The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study

Abstract

Level 1 study according to Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.

Tranexamic Acid for Blood Loss after Transforaminal Posterior Lumbar Interbody Fusion Surgery: A Double-Blind, Placebo-Controlled, Randomized Study

“…Low dose (5 mg/kg of bolus loading dose and 1 mg/kg of continuous infusion until 5 h after surgery) and high dose (10 mg/kg of bolus loading dose and 2 mg/kg of continuous infusion until 5 h after surgery) of TXA were applied for single-level posterior lumbar interbody fusion, and 24 cases were included in each group. The results found that TXA resulted in the significant decrease in intraoperative blood loss (385 ± 139 ml versus 542 ± 333 ml in the control group, P = 0:03), but there was no statistical difference between the low dose of TXA and the control group (508 ± 269 ml versus 542 ± 333 ml, P = 0:74), indicating that high dose of TXA was effective to reduce blood loss for posterior lumbar interbody fusion [18]. Considering the outcomes including Hb and HCT, high dose of TXA and control intervention resulted in similar change of Hb (1:3 ± 0:6 versus 1:7 ± 0:2 g/dl, respectively, P = 0:75) and HCT (2:3 ± 1:6 versus 5:8 ± 2:3%, respectively, P = 0:15) [18], which was also confirmed by another study involving 50 patients in the TXA group and 46 patients in the control group for posterior lumbar surgery [17].…”

“…Only two RCTs reported the impact of preoperative and intraoperative intravenous infusion of TXA on blood loss for spinal fusion surgery [17,18]. Intravenous tranexamic acid might have the better ability to reduce blood loss than its local infiltration [26].…”

“…This RCT investigates the influence of higher dose (10 mg/kg 15 minutes before skin incision followed by intravenous infusion of 6-8 mg/kg/h up to a total dose of 15 mg/kg during the surgery) of TXA for TLIF than the study conducted by Kim et al [18]. Theoretically, the better efficacy to reduce blood loss should be observed in our results, but the mean intraoperative blood loss of the two groups was 91:50 ± 37:31 ml for TXA and 145 ± 108:7 ml for placebo, respectively.…”

“…Some studies confirmed the efficacy of TXA for controlling blood loss in total knee arthroplasty and total hip arthroplasty [15,16]. Only two studies reported the combination use of TXA by preoperative bolus loading and continuous infusion maintenance [17,18]. To our knowledge, this prospective randomized, double-blind, placebo-controlled trial is the first study to focus on the safety and effect of TXA combination use (intravenous bolus of 10 mg/kg 15 minutes before skin incision followed by intravenous infusion of 6-8 mg/kg/h up to a total dose of 15 mg/kg during the surgery) on blood loss reduction in TLIF.…”

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

“…e optimal dosage and application of TXA has been a hot topic in clinical discussion. In one study, the high-dose and low-dose groups received 10 and 5 mg/kg of bolus loading dose and 2 and 1 mg/kg of continuous infusion until 5 h after surgery [31].…”