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Lou Z, Jiang Y, Jiang K, Zhu J, Lai L, Huang Z, Zhu J. Efficacy and safety of tranexamic acid use in elderly patients undergoing anterior cervical discectomy and fusion: a retrospective study. J Int Med Res 2024; 52:3000605241285661. [PMID: 39340253 PMCID: PMC11445765 DOI: 10.1177/03000605241285661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2024] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of intravenous tranexamic acid (TXA) administration in anterior cervical discectomy fusion (ACDF) for the treatment of cervical spondylosis in the elderly. METHODS Data from elderly patients who underwent ACDF between January 2020 and January 2023 were retrospectively reviewed. Patients who received 1 g intravenous TXA administration before skin incision (TXA group) were compared with patients who did not receive TXA (controls). Total and hidden blood loss were calculated, and the following outcomes were recorded: haemoglobin and haematocrit drop, operation time, drainage duration, drain volume, length of hospitalization, coagulation changes, and incidence of complications. RESULTS A total of 114 patients were included (TXA group, n = 53 and controls, n = 61). Total blood loss, hidden blood loss, and postoperative drainage volume, haemoglobin and haematocrit drop were significantly lower in the TXA group than the control group. There were no significant differences in operation time, intraoperative blood loss, drainage duration, length of hospitalization, or coagulation function between the two groups. The incidence of complications did not differ significantly between the two groups during 3 months of follow-up. CONCLUSIONS Intravenous TXA is effective in reducing perioperative blood loss in elderly patients undergoing ACDF without changing the coagulation function or increasing the risk of complications.
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Affiliation(s)
- Zhenqi Lou
- Department of Orthopaedic Surgery, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Yi Jiang
- Department of Orthopaedic Surgery, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Kanling Jiang
- Department of Orthopaedic Surgery, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Jieyang Zhu
- Department of Orthopaedic Surgery, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Lan Lai
- Department of Anaesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Zhihai Huang
- Department of Orthopaedic Surgery, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Jinyu Zhu
- Department of Orthopaedic Surgery, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
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Li Y, Ge M, Tian J, Zhou J, Kang Y, Xia C, Shao H, Wang Y, Huang Y, Zhao T. Effect of Tranexamic Acid on Hidden Blood Loss in Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion: A Retrospective Study. Ther Clin Risk Manag 2024; 20:325-334. [PMID: 38827486 PMCID: PMC11144425 DOI: 10.2147/tcrm.s462784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/19/2024] [Indexed: 06/04/2024] Open
Abstract
Purpose Percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) has become one of the most popular minimally invasive surgeries today. However, the issue of hidden blood loss (HBL) in this surgery has received little attention. This study aims to examine the HBL in PE-TLIF surgery and the effect of tranexamic acid (TXA) on blood loss. Methods In our research, We conducted a retrospective analysis of 300 patients who underwent PE-TLIF from September 2019 to August 2023. They were divided into 2 groups based on whether they received intravenous TXA injection before surgery. The variables compared included: demographic data, pre-and postoperative hemoglobin (HB), hematocrit (HCT), platelets (PLT), red blood cells (RBC), total blood loss (TBL), visible blood loss (VBL), HBL, operation time, postoperative hospital stay, inflammatory markers, coagulation parameters, and adverse events. Results Regarding demographic characteristics, besides the operation time, no significant differences were observed between the two groups. Compared with the control group, the TXA group showed a significant reduction trend in TBL, HBL, and VBL (P < 0.05). On the first day after surgery, there were significant differences in prothrombin (PT), activated partial thromboplastin time (APTT), and D-dimer (D-D) levels between the two groups. Similarly, HCT also found similar results on the third day after surgery. No adverse events occurred in either group. Conclusion Research has found that there is a significant amount of HBL in patients undergoing PE-TLIF. Intravenous injection of TXA can safely and effectively reduce perioperative HBL and VBL. Additionally, compared to the control group, the TXA group shows a significant reduction in operation time.
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Affiliation(s)
- Yanlei Li
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Meng Ge
- Department of Orthopedics, Hospital of Traditional Chinese Medicine of Xiaoshan District, Hangzhou, Zhejiang, People’s Republic of China
| | - Jinlong Tian
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Jinlei Zhou
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yao Kang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Chen Xia
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Haiyu Shao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Yongguang Wang
- Department of Orthopedics, Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Yazeng Huang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
| | - Tingxiao Zhao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China
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Yamanouchi K, Funao H, Fujita N, Ebata S, Yagi M. Safety and Efficacy of Tranexamic Acid in Spinal Surgery: A Systematic Review and Meta-Analysis. Spine Surg Relat Res 2024; 8:253-266. [PMID: 38868794 PMCID: PMC11165496 DOI: 10.22603/ssrr.2023-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/14/2023] [Indexed: 06/14/2024] Open
Abstract
Background Tranexamic acid (TXA) has gained popularity in spinal surgery because of its potential to reduce blood loss. However, concerns regarding its safety and efficacy remain. This systematic review and meta-analysis aimed to evaluate the efficacy of TXA in reducing blood loss and its safety profile in spinal surgeries. Methods A comprehensive search was conducted in electronic databases for randomized controlled trials and prospective studies evaluating the use of TXA in spinal surgery. The primary outcomes were intraoperative and total estimated blood loss (EBL), and the secondary outcomes included the incidence and types of complications associated with TXA use. Meta-analyses were performed using random-effects models. Results Thirteen studies involving 1,213 participants were included in the meta-analysis. The use of TXA was associated with significant reductions in both intraoperative (mean difference: -46.56 mL [-73.85, -19.26], p<0.01]) and total EBL (mean difference: -210.17 mL [-284.93, -135.40], p<0.01) while also decreasing the need for blood transfusions (risk ratio: 0.68 [0.51, 0.90], p<0.01). No significant difference was found in the incidence and types of thrombotic complications when TXA was used in spinal surgery. Subgroup analysis showed consistent results in instrumentation and fusion surgery and different doses of TXA. Conclusions TXA is effective in reducing intraoperative and overall blood loss in spinal surgery without increasing the risk of complications. These findings support the use of TXA to improve patient outcomes. However, caution should be exercised because of the heterogeneity among the included studies. Further research is needed to confirm these findings and explore potential long-term complications.
