The Safety and Effectiveness of Tranexamic Acid in Lumbar Interbody Fusion Surgery: An Updated Meta-analysis of Randomized Controlled Trials

Lin, Guang‐Xun; Chen, Chien‐Min; Zhu, Mingtao; Zheng, Linfei

doi:10.1016/j.wneu.2022.07.139

Cited by 5 publications

(7 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.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…TXA is widely used in lumbar fusion surgery because it reduces IBL, OT, LOS, and even blood transfusion rates. [9–34] A systematic review and meta-analysis by Gong et al demonstrated that intravenous TXA during PLIF surgery is safe and can help reduce surgical blood loss; however, the authors concluded that it does not reduce transfusion rates. [10] Bai et al made similar conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…[10] However, Hui et al and Lin et al found that perioperative intravenous TXA administration in spinal surgery can reduce IBL as well as transfusion rates. [11,12] In addition, more than one study has found that intraoperative TXA use can reduce PDV and LOS. [13][14][15][16][17][18] However, no studies have reported whether using TXA or not using TXA within 24 hours after surgery will result in different perioperative clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Several clinicians have adopted the use of antifibrinolytics, particularly tranexamic acid (TXA), in posterior lumbar fusion surgeries, and the TXA use has been demonstrated to help improve the perioperative clinical outcomes, such as reduction in intraoperative blood loss (IBL) and operative time (OT), transfusion rates, hidden blood loss, and length of hospital stay (LOS). [9–34] However, to date, studies comparing the differences in perioperative clinical outcomes with and without postoperative TXA administration are lacking. The impact of the postoperative TXA use on reducing postoperative drainage volume (PDV), LOS, and the rate of postoperative blood or albumin transfusions remains to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative clinical outcomes with and without short-term intravenous tranexamic acid after posterior lumbar interbody fusion: A prospective cohort study

Ji,

Wang,

Shi

et al. 2023

Medicine

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The use of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF) surgery is believed to be beneficial for reducing intraoperative blood loss, postoperative drainage volume (PDV), and length of hospital stay (LOS). However, whether continued administration of intravenous TXA within 24 hours after surgery is more beneficial to patients has not yet been studied. This study prospectively analyzed the perioperative outcomes of patients who received and did not receive intravenous TXA within 24 hours after PLIF (≥2 segments) surgery from January 2018 to December 2021. A total of 78 and 69 patients were included in the TXA (receive intravenous TXA intraoperatively and within 24 hours postoperatively) and non-TXA (only receive intravenous TXA intraoperatively) groups, respectively. No significant differences were observed in the intraoperative blood loss and operative time between the 2 groups. The postoperative drainage volume, postoperative drainage time, and length of hospital stay in the TXA group were significantly lower than those in the non-TXA group. The rates and volumes of postoperative blood and albumin transfusions were significantly lower in the TXA group than those in the non-TXA group. No significant differences were observed in the perioperative complication rates between the 2 groups. No increase in thrombosis-related complications was observed with postoperative TXA administration. Short-term TXA use after PLIF (≥2 segments) surgery is safe. In addition to intraoperative use of TXA, additionally administration of intravenous TXA within 24 hours postoperatively can improve the perioperative clinical outcomes of patients without increasing the risk of thrombotic events.

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“…In instances where conflicts occurred during the screening process, a judicious approach was taken by consulting the other coauthors. The resolution of discrepancies was achieved through collaborative discussion, ensuring a consensus reflecting the collective expertise of the research team [ 13 ]. The selection process involved a meticulous evaluation of the titles and abstracts to discern their relevance to the specific parameters of our study.…”

Section: Methodsmentioning

confidence: 99%

Comparative outcomes of obese and non-obese patients with lumbar disc herniation receiving full endoscopic transforaminal discectomy: a systematic review and meta-analysis

Feng,

Yu,

Chen

et al. 2024

BMC Musculoskelet Disord

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Objective This study aimed to assess the impact of full endoscopic transforaminal discectomy (FETD) on clinical outcomes and complications in both obese and non-obese patients presenting with lumbar disc herniation (LDH). Methods A systematic search of relevant literature was conducted across various primary databases until November 18, 2023. Operative time and hospitalization were evaluated. Clinical outcomes included preoperative and postoperative assessments of the Oswestry Disability Index (ODI) and visual analogue scale (VAS) scores, conducted to delineate improvements at 3 months postoperatively and during the final follow-up, respectively. Complications were also documented. Results Four retrospective studies meeting inclusion criteria provided a collective cohort of 258 patients. Obese patients undergoing FETD experienced significantly longer operative times compared to non-obese counterparts (P = 0.0003). Conversely, no statistically significant differences (P > 0.05) were observed in hospitalization duration, improvement of VAS for back and leg pain scores at 3 months postoperatively and final follow-up, improvement of ODI at 3 months postoperatively and final follow-up. Furthermore, the overall rate of postoperative complications was higher in the obese group (P = 0.02). The obese group demonstrated a total incidence of complications of 17.17%, notably higher than the lower rate of 9.43% observed in the non-obese group. Conclusion The utilization of FETD for managing LDH in individuals with obesity is associated with prolonged operative times and a higher total complication rate compared to their non-obese counterparts. Nevertheless, it remains a safe and effective surgical intervention for treating herniated lumbar discs in the context of obesity.

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The Safety and Effectiveness of Tranexamic Acid in Lumbar Interbody Fusion Surgery: An Updated Meta-analysis of Randomized Controlled Trials

Cited by 5 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

Postoperative clinical outcomes with and without short-term intravenous tranexamic acid after posterior lumbar interbody fusion: A prospective cohort study

Comparative outcomes of obese and non-obese patients with lumbar disc herniation receiving full endoscopic transforaminal discectomy: a systematic review and meta-analysis

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