were significantly lower in the topical TXA group (all p <0.05). The postoperative packed red cell transfusion rate was significantly lower in the topical TXA group than that in the control group (15 of 25, 60% vs. 23 of 26, 88.5%; p=0.02; risk ratio, 0.68; 95% confidence interval, 0.48–0.96). Conclusions: The use of topically administered 1 g TXA in AIS patients undergoing instrumented PSF effectively reduced postoperative transfusion requirements, decreased the total amount of drainage blood loss, reduced the time till drain removal, and shortened the length of postoperative hospitalization.
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