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Affiliation(s)
- Kento Yamanouchi
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Japan
| | - Naruhito Fujita
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Japan
| | - Shigeto Ebata
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Japan
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Honda A, Iizuka Y, Michihata N, Uda K, Mieda T, Takasawa E, Ishiwata S, Kakuta Y, Tomomatsu Y, Ito S, Inomata K, Matsui H, Fushimi K, Yasunaga H, Chikuda H. Effect of Intraoperative Tranexamic Acid on Perioperative Major Hemorrhage Requiring Transfusion in Patients Undergoing Elective Spine Surgery: A Propensity Score-Matched Analysis Using a National Inpatient Database. Global Spine J 2024; 14:804-811. [PMID: 36006871 PMCID: PMC11192125 DOI: 10.1177/21925682221123317] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aimed to examine whether the use of intravenous TXA in elective spine surgery is associated with reduced perioperative massive hemorrhage requiring transfusion. METHODS We extracted all patients who underwent decompression with or without fusion surgery for the cervical, thoracic, and lumbar spine between April 2012 and March 2019. The primary outcome was the occurrence of massive hemorrhage requiring transfusion, defined as at least 560 mL of blood transfusion within 2 days of spine surgery or the requirement of additional blood transfusion from 3-7 days postoperatively. Secondary outcomes were the occurrence of thrombotic complications (pulmonary embolism, acute coronary syndrome, and stroke) and postoperative hematoma requiring additional surgery. RESULTS We identified 83,821 eligible patients, with 9747 (12%) patients in the TXA group. Overall, massive hemorrhage requiring transfusion occurred in 781 (.9%) patients. Propensity score matching yielded 8394 pairs. In the matched cohort, the TXA group had a lower proportion of massive hemorrhage requiring transfusion than the control group (.7% vs 1.1%; P = .002). There was no significant difference in the occurrence of thrombotic complications and postoperative hematoma requiring additional surgery between both groups. The multivariable regression analysis also showed that the use of TXA was associated with significantly lower proportions of massive hemorrhage requiring transfusion (odds ratio, .62; 95% confidence interval, .43-.90; P = .012). CONCLUSIONS In this analysis using real-world data, TXA use in elective spinal surgery was associated with reduced perioperative massive hemorrhage requiring transfusion without increasing thrombotic complications. LEVEL OF EVIDENCE Prognostic Level Ⅲ.
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Affiliation(s)
- Akira Honda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuaki Uda
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Sho Ishiwata
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yohei Kakuta
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yusuke Tomomatsu
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Shunsuke Ito
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kazuhiro Inomata
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Ji X, Wang X, Shi L, Tian F. Postoperative clinical outcomes with and without short-term intravenous tranexamic acid after posterior lumbar interbody fusion: A prospective cohort study. Medicine (Baltimore) 2023; 102:e35911. [PMID: 37986288 PMCID: PMC10659680 DOI: 10.1097/md.0000000000035911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023] Open
Abstract
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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Affiliation(s)
- Xianqun Ji
- Department of Orthopedics, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Xiaochen Wang
- Department of Pharmacy, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Liang Shi
- Department of Orthopedics, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Fangtao Tian
- Department of Orthopedics, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
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Akosman I, Lovecchio F, Fourman M, Sarmiento M, Lyons K, Memtsoudis S, Kim HJ. Is High-Dose Tranexamic Safe in Spine Surgery? A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:2085-2095. [PMID: 36592635 PMCID: PMC10556905 DOI: 10.1177/21925682221148686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
STUDY DESIGN Literature review and meta-analysis. OBJECTIVES Single-center series may be underpowered to detect whether high-dose (HD) tranexamic acid (TXA) confers a higher risk of complications. We sought to determine the safety and efficacy of HD TXA as compared to low-dose (LD) or placebo. METHODS A systematic literature review was performed to find studies where spine surgery patients were given HD TXA (loading dose ≥30 mg/kg). Complication rates were pooled, and meta-analyses performed on outcomes of interest. Articles were evaluated for risk of bias and a strength of evidence assessment was given for each conclusion. RESULTS Twenty three studies (n = 2331) were included. The pooled medical complication rate was 3.2% in pediatric patients, 8.2% in adults. Using lower dose TXA or placebo as the reference, meta-analysis showed no difference in medical complications (n = 1,723, OR 1.22 [95% CI, .78 to 1.22]; P = .388; I2 = 0%) or thrombotic events (n = 1158 patients, OR 1.27 [95% CI, .71 to 2.63]; P = .528; I2 = 0%). Compared to LD, HD TXA was associated with less intraoperative blood loss (823 patients, WMD = -285 [95% CI, -564 to -5.90]; P = .0454; I2 = 86%), fewer perioperative transfusions (n = 505, OR .28 [95% CI, .082 to .96]; P = .043; I2 = 76%) and lower perioperative transfusion volumes (n = 434, WMD -227.7 mL [95% CI, -377.3 to -78.02]; P = .0029; I2 = 0%). CONCLUSION Compared to LD TXA or placebo, there is moderate evidence that HD is not associated with an increased risk of medical complications. Compared to LD, there is moderate evidence that HD reduces transfusion requirements. High-Dose TXA can be safely utilized in healthy patients undergoing major spine surgery.
