Safety and Efficacy of Topical Administration of Tranexamic Acid in High-Risk Patients Undergoing Posterior Lumbar Interbody Fusion Surgery

Shi, Pengzhi; Wang, Junwu; Cai, Tong; Chen, Dong; Wang, Shuguang; Feng, Xiaoshan; Wang, Yongxiang; Zhang, Wenjie; Zhang, Liang

doi:10.1016/j.wneu.2021.04.088

Cited by 8 publications

(16 citation statements)

References 36 publications

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“…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.…”

Section: Discussionmentioning

confidence: 74%

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

Dai

Feng

et al. 2022

BMC Musculoskelet Disord

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Background Lumbar interbody fusion(LIF) is the leading way to treat Lumbar Degenerative Diseases(LDD). At present, there is a lack of research on the influencing factors of hidden blood loss in minimally invasive hybrid lumbar interbody fusion. This study comprehensively explores the definite factors affecting the hidden blood loss in minimally invasive hybrid lumbar interbody fusion. Materials and methods One hundred patients with Lumbar degenerative diseases who underwent minimally invasive hybrid lumbar interbody fusion in our center were included. Demographics, laboratory data, surgical data, and radiographic data were collected. The Gross equation and Sehat equation were used to calculate the estimated value of hidden blood loss. Multi-factor linear regression analysis was used to determine the influencing factors of hidden blood loss. Result We reviewed and collected 100 patients who underwent minimally invasive hybrid approach, mean age 65 ± 10 years, male: female 37:63; 17 patients of diabetes and 83 patients of non-diabetes; Total blood loss was 645.59 ± 376.37 ml, hidden blood loss was 421.39 ± 337.45 ml, the hidden blood loss percentage was 57 ± 26%. Results from the multi-factorial linear regression model: Diabetes (p < 0.05), hypertension (p < 0.05), psoas thickness (p < 0.05) and dorsal extensor group thickness (p < 0.05) were potential risk factors for postoperative hidden blood loss. Conclusion Although minimally invasive hybrid approach is minimally invasive surgery, there is still a significant amount of hidden blood loss. There is a greater risk of blood loss in diabetes, hypertension and preoperative MRI assessment of thickness of the psoas, thickness of the dorsal extensor group.

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Section: Discussionmentioning

confidence: 74%

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

Dai

Feng

et al. 2022

BMC Musculoskelet Disord

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“…Topical administration is as effective as intravenous infusion, but topical administration can be absorbed to systemic circulation to a minimum, with lower serum concentration and higher local drug concentration. Topical administration is generally used before wound closure, which can reduce the drainage volume, but has little effect on IBL 14,27 . This study was carried out under percutaneous endoscope and saline was needed to irrigation continuously during operation to keep the eld of vision clear.…”

Section: Discussionmentioning

confidence: 99%

“…For elderly patients who are frail and have anemia before operation, excessive HBL will further reduce the postoperative quality of life and increase perioperative risk 36 . As an anti brinolytic drug, TXA has been reported to reduce HBL effectively and safely in spinal surgery [12][13][14][15] . In this study, we found that HBL in the control group was signi cantly higher than that of the TXA group.…”

Section: Discussionmentioning

confidence: 99%

“…TXA is mainly used in hip and knee replacement surgery in orthopedic surgery in the early days 10,11, and it does not increase the risk of thrombosis during the perioperative period. In the recent years, TXA is gradually used in thoracolumbar fusion surgery 12 , spinal deformity surgery 13 , pedicle screw xation surgery 9 and posterior lumbar fusion surgery 14,15 , which can also signi cantly reduce perioperative blood loss.…”

Section: Introductionmentioning

confidence: 99%

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The efficacy and safety of topical saline-irrigation with tranexamic acid on perioperative blood loss in patients treated with percutaneous endoscopic interlaminar discectomy

