Abstract
Study design
This study is randomized controlled trial.
Purpose
To evaluate the effect of tranexamic acid (TXA) on reducing postoperative blood loss in posterior approach lumbar surgery for degenerative lumbar instability with stenosis.
Methods
Sixty patients with degenerative lumbar instability with stenosis were randomized into TXA and control groups, receiving 15 mg/kg body weight of TXA or placebo (0.9 % Sodium chloride solution) intravenously, respectively, before the skin incision was made. The operation of pedicle screw system fixation was performed for all patients, and then selective laminectomy and posterior lumbar interbody fusion (PLIF) were carried out. Intraoperative and postoperative blood loss were compared between the two groups. And the complication of TXA was also investigated.
Results
There were no statistically significant differences between the TXA and control groups in terms of age, sex, body mass index, and operation time. There was no significantly difference in intraoperative blood loss between the two groups. However, in the TXA group, postoperative blood loss was significantly lower than that in the control group (13.0 %). Especially, postoperative blood loss during the first 12 h was reduced by 29.9 % as compared to the control group. There were no thromboembolic events or other complications occurred in either group.
Conclusions
Preoperative single-dose TXA can significantly reduce postoperative blood loss in posterior approach lumbar surgery, and there were no significant side effects.
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References
Lemaire R (2008) Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg Br 90(9):1128–1136
Yonenobu K, Hosono N, Iwasaki M et al (1991) Neurologic complications of surgery for cervical compression myelopathy. Spine 16(11):1277–1282
Kebaish KM, Awad JN (2004) Spinal epidural hematoma causing acute cauda equina syndrome. Neurosurg Focus 16(6):e1
Sokolowski MJ, Garvey TA, Perl J II et al (2008) Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine 33(1):108–113
Hu SS (2004) Blood loss in adult spinal surgery. Eur Spine J 13(Suppl 1):3–5
Mannucci PM, Levi M (2007) Prevention and treatment of major blood loss. N Engl J Med 356(22):2301–2311
Neilipovitz DT (2004) Tranexamic acid for major spinal surgery. Eur Spine J 13(Suppl 1):62–65
Mannucci PM (1998) Hemostatic drugs. N Engl J Med 339(4):245–253
Henry DA, Carless PA, Moxey AJ et al (2007) Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev; 4:CD001886
Benoni G, Fredin H (1996) Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br 78(4):434–440
Tanaka N, Sakahashi H, Sato E et al (2001) Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br 83(5):702–705
Johansson T, Pettersson LG, Lisander B (2005) Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double blind study in 100 patients. Acta Orthop 76(3):314–319
Yamasaki S, Masuhara K, Fuji T (2005) Tranexamic acid reduces postoperative blood loss in cement less total hip arthroplasty. J Bone Joint Surg Am 87(4):766–770
Neilipovitz DT, Murto K, Hall L et al (2001) A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg 93(1):82–87
Sethna NF, Zurakowski D, Brustowicz RM et al (2005) Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology 102(4):727–732
Gill JB, Chin Y, Levin A et al (2008) The use of antifibrinolytic agents in spine surgery. A meta-analysis. J Bone Joint Surg Am 90(11):2399–2407
Wong J, El Beheiry H, Rampersaud YR et al (2008) Tranexamic acid reduces perioperative blood loss in adult patients having spinal fusion surgery. Anesth Analg 107(5):1479–1486
Panjabi MM, White AA 3rd (1980) Basic biomechanics of the spine. Neurosurgery 7(1):76–93
Douketis JD, Berger PB, Dunn AS et al (2008) The perioperative management of antithrombotic therapy: American college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest 133(Suppl 6):299S–339S
Griffiths NJ (1979) Factors affecting the fibrinolytic response to surgery. Ann R Coll Surg Engl 61(1):12–16
Pilbrant A, Schannong M, Vessman J (1981) Pharmacokinetics and bioavailability of tranexamic acid. Eur J Clin Pharmacol 20(1):65–72
Tsutsumimoto T, Shimogata M, Ohta H et al (2011) Tranexamic acid reduces perioperative blood loss in cervical laminoplasty: a prospective randomized study. Spine (Phila Pa 1976); 36(23):1913–8
Elwatidy S, Jamjoom Z, Elgamal E et al (2008) Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebo-controlled study. Spine 33(24):2577–2580
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J. Liu and R. Fan are Co-first authors.
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Wang, Q., Liu, J., Fan, R. et al. Tranexamic acid reduces postoperative blood loss of degenerative lumbar instability with stenosis in posterior approach lumbar surgery: a randomized controlled trial. Eur Spine J 22, 2035–2038 (2013). https://doi.org/10.1007/s00586-013-2836-z
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DOI: https://doi.org/10.1007/s00586-013-2836-z