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Affiliation(s)
| | - Francis Lovecchio
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Mitchell Fourman
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Manuel Sarmiento
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Keith Lyons
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Stavros Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, USA
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Tan H, Pan S, Wei C, Chen Z, Chen T. Comparative efficacy and safety of different hemostatic medications during spinal surgery: A network meta-analysis. Medicine (Baltimore) 2023; 102:e32923. [PMID: 36862901 PMCID: PMC9981439 DOI: 10.1097/md.0000000000032923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Significant blood loss is still one of the most frequent issues in spinal surgery. There were different hemostatic methods to prevent blood loss during spinal surgery. However, the optimal hemostatic therapy for spinal surgery is controversial. The purpose of this study was to assess the efficacy and safety of different hemostatic therapies in spinal surgery. METHODS Two independent reviewers conducted electronic literature searches in 3 electronic databases (PubMed, Embase, and Cochrane library database) as well as a manual search to identify eligible clinical studies from inception to Nov 2022. Studies that including different hemostatic therapy (tranexamic acid [TXA], epsilon-acetyl aminocaproic acid [EACA], and aprotinin [AP]) for spinal surgery were included. The Bayesian network meta-analysis was performed with a random effects model. The surface under the cumulative ranking curve (SUCRA) analysis was performed to determine the ranking order. All analyses were performed by R software and Stata software. P value less than .05 was identified as statistically significant. RESULTS Finally, a total of 34 randomized controlled trials met the inclusion criteria and finally included in this network meta-analysis. The SUCRA shows that TXA ranked first (SUCRA, 88.4%), AP ranked second (SUCRA, 71.6%), EACA ranked third (SUCRA, 39.9%), and placebo ranked the last (SUCRA, 0.3%) as for total blood loss. The SUCRA shows that TXA ranked first (SUCRA, 97.7%), AP ranked second (SUCRA, 55.8%), EACA ranked third (SUCRA, 46.2%), and placebo ranked the last (SUCRA, 0.2%) for need for transfusion. CONCLUSIONS TXA appears optimal in the reduction of perioperative bleeding and blood transfusion during spinal surgery. However, considering the limitations in this study, more large-scale, well-designed randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- Haitao Tan
- Department of Spinal Surgery, The First Affiliated Hospital of Hainan Medical University (Hainan Province Clinical Medical Center), Haikou, China
| | - Songli Pan
- Department of Spinal Surgery, The First Affiliated Hospital of Hainan Medical University (Hainan Province Clinical Medical Center), Haikou, China
| | - Chuanchun Wei
- Department of Anesthesia and Operation, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zhilin Chen
- Department of Breast surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Tao Chen
- Department of Spinal Surgery, The First Affiliated Hospital of Hainan Medical University (Hainan Province Clinical Medical Center), Haikou, China
- *Correspondence: Tao Chen, Department of Spinal Surgery, The First Affiliated Hospital of Hainan Medical University (Hainan Province Clinical Medical Center), No. 31, Longhua Road, Longhua District, Haikou, Hainan 570102, China (e-mail: )
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Luan H, Liu K, Peng C, Tian Q, Song X. Efficacy and safety of tranexamic acid in posterior lumbar interbody fusion: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18:14. [PMID: 36604661 PMCID: PMC9817320 DOI: 10.1186/s13018-022-03493-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of tranexamic acid (TXA) in hemostasis in patients undergoing posterior lumbar interbody fusion (PLIF) by meta-analysis. METHODS This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42022354812). The databases PubMed, Cochrane Library, Web of Science, and Embase were searched for randomized controlled trial (RCT) papers on the use of TXA in patients with PLIF from database establishment to August 2022. Two researchers screened the literature, extracted data, evaluated the risk of bias of the included studies, recorded the authors, sample size, type of study design, and TXA dose of each study, and extracted the intraoperative blood loss, number of blood transfusions, total blood loss, drainage volume, operation time, and incidence of deep venous thrombosis in each study. Meta-analysis was performed using RevMan 5.4 software provided by Cochrane Library. RESULTS A total of 14 RCTs with a total of 1681 patients were included in this study, including 836 patients in the TXA group and 845 patients in the control group. The intraoperative blood loss [mean difference (MD) = - 125.97, 95% confidence interval (CI) (- 138.56, - 113.37), P < 0.0001] and less total blood loss [MD = - 204.28, 95% CI (- 227.38, - 181.18), P < 0.00001] in TXA group were lower than the control group. Statistical significance was also observed in postoperative drainage volume [MD = - 115.03, 95% CI (- 123.89, - 106.17), P < 0.00001], operation time [MD = - 8.10, 95% CI (- 14.49, - 1.71), P = 0.01], and blood transfusion rate [odds ratio (OR) = 0.30, 95% CI (0.23, 0.39), P < 0.00001]. However, there was no statistical difference observed in the incidence of deep venous thrombosis [OR = 0.83, 95% CI (0.56, 1.21), P = 0.33]. CONCLUSION The application of TXA in PLIF can reduce intraoperative blood loss, total blood loss, drainage volume, the incidence of transfusion events, and operation time without increasing the risk of deep venous thrombosis.
