High-dose tranexamic acid reduces intraoperative and postoperative blood loss in posterior lumbar interbody fusion

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Tranexamic acid (TXA), a synthetic antifibrinolytic drug, has been reported to reduce blood loss in orthopedic surgery, but there have been few reports of its use in spine surgery. Previous studies included limitations in terms of different TXA dose regimens, different levels and numbers of fused segments, and different surgical techniques. Therefore, the authors decided to strictly limit TXA dose regimens, surgical techniques, and fused segments in this study. There have been no reports of using TXA for prevention of intraoperative and postoperative blood loss in posterior lumbar interbody fusion (PLIF). The purpose of the study was to evaluate the efficacy of high-dose TXA in reducing blood loss and its safety during single-level PLIF.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The study was a nonrandomized, case-controlled trial. Sixty consecutive patients underwent single-level PLIF at a single institution. The first 30 patients did not receive TXA. The next 30 patients received 2000 mg of intravenous TXA 15 minutes before the skin incision was performed and received the same dose again 16 hours after the surgery. Intra- and postoperative blood loss was compared between the groups.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>There were no statistically significant differences in preoperative parameters of age, sex, body mass index, preoperative diagnosis, or operating time. The TXA group experienced significantly less intraoperative blood loss (mean 253 ml) compared with the control group (mean 415 ml; p &lt; 0.01). The TXA group also had significantly less postoperative blood loss over 40 hours (mean 321 ml) compared with the control group (mean 668 ml; p &lt; 0.01). Total blood loss in the TXA group (mean 574 ml) was significantly lower than in the control group (mean 1080 ml; p &lt; 0.01). From 2 hours to 40 hours, postoperative blood loss in the TXA group was consistently significantly lower. There were no perioperative complications, including thromboembolic events.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>High-dose TXA significantly reduced both intra- and postoperative blood loss without causing any complications during or after single-level PLIF.</jats:p></jats:sec>

Increased Nociception Following Administration of Different Doses of Tranexamic Acid in Adolescent Idiopathic Scoliosis Surgery

“…Yet, this was in accordance with previously published reports which didn't document any significant association between TXA use and increased risk of vascular complications whether TXA used was in a low dose [12,14] or in a high dose [16,17]. Another theory why TXA did not increase the risk of thromboembolism is that TXA reduces blood loss by deactivating the fibrinolytic system, not by activating the coagulation cascade [14]. On the contrary, there were three thromboembolic complications, including one Pulmonary Embolism (PE) and two Deep Vein Thrombosis (DVTs) in Lin's and his colleagues [13] study which were all treated successfully with anticoagulation.…”

“…Absence of deep venous thrombosis detection may be attributed to the short monitoring period in the study which extended up to 24 hours after the operation only. Yet, this was in accordance with previously published reports which didn't document any significant association between TXA use and increased risk of vascular complications whether TXA used was in a low dose [12,14] or in a high dose [16,17]. Another theory why TXA did not increase the risk of thromboembolism is that TXA reduces blood loss by deactivating the fibrinolytic system, not by activating the coagulation cascade [14].…”

Establishment and Assessment of a Nomogram for Predicting Blood Transfusion Risk in Posterior Lumbar Spinal Fusion

“…Moreover, even in the same diseases, we observed a signi cant positive relationship between blood loss and different procedures, including open surgery or minimally invasive surgery, and unilateral laminar fenestration decompression and fusion, laminar fenestration decompression and fusion, and total laminectomy and decompression. Yang et al (29) conducted a randomized controlled study on blood loss during lumbar minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open transforaminal lumbar interbody fusion (TLIF), and reported that the total operative blood loss was 355 ml for MIS-TLIF and 538 ml for open TLIF. Zhang et al (30) reported that the total intraoperative blood loss was 602 ml for lumbar MIS-TLIF and 42 ml for oblique lumbar interbody fusion (OLIF).…”

Letter to the Editor. Utility of intravenous tranexamic acid in single-level posterior lumbar interbody fusions

“…Furthermore, we all performed exactly the same surgical technique as previously published. 1 Finally, the study design, which was not a double-blinded randomized control trial, is a limitation of this study, as we mentioned in the paper. We agree with the opinion that TXA use must be weighed against the risk of rare complications.…”

“…TO THE EDITOR: We read with great interest the recent article by Kushioka et al 1 (Kushioka J, Yamashita T, Okuda S, et al: High-dose tranexamic acid reduces intraoperative and postoperative blood loss in posterior lumbar interbody fusion. J Neurosurg Spine 26:363-367, March 2017) regarding the use of intravenous tranexamic acid (TXA) for single-level posterior lumbar interbody fusions (PLIFs).…”