A Randomized Controlled Trial of Topical Application of Tranexamic Acid in Patients with Thoracolumbar Spine Trauma Undergoing Long-Segment Instrumented Posterior Spinal Fusion

Sudprasert, Weera; Tanaviriyachai, Terdpong; Choovongkomol, Kongtush; Jongkittanakul, Sarut; Piyapromdee, Urawit

doi:10.31616/asj.2018.0125

Cited by 18 publications

(26 citation statements)

References 26 publications

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“…Table (1) shows that the female (63.3%) and male (36.7%), also age ranged 33-52 with mean 39±4.95; body mass index ranged 22,2±3.3 (kg/m 2 ), according to TLICS score (76.6%) had score 5, (3.3%) had score 6, (20.1%) had score 7; according to mechanism of injury (63.3%) falling from height, (13.3%) had motorcycle accident, (16.6%) had motor vehicle accident, (6,6%) had stuck a heavy object; according to fractured vertebra, (6,6%) had fracture T11, (20%) had fracture T12, (53.3%) had fracture L1, (20%) had fracture L2. Table (2) shows no statistically significant difference between groups according to age and gender data.…”

Section: Resultsmentioning

confidence: 99%

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Effect of Topical Use of Tranexamic Acid in Patients With Thoracolumbar Fracture Undergoing Posterior Spinal Fixation and Fusion

Wanis

Sleem

Abdel-all

2020

Egyptian Journal of Orthopedic Research

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Thoracic and lumbar spine trauma (TLST) is frequently associated with chest and abdominal injuries. Multilevel spinal fusions require a longer operative time, with significant soft tissue stripping as well as blood loss, which frequently leads to allogenic blood transfusion. Topical TXA might enhance patient safety, reducing excessive postoperative bleeding. To evaluate effect of topically applied 1 g TXA on postoperative whole blood transfusion and blood loss in neurologically intact patients with thoracolumbar spine fracture. A clinical prospective randomized study is done on 30 patients with thoracolumbar fracture, undergoing primary posterior instrumented fixation and fusion. Patients were randomized to 2 groups, first group (15 patients) was injected with saline only and second group (15 patients) was injected with mixture of tranexamic acid and saline. Patients were operated under general anesthesia, using a standard midline incision. Wounds are closed in layers over a 16 gauge suction drain; injection cocktail was delivered retrograde into the drain which was then closed for 2 hours. There was a highly significant decrease in blood loss in Group 2. The decrease in Hb level is less in the 2 nd group than in the 1 st group, indicating less postoperative anemia in the blood count (highly significant). Use of topically administered 1 g of TXA (20 mL) in thoracic and lumbar spinal trauma cases undergoing posterior instrumented fixation and fusion effectively decreased postoperative transfusion requirements. Treatment also reduced total drainage volume, time until drain removal, and length of postoperative hospital stay.

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Section: Resultsmentioning

confidence: 99%

“…Thoracic and lumbar spine trauma (TLST) usually results from a high energy injury and is frequently associated with chest and abdominal injuries [1]. Mechanically unstable spinal injuries are commonly noted following severe spine trauma, and they often require surgical stabilization due to a high risk of neurological decline [2].…”

Section: Introductionmentioning

confidence: 99%

Effect of Topical Use of Tranexamic Acid in Patients With Thoracolumbar Fracture Undergoing Posterior Spinal Fixation and Fusion

Wanis

Sleem

Abdel-all

2020

Egyptian Journal of Orthopedic Research

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“…e potential thrombotic risk of intravenous application of TXA promoted the topical administration of TXA as a potentially safer and more targeted intraoperative hemostasis strategy [2]. Topical TXA has been widely used to reduce blood loss in orthopedic, cardiac, and thoracic surgery [26]. Topical TXA can provide direct and local high concentration drugs at the bleeding site and avoid the systemic exposure of TXA [1,2,27].…”

Section: Postoperative Aptt (Seconds)mentioning

confidence: 99%

“…Topical TXA can provide direct and local high concentration drugs at the bleeding site and avoid the systemic exposure of TXA [1,2,27]. Sudrasert et al [26] demonstrated that topical TXA could effectively decrease postoperative transfusion requirements and postoperative blood loss in patients undergoing long-segment instrumented posterior spinal fusion. A latest meta-analysis in 2018 showed that the topical administration of TXA in spine Total (95% CI) Heterogeneity: tau 2 = 0.02, chi 2 = 19.12, df = 5 (P = 0.002); I 2 = 74% Test for overall effect: Z = 0.57 (P = 0.57) Test for subgroup differences: chi 2 = 0.91, df = 1 (P = 0.34); I 2 = 0% surgery decreased TBL and drainage volume and reserved higher postoperative Hb level without increasing the risk of DVT, PE, or wound infection [1].…”

Section: Postoperative Aptt (Seconds)mentioning

confidence: 99%

Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity Spine Surgery: A Meta-Analysis

Xiong

Liu

et al. 2020

BioMed Research International

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Objective. Tranexamic acid (TXA), an antifibrinolytic agent, interferes with fibrinolysis and has been used for many years to reduce blood loss during spine surgery. The purpose of our meta-analysis was to compare the effect of intravenous versus topical administration of TXA in patients undergoing nondeformity spine surgery. Methods. We searched multiple databases, including PubMed, Embase, the Cochrane library, CNKI, WanFang database, and VIP to find studies that met the inclusion criteria. A meta-analysis was performed according to the guidelines of the Cochrane Reviewer’s Handbook. Results. Eight randomized controlled trials (RCTs) were identified, including 660 patients. The surgical methods used in the included studies were nondeformity spine surgery. No significant differences were found in the two groups regarding total blood loss, intraoperative blood loss, hidden blood loss, hematocrit, hemoglobin, fibrinogen, postoperative prothrombin time (PT), postoperative activated partial thromboplastin time (APTT), drainage volume, and blood transfusion rate. There were statistically significant differences in the two groups in terms of preoperative PT (MD = −0.39, 95% CI: [−0.63, −0.15], P=0.002) and preoperative APTT (MD = 1.12, 95% CI: [0.57, 1.68], P<0.0001). Conclusion. During nondeformity spine surgery, intravenous administration of TXA did not have a significant effect on the decrease of blood loss and blood transfusion rate compared with the topical group. According to the pooled analysis of PT and APTT, intravenous and topical application of TXA may have different effects on the coagulation pathway. More high-quality RCTs are needed to explore the optimal dosage, method, timing in the future in order to recommend TXA widespread use in spine surgery.

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“…Topical TXA has the advantage of direct and high local concentration at the bleeding site, and the risks associated with systemic administration are avoided. Although a few studies have looked at spine surgery [21][22][23], there is no consensus for its topical use in this field.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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A Randomized Controlled Trial of Topical Application of Tranexamic Acid in Patients with Thoracolumbar Spine Trauma Undergoing Long-Segment Instrumented Posterior Spinal Fusion

Cited by 18 publications

References 26 publications

Effect of Topical Use of Tranexamic Acid in Patients With Thoracolumbar Fracture Undergoing Posterior Spinal Fixation and Fusion

Effect of Topical Use of Tranexamic Acid in Patients With Thoracolumbar Fracture Undergoing Posterior Spinal Fixation and Fusion

Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity Spine Surgery: A Meta-Analysis

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

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