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Affiliation(s)
- Haopeng Luan
- grid.13394.3c0000 0004 1799 3993Department of Spine Surgery, The Six Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830002 Xinjiang China
| | - Kai Liu
- grid.412631.3Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830054 Xinjiang China
| | - Cong Peng
- grid.13394.3c0000 0004 1799 3993Department of Spine Surgery, The Six Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830002 Xinjiang China
| | - Qi Tian
- grid.412631.3Department of Bone Tumor Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830054 Xinjiang China
| | - Xinghua Song
- grid.13394.3c0000 0004 1799 3993Department of Spine Surgery, The Six Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830002 Xinjiang China
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Cao Z, Li Q, Guo J, Li Y, Wu J. Optimal administration strategies of tranexamic acid to minimize blood loss during spinal surgery: results of a Bayesian network meta-analysis. Ann Med 2022; 54:2053-2063. [PMID: 35862264 PMCID: PMC9307111 DOI: 10.1080/07853890.2022.2101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Tranexamic acid (TXA) has been widely used for bleeding reduction in spinal surgery. Available evidence is insufficient to inform clinical decisions making and there remains a lack of comprehensive comparisons of dose regimens and delivery routes. This study is aimed to assess and compare different strategies regarding the involvement of TXA in spinal surgery for the optimal pathway of efficacy and safety. MATERIALS AND METHODS Cochrane Library, PubMed, Embase, Scopus and CNKI were searched for the period from January 1990 to October 2021. A random-effect model was built in the Bayesian network meta-analysis. The surface under the cumulative ranking analysis (SUCRA) and clustering rank analysis was performed for ranking the effects. RESULTS The current network meta-analysis incorporated data from 33 studies with 3302 patients. Combination administration showed superior effects on reducing intraoperative bleeding (SUCRA 78.78%, MD -129.67, 95% CI [(-222.33, -40.58)]) than placebo, and was ranked as top in reducing postoperative bleeding (SUCRA 86.91%, MD -169.92, 95% CI [(-262.71, -83.52)]), changes in haemoglobin (SUCRA 97.21%, MD -1.28, 95% CI [(-1.84, -0.73)]), and perioperative blood transfusion (SUCRA 93.23%, RR 0.10, 95% CI [(0.03, 0.25)]) simultaneously, and was shown as the best effectiveness and safety (cluster-rank value for IBL and VTE: 4057.99 and for TRF and VTE: 4802.26). CONCLUSIONS Intravenous (IV) plus topical administration of TXA appears optimal in the reduction of perioperative bleeding and blood transfusion, while the local infiltration administration is not effective for blood conservation. Further studies are required to verify the current findings.
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Affiliation(s)
- Ziqin Cao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Qiangxiang Li
- Ningxia Geriatric Disease Clinical Research Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, P. R. China.,National Clinical Research Center for Geriatric Disorders of Xiangya Hospital, Central South University (Sub-Center of Ningxia), Yinchuan, P. R. China.,Department of Hunan Institute of Geriatrics, Hunan People's Hospital, Changsha, P. R. China
| | - Jia Guo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Yajia Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Jianhuang Wu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, P. R. China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, P. R. China
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10
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Lin GX, Chen CM, Zhu MT, Zheng L. The Safety and Effectiveness of Tranexamic Acid in Lumbar Interbody Fusion Surgery: An Updated Meta-analysis of Randomized Controlled Trials. World Neurosurg 2022; 166:198-211. [PMID: 36084620 DOI: 10.1016/j.wneu.2022.07.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Several previous meta-analyses have been published, followed by additional randomized clinical trials investigating the effects of tranexamic acid (TXA) in patients undergoing posterior lumbar interbody fusion (PLIF) surgery. As a result, the purpose of this research is to present an updated quantitative analysis of the existing literature and to further explicate its effectiveness. METHODS PubMed, Embase, Web of Science, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing the application of TXA and placebo in patients undergoing PLIF surgery from their establishment to December 31, 2021. Data on clinical outcomes, perioperative outcomes, and complications were collected. The summary statistics for continuous and dichotomous variables were derived as weighted mean difference (WMD) and relative risk (RR), respectively. RESULTS A total of 12 studies enrolling 1088 participants were included in this meta-analysis. The combined results revealed that TXA can decrease intraoperative blood loss (WMD: -84.83, P < 0.0001), total blood loss (WMD: -189.93, P < 0.00001), hidden blood loss (WMD: -134.69, P = 0.002), postoperative drainage (WMD: -100.71, P < 0.00001), postoperative hemoglobin loss (WMD: 6.21, P < 0.00001), operative time (WMD: -3.80, P = 0.007), hospital stay (WMD: -1.86, P = 0.001), and transfusion rates (RR: 0.41, P < 0.00001) in PLIF without increasing the risk of thromboembolic events (RR: 0.80, P = 0.43). CONCLUSIONS TXA can considerably decrease surgical blood loss, postoperative drainage, reduce operative times, hospital stays, and transfusion rates. Furthermore, the TXA group had lower postoperative hemoglobin drop values than the placebo group.
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Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The Third Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Tao Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Linfei Zheng
- Department of Neurosurgery, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, Fuzhou, China; Fuzhou Second Hospital, Fuzhou, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma (2020Y2014), Fuzhou, China.
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11
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Liu ZG, Yang F, Zhu YH, Liu GC, Zhu QS, Zhang BY. Is Tranexamic Acid Beneficial in Open Spine Surgery? and its Effects Vary by Dosage, Age, Sites, and Locations: A Meta-Analysis of Randomized Controlled Trials. World Neurosurg 2022; 166:141-152. [PMID: 35843575 DOI: 10.1016/j.wneu.2022.07.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The role of tranexamic acid (TXA) in controlling blood loss during spine surgery remains unclear. With the publication of new randomized controlled trials (RCTs), we conducted a meta-analysis to determine the safety and efficacy of TXA in spine surgery. METHODS PubMed, Embase, Web of Science, and Cochrane databases were searched for relevant studies through 2022. Only RCTs were eligible for this study. The extracted data were analyzed using RevMan 5.3 software for meta-analysis. RESULTS Twenty RCTs including 1497 patients undergoing spine surgery were included in this systematic evaluation. Compared with the control group, TXA significantly reduced total blood loss (mean difference [MD] = - 218.96, 95% confidence interval [CI] = - 309.77 to - 128.14, P < 0.00001), perioperative blood loss (MD = - 90.54, 95% CI = - 139.33 to - 41.75, P = 0.0003), postoperative drainage (MD = - 102.60, 95% CI = - 139.51 to - 65.70, P < 0.00001),reduced hospital stay (MD = - 1.42, 95% CI = - 2.71 to - 0.14, P = 0.03), reduced total blood transfusion volume (MD = - 551.06, 95% CI = - 755.90 to - 346.22, P < 0.00001), and international normalized ratio (MD = -0.03, 95% CI = -0.04 to -0.02, P < 0.00001). CONCLUSIONS Based on the meta-analysis of 20 RCTs, we demonstrated that TXA reduces blood loss in open spine surgery, decreases transfusion rates, and shortens hospital stays. The TXA administration during the perioperative period does not increase the incidence of postoperative complications.
