Antifibrinolytics use during surgery for oncological spine diseases: A systematic review

Abstract

Background: Data exist of the benefits of antifibrinolytics such as tranexamic acid (TXA) in general spine surgery. However, there are limited data of its use in oncological spine patients. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane, OVID, and Embase databases were searched. Search terms: “tranexamic acid”, “aprotinin,” “aminocaproic acid,” “spine surgery,” “spine tumors,” and “spine oncology.” Included studies were full text publications written in English with patients treated with either agent or who had surgery for oncological spine disease (OSD). Results: Seven hundred results were reviewed form the different databases, seven were selected. A total of 408 patients underwent spine surgery for OSD and received antifibrinolytics. There was a male predominance (55.2%) and mean age ranged from 43 to 62 years. The most common tumor operated was metastatic renal cancer, followed by breast and lung. Most studies administered TXA as a bolus followed by an infusion during surgery. Median blood loss was of 667 mL (253.3–1480 mL). Patients with TXA required 1–2 units less of transfusion and had 56–63 mL less of postoperative drainage versus no TXA. The median incidence of deep venous thrombosis (DVT) was 2.95% (0–7.9%) and for pulmonary embolism (PE) was 4.25% (0–14.3%). The use of TXA reduced intraoperative blood loss, transfusions and reduced postoperative surgical drainage output compared to no TXA use in patients with OSD. Conclusion: In this review, we found that TXA may diminish intraoperative blood loss, the need for transfusion and postoperative drainage from surgical drains when used in OSD without major increase in rates of DVT or PE.

Tranexamic Acid Use in Pediatric Craniotomies at a Large Tertiary Care Pediatric Hospital: A Five Year Retrospective Study

“…In a study of adult patients surgically treated for vertebral column tumors, Pennington et al found that TXA was not associated with increased VTE risk, although high-dose TXA (≥20 mg/kg) was associated with increased odds of deep vein thrombosis (DVT) or pulmonary embolism (PE) [ 25 ]. A recent systematic review of antifibrinolytic use in adult patients ( n = 408 patients in 7 studies) undergoing spinal surgery for oncological spinal disease reports efficacy with no increased risk of DVT or PE [ 27 ]. While this information cannot be directly extrapolated and applied to neurosurgical pediatric populations, our small single center study supports this in reporting no increased thromboembolic events related to TXA in this cohort.…”