Zhang

Zhao

et al. 2022

Preprint

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Background: Adequate visualization in percutaneous endoscopic interlaminar discectomy (PEID) surgery is essential for the successful completion of lumbar discectomy. However, there is currently no relevant research on the efficacy and safety of adding tranexamic acid (TXA) to the saline irrigation fluid in PEID surgery. To evaluate the efficacy and safety of topical saline-irrigation with TXA for PEID in the treatment of lumbar disc herniation.Methods: Patients who underwent PEID surgery for L5-S1 lumbar disc herniation were divided into two groups. PEID was performed with saline-irrigation fluid containing 0.33 g of TXA per 1 L of saline in the TXA group (n=38) and only saline in the control group (n=51). All PEID surgeries were performed by the same spine surgery team. The hidden blood loss (HBL), intraoperative blood loss (IBL), total blood loss (TBL), amount of fluid used, operation time, visual clarity, hospital stay, blood transfusion rate, coagulation index and complication rate were compared between the two groups.Results: The TBL, HBL, and IBL in the TXA group were significantly lower than those of the control group. The postoperative hemoglobin in the TXA group was significantly higher than that of the control group. Visual clarity was significantly better and operation time was significantly shorter in the TXA group. However, there was no significant difference in postoperative hematocrit, blood coagulation function, amount of fluid used, blood transfusion rate and perioperative complications between the two groups.Conclusion: In PEID surgery, addition TXA to topical saline-irrigating fluid can significantly reduce HBL, IBL and TBL. Addition TXA to topical saline-irrigating fluid can improve visual clarity in the surgery and reduce operation time, but do not change coagulation function or increase complication rate.

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“…8,9 TXA is mainly used in hip and knee replacement surgery in orthopaedic surgery in the early days, 10,11 and it does not increase the risk of thrombosis during the perioperative period. In the recent years, TXA is gradually being used in the thoracolumbar fusion surgery, 12 spinal deformity surgery, 13 pedicle screw fixation surgery, 9 and posterior lumbar fusion surgery, 14,15 which can also significantly reduce perioperative blood loss. Previous studies found epinephrine (EPN) added to the saline irrigating fluid can reduce surgical blood loss and improve visual clarity in arthroscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Percutaneous Endoscopic Interlaminar Diskectomy: A Retrospective Study

Zhang,

Zhao,

et al. 2023

J Neurol Surg A Cent Eur Neurosurg

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Background Tranexamic acid (TXA) is safe and effective in preventing bleeding during spinal surgery. However, there is currently no relevant research on the efficacy and safety of adding TXA to the saline irrigation fluid in percutaneous endoscopic interlaminar diskectomy (PEID). This study aimed to evaluate the efficacy and safety of topical saline irrigation with TXA for PEID in the treatment of lumbar disk herniation. Methods In this single-center, retrospective cohort study, patients who underwent PEID for L5–S1 lumbar disk herniation were included and allocated to two groups according to whether they had been administered TXA. PEID was performed with saline irrigation fluid containing 0.33 g of TXA per 1 L of saline in the TXA group (n = 38). In the control group (n = 51), the saline irrigation fluid was injected with the same volume of normal saline. All PEIDs were performed by the same spine surgery team. The hidden blood loss (HBL), intraoperative blood loss (IBL), total blood loss (TBL), amount of fluid used, operation time, visual clarity, hospital stay, blood transfusion rate, coagulation index, and complication rate were compared between the two groups. Results The TBL, HBL, and IBL in the TXA group were significantly lower than those of the control group. The postoperative hemoglobin in the TXA group was significantly higher than that of the control group. Visual clarity was significantly better and the operation time was significantly shorter in the TXA group. However, there was no significant difference in postoperative hematocrit, blood coagulation function, amount of fluid used, blood transfusion rate, and perioperative complications between the two groups. Conclusion In PEID, the addition of TXA to topical saline irrigating fluid can significantly reduce the HBL, IBL, and TBL. The addition of TXA to topical saline irrigating fluid can improve visual clarity in the surgery and reduce operation time, but it does not change the coagulation function or the complication rate.

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Safety and Efficacy of Topical Administration of Tranexamic Acid in High-Risk Patients Undergoing Posterior Lumbar Interbody Fusion Surgery

Cited by 8 publications

References 36 publications

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

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

The efficacy and safety of topical saline-irrigation with tranexamic acid on perioperative blood loss in patients treated with percutaneous endoscopic interlaminar discectomy

The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Percutaneous Endoscopic Interlaminar Diskectomy: A Retrospective Study

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