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Affiliation(s)
- Zhen-Gang Liu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Fan Yang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yu-Hang Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guang-Chen Liu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qing-San Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Bo-Yin Zhang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China.
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12
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Kanhere AP, Lambrechts MJ, Issa TZ, Karamian BA, Hendow CJ, Reddy YC, Slota PJ, D'Antonio ND, Kaye ID, Canseco JA, Woods BI, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The Effect of Tranexamic Acid on Operative and Postoperative Blood Loss in Transforaminal Lumbar Interbody Fusions. World Neurosurg 2022; 166:e443-e450. [PMID: 35840090 DOI: 10.1016/j.wneu.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this retrospective cohort study was to evaluate the effect of tranexamic acid (TXA) on reducing perioperative blood loss and length of stay after transforaminal lumbar interbody fusion (TLIF). Spine surgery is associated with the potential for significant blood loss, and adequate hemostasis is essential to visualizing crucial structures during the approach and procedure. Although TXA use has been extensively studied in the pediatric and adult spinal deformity literature, there is a dearth of literature on its efficacy in reducing blood loss for patients who undergo 1- to 3-level TLIF. METHODS All patients requiring 1- to 3-level TLIF who received a preoperative loading dose of TXA were grouped and compared with patients who didn't receive TXA. Demographic, surgical, and laboratory values were collected and analyzed. Continuous and categorical variables were analyzed with χ2, Kruskal-Wallis, or analysis of variance tests, depending on normality and data type. Multiple linear regressions were developed to determine independent predictors of the estimated blood loss (EBL), total blood loss, drain output, and length of stay. Statistical significance was set at P < 0.05. RESULTS Patients who received preoperative TXA had more comorbidities (P = 0.006), longer surgery length (P < 0.001), and longer length of stay (P = 0.004). TXA was independently associated with a decreased day 0, 1, 2, and total drain output (P < 0.001, P = 0.001, P = 0.007, P < 0.001, respectively), but was not associated with a change in EBL, total blood loss, or length of stay. CONCLUSIONS The application of preoperative TXA for patients undergoing 1- to 3-level TLIF reduced drain output in the first 2 postoperative days, but it did not affect hospital length of stay, total blood loss, or EBL.
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Affiliation(s)
- Arun P Kanhere
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Tariq Ziad Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chelsea J Hendow
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yashas C Reddy
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul J Slota
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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13
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Erdogan U, Sari S, Akbas A. The Efficiency of Simultaneous Systemic and Topical Use of Tranexamic Acid in Spinal Fusion Surgery. J Neurol Surg A Cent Eur Neurosurg 2021; 83:46-51. [PMID: 34794191 DOI: 10.1055/s-0041-1731751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIM Multilevel posterior spinal fusion surgery in adults is associated with significant intra- and postoperative blood loss. Tranexamic acid (TXA) is an antifibrinolytic agent for reducing blood loss and allogenic blood transfusion. The purpose of this study was to evaluate the efficiency of TXA in reducing blood loss and improving hematologic parameters in adult patients undergoing posterior thoracic/lumbar instrumented spinal fusion surgery. PATIENTS AND METHODS This is a retrospective observational study comparing the intra- and postoperative hemodynamic findings of two groups treated with and without TXA. The study included 112 adult patients receiving elective posterior thoracic/lumbar instrumented spinal fusion surgery. The patients were evaluated in terms of age, gender, type of surgery, intraoperative blood loss, pre- and postoperative hemoglobin (Hb) and hematocrit values, postoperative systemic anticoagulant use, intra- and postoperative use of blood products, and the volume of the drainage fluid as an indicator of postoperative blood loss. The TXA group received preoperative 10 mg/kg intravenous TXA, another dose of 10 mg/kg/h in isotonic solution during the operation, and local administration of TXA before the closure of the surgical site (1g in patients undergoing surgery in ≤3 segments, and 2g in patients undergoing surgery in ≥4 segment group). RESULTS Intra- and postoperative blood loss and need for transfusion were significantly lower in the TXA group. Fifty-three of 112 patients required intra- and postoperative transfusion, and postoperative anticoagulants were given to 25/112 patients. The postoperative Hb level was lower, and the difference of pre- and postoperative Hb values was higher in the non-TXA group (not significant). CONCLUSION Simultaneous systemic and topical application of TXA is a safe and efficient blood conservation strategy for adult patients undergoing major multilevel spinal surgery.
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Affiliation(s)
- Uzay Erdogan
- Department of Neurosurgery, University of Health Sciences, Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
| | - Seckin Sari
- Department of Orthopedics, Sportoteam Sport and Spine Center, Istanbul, Turkey
| | - Ahmet Akbas
- Department of Neurosurgery, Istanbul Taksim Training and Research Hospital, Istanbul, Turkey
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14
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Yuan L, Jiang Y, Liu Y, Zeng Y, Chen Z, Li W. Cost-Benefit Analysis of Using A Single Dose of Tranexamic Acid in Degenerative Lumbar Scoliosis Patients Undergoing Long-Segment Spinal Fusion Surgery: A Retrospective Study. Med Sci Monit 2021; 27:e930352. [PMID: 34424890 PMCID: PMC8394591 DOI: 10.12659/msm.930352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Degenerative lumbar scoliosis (DLS) patients undergoing posterior long-segment spinal fusion surgery often require perioperative blood transfusions, and previous studies have reported that increased complications and additional costs accompany these transfusions. One method for decreasing transfusions is the administration of tranexamic acid (TXA). We sought to evaluate the costs and benefits of preoperative administration of 1 g of intravenous TXA, without maintenance, in DLS patients undergoing long-segment spinal fusion surgery. Material/Methods Patients who received TXA (TXA group) were compared with patients who did not receive TXA (NTXA group) with regard to blood loss, units of packed red blood cells (PRBC) transfused, hemostasis costs, and perioperative complications. The benefits and costs were estimated through analysis of the spending on NTXA and TXA patients, and were compared. The difference between the cost per patient in the 2 groups was designated as the net cost-benefit. Then, both groups were substratified into non-osteotomy and osteotomy subgroups for further analysis. Results Of the 173 patients who met the inclusion criteria, 54 TXA patients had significantly reduced perioperative blood loss and total hemostasis costs compared with NTXA patients (n=119). In the group without osteotomy (n=72), TXA (n=13) reduced perioperative blood loss but did not significantly decrease PRBC units and hemostasis costs. However, in patients undergoing osteotomy (n=101), a remarkable net cost savings of ¥648.77 per patient was shown in the TXA group (n=41) (P<0.001). This was because patients undergoing osteotomy in the TXA group received fewer PRBC units (3.7 vs 5.7, P=0.001). Conclusions A single dose of TXA significantly decreased perioperative blood loss and total hemostasis costs for DLS patients undergoing osteotomy. Furthermore, TXA led to no additional net costs in patients without osteotomy.
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Affiliation(s)
- Lei Yuan
- Department of Orthopedics, Peking University Third Hospital, Beijing, China (mainland).,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China (mainland).,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China (mainland)
| | - Yu Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China (mainland).,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China (mainland).,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China (mainland)
| | - Yinhao Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China (mainland).,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China (mainland).,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China (mainland)
| | - Yan Zeng
- Department of Orthopedics, Peking University Third Hospital, Beijing, China (mainland).,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China (mainland).,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China (mainland)
| | - Zhongqiang Chen
- Department of Orthopedics, Peking University Third Hospital, Beijing, China (mainland).,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China (mainland).,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China (mainland)
| | - Weishi Li
- Department of Orthopedics, Peking University Third Hospital, Beijing, China (mainland).,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China (mainland).,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China (mainland)
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15
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Arun-Kumar V, Naresh-Babu J. Is There a Role for Preoperative Local Infiltration of Tranexamic Acid in Elective Spine Surgery? A Prospective Randomized Controlled Trial Analyzing the Efficacy of Intravenous, Local Infiltration, and Topical Administration of Tranexamic Acid. Global Spine J 2021; 11:21-27. [PMID: 32875830 PMCID: PMC7734265 DOI: 10.1177/2192568219888446] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
STUDY DESIGN Randomized control trial. OBJECTIVE The purpose of the study is to evaluate the safety and efficacy of tranexamic acid in reducing blood loss when administered through various routes in instrumented spine surgeries. METHODS A total of 104 patients undergoing instrumented spine surgery were randomly assigned to 4 groups (n = 26 in each group). Groups included (1) ivTXA-intravenous administration of tranexamic acid (TXA) 1 hour prior to surgery, (2) loTXA-local infiltration of TXA bilaterally into the paraspinal musculature prior to incision, (3) tTXA-topical application of TXA just before wound closure, and (4) control group. Outcome measures included intraoperative blood loss, postoperative blood loss, need for blood transfusion, length of hospital stay, and hematological parameters. RESULTS All the 3 different modes of TXA administration were found to be effective in reducing blood loss in the treated groups compared with the control group. Intraoperative blood loss was significantly reduced in ivTXA (223.6 ± 40.1 mL, P < .0001) and loTXA (256.07 ± 119 mL, P = .0039) groups when compared with controls (344 ± 88.5 mL).The postoperative blood loss was least in tTXA followed by ivTXA, loTXA, and controls. There was 67% reduction in need for blood transfusion in tTXA group, 55.5% reduction in ivTXA group, and 33% reduction in loTXA group when compared with the control group. CONCLUSION In instrumented spine surgery, ivTXA and loTXA were found to be equally effective in reducing the intraoperative blood loss. The tTXA has better postoperative blood conserving effects. This is the first study to detail about safety and efficacy on local infiltration of TXA in spine surgery, which is an effective and safe method for reducing intraoperative blood loss.
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Affiliation(s)
- Viswanadha Arun-Kumar
- Mallika Spine Centre, Guntur, Andhra Pradesh, India,Viswanadha Arun-Kumar, Mallika Spine Centre, 12-12-30, Old Club Road, Kothapet, Guntur, Andhra Pradesh, India.
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16
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Two Doses of Tranexamic Acid Reduce Blood Loss in Primary Posterior Lumbar Fusion Surgery: A Randomized-controlled Trial. Clin Spine Surg 2020; 33:E593-E597. [PMID: 32349059 DOI: 10.1097/bsd.0000000000000999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to reduce perioperative blood loss and blood transfusion, but the dosage and efficacy of TXA in posterior lumbar spinal surgery are not fully clear. The aim of this study was to investigate the efficacy and safety of TXA and to determine whether 2 doses of TXA could reduce the blood loss in primary single-segment or double-segment posterior lumbar fusion surgery. MATERIALS AND METHODS A total of 150 patients with lumbar degenerative disease undergoing posterior lumbar interbody fusion surgery between October 2017 and February 2019 were randomized to 3 groups. Group A was treated with 0.9% normal saline solution without TXA, group B was treated with a 15 mg/kg loading dose intravenous infusion 30 minutes before surgery, and group C was treated with a 15 mg/kg loading dose intravenous infusion 30 minutes before surgery; then, the same dose was administered again 3 hours later. The assessed outcomes were the operation time, the total blood loss, the hidden blood loss, postoperative drainage, blood transfusions, incidence of venous thromboembolism, and incision infection. RESULTS The total blood loss, the hidden blood loss, and postoperative drainage were the lowest in group C. The amount of intraoperative blood loss was similar among the 3 groups. The hemoglobin and hematocrit values of the third postoperative day were the highest in group C. No significant differences in the incidence of complications and adverse events from TXA use were observed among the 3 groups. The use of TXA, the operation time, and the number of fusion segments were identified as risk factors related to total blood loss. CONCLUSION Two doses of TXA significantly reduced the total blood loss, the hidden blood loss and postoperative drainage, and decreased hemoglobin and hematocrit drop in patients undergoing posterior lumbar fusion without increasing the risk of complications.
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17
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Li J, Wang L, Bai T, Liu Y, Huang Y. Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion. J Orthop Surg Res 2020; 15:339. [PMID: 32819445 PMCID: PMC7439654 DOI: 10.1186/s13018-020-01758-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/16/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The current study was conducted to assess the efficacy and safety of the intravenous (IV) administration combined with topical administration of tranexamic acid (TXA)in patients (aged over 60) scheduled for a 2-level lumbar fusion surgery. METHODS Two hundred eighty patients scheduled for a 2-level lumbar fusion surgery were randomized into four groups, including an IV group, a local group, a combined group, and a control group. Patients in the combined group, in the IV group, in the topical group, and in the control group were administrated with 15 mg/kg of IV-TXA + 2 g TXA in local, 15 mg/kg IV-TXA, 2 g TXA in local, and 100 ml IV, respectively. The results of total blood loss (TBL), maximum hemoglobin drop, the transfusion rate, and the number of allogeneic blood units were compared. Deep venous thrombosis (DVT) and pulmonary embolism (PE) events were monitored and recorded. RESULTS The TBL was 635.49 ± 143.60, 892.62 ± 166.85, 901.11 ± 186.25, and 1225.11 ± 186.25 mL for the combined group, the IV group, the topical group, and the control group, respectively (p = 0.015, p = 0.001, respectively). The average maximum hemoglobin drop in the four above groups was 2.18 ± 0.24, 2.80 ± 0.37, 2.40 ± 0.64, and 3.40 ± 1.32 g/dL, respectively. No PE event was reported during the follow-up. Although asymptomatic DVT events were reported by 1, 2, and 2 patients in the combined group, topical group, and control group, respectively, there is no intergroup difference. CONCLUSIONS The combined use of TXA effectively reduced the total blood loss and blood transfusion rate in patients aged over 60 scheduled for a 2-level lumbar fusion, without increasing the incidence of DVT and PE formation.
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Affiliation(s)
- Jianjiang Li
- Department of Orthopedic Surgery, Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China
| | - Long Wang
- Department of Orthopedic Surgery, Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China
| | - Tao Bai
- Department of Orthopedic Surgery, Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China
| | - Yanlu Liu
- Department of Orthopedic Surgery, Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China
| | - Yifei Huang
- Department of Orthopedic Surgery, Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China.
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Tranexamic Acid for Blood Loss after Transforaminal Posterior Lumbar Interbody Fusion Surgery: A Double-Blind, Placebo-Controlled, Randomized Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8516504. [PMID: 32855972 PMCID: PMC7443232 DOI: 10.1155/2020/8516504] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/12/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022]
Abstract
Background Transforaminal lumbar interbody fusion (TLIF) may result in significant blood loss and an increase in blood transfusion. Though tranexamic acid (TXA) is widely studied for the hemostasis of arthroplasty, there is little information on the use of TXA for TLIF surgery. Methods This prospective randomized, double-blind, placebo-controlled trial was conducted to study the influence of TXA (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 the blood loss and Enhanced Recovery After Surgery (ERAS) after TLIF surgery. 40 patients were randomized into two groups: TXA group (tranexamic acid) and control group (placebo). Baseline characteristics were comparable between the TXA group and the control group before the surgery. Outcomes assessed included blood loss, total postoperative drainage, time for drainage removal, time to ambulation, hospital stay after surgery, postoperative hemoglobin (Hb) one day after surgery, and adverse events. Results Compared to patients in the control group after TLIF surgery, patients in the TXA group have significantly reduced intraoperative hemorrhage and time to ambulation after surgery but show similar hospital stay, postoperative drainage, time for drainage removal, postoperative Hb one day after surgery, and adverse events. Conclusions TXA shows important ability in controlling blood loss and promoting the ERAS after TLIF surgery.
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19
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Combined use of tranexamic acid and rivaroxaban in posterior lumbar interbody fusion safely reduces blood loss and transfusion rates without increasing the risk of thrombosis—a prospective, stratified, randomized, controlled trial. INTERNATIONAL ORTHOPAEDICS 2020; 44:2079-2087. [DOI: 10.1007/s00264-020-04699-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
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20
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de Faria JL, da Silva Brito J, Costa E Silva LT, Kilesse CTSM, de Souza NB, Pereira CU, Figueiredo EG, Rabelo NN. Tranexamic acid in Neurosurgery: a controversy indication-review. Neurosurg Rev 2020; 44:1287-1298. [PMID: 32556832 DOI: 10.1007/s10143-020-01324-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
Tranexamic acid (TXA) is one of the measures indicated to reduce bleeding and the need for volume replacement. However, data on risks and benefits are controversial. This study analyzes the effectivity and risks of using tranexamic acid in neurosurgery. We selected articles, published from 1976 to 2019, on the PubMed, EMBASE, Science Direct, and The Cochrane Database using the descriptors: "tranexamic acid," "neurosurgery," "traumatic brain injury," "subdural hemorrhage," "brain aneurysm," and "subarachnoid hemorrhage." TXA can reduce blood loss and the need for blood transfusion in trauma and spinal surgery. Despite the benefits of TXA, moderate-to-high doses are potentially associated with neurological complications (seizures, transient ischemic attack, delirium) in adults and children. In a ruptured intracranial aneurysm, the use of TXA can considerably reduce the risk of rebleeding, but there is weak evidence regarding its influence on mortality reduction. The TXA use in brain surgery does not present benefit. However, this conclusion is limited because there are few studies. TXA in neurosurgeries is a promising method for the maintenance of hemostasis in affected patients, mainly in traumatic brain injury and spinal surgery; nevertheless, there is lack of evidence in brain and vascular surgeries. Many questions remain unanswered, such as how to determine the dosage that triggers the onset of associated complications, or how to adjust the dose for chronic kidney disease patients.
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Affiliation(s)
- José Luiz de Faria
- Department of Neurosurgery, University Center UNiAtenas, Paracatu, Minas Gerais, Brazil
| | - Josué da Silva Brito
- Department of Neurosurgery, University Center UNiAtenas, Paracatu, Minas Gerais, Brazil
| | | | | | | | | | - Eberval Gadelha Figueiredo
- Department of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - Nícollas Nunes Rabelo
- Department of Neurosurgery, University Center UNiAtenas, Paracatu, Minas Gerais, Brazil. .,Department of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil.
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Xiong Z, Liu J, Yi P, Wang H, Tan M. Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity Spine Surgery: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7403034. [PMID: 32219141 PMCID: PMC7085364 DOI: 10.1155/2020/7403034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/14/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Tranexamic acid (TXA), an antifibrinolytic agent, interferes with fibrinolysis and has been used for many years to reduce blood loss during spine surgery. The purpose of our meta-analysis was to compare the effect of intravenous versus topical administration of TXA in patients undergoing nondeformity spine surgery. METHODS We searched multiple databases, including PubMed, Embase, the Cochrane library, CNKI, WanFang database, and VIP to find studies that met the inclusion criteria. A meta-analysis was performed according to the guidelines of the Cochrane Reviewer's Handbook. RESULTS Eight randomized controlled trials (RCTs) were identified, including 660 patients. The surgical methods used in the included studies were nondeformity spine surgery. No significant differences were found in the two groups regarding total blood loss, intraoperative blood loss, hidden blood loss, hematocrit, hemoglobin, fibrinogen, postoperative prothrombin time (PT), postoperative activated partial thromboplastin time (APTT), drainage volume, and blood transfusion rate. There were statistically significant differences in the two groups in terms of preoperative PT (MD = -0.39, 95% CI: [-0.63, -0.15], P=0.002) and preoperative APTT (MD = 1.12, 95% CI: [0.57, 1.68], P=0.002) and preoperative APTT (MD = 1.12, 95% CI: [0.57, 1.68]. CONCLUSION During nondeformity spine surgery, intravenous administration of TXA did not have a significant effect on the decrease of blood loss and blood transfusion rate compared with the topical group. According to the pooled analysis of PT and APTT, intravenous and topical application of TXA may have different effects on the coagulation pathway. More high-quality RCTs are needed to explore the optimal dosage, method, timing in the future in order to recommend TXA widespread use in spine surgery.
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Affiliation(s)
- Zhencheng Xiong
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100029, China
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Junyuan Liu
- Peking University Aerospace School of Clinical Medicine, Beijing 100029, China
| | - Ping Yi
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Hao Wang
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Mingsheng Tan
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100029, China
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing 100029, China
- Beijing University of Chinese Medicine, Beijing 100029, China
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Wang F, Nan L, Feng X, Wang Y, Yang J, Tao Y, Cheng X, Zhang S, Zhang L. The efficacy and safety of multiple-dose intravenous tranexamic acid in reducing perioperative blood loss in patients with thoracolumbar burst fracture. Clin Neurol Neurosurg 2020; 193:105766. [PMID: 32146231 DOI: 10.1016/j.clineuro.2020.105766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of tranexamic acid (TXA) for single-segment thoracolumbar burst fracture without neurologic injury underwent pedicle screw fixation via Wiltse approach. PATIENTS AND METHODS We identified 264 patients with single-segment thoracolumbar burst fracture without neurologic injury underwent pedicle screw fixation via Wiltse approach (January 2016-June 2019) at a single center. The cohort was separated into three groups. Group A received 20 mg/kg TXA at 5 min before skin incision and 16 h after first dose; Group B received 20 mg/kg TXA at 5 min before skin incision; Group C received NS at each same time point. The outcomes were evaluated by hidden blood loss (HBL), total blood loss (TBL), intraoperative blood loss (IBL), transfusion rate, maximum hemoglobin (Hb) drop, prethrombotic state molecular markers, liver and renal function, coagulation function, inflammatory factor and adverse events. RESULTS The HBL, TBL and maximum Hb drop were significantly lower in Group A than those of Group B and Group C, while the difference between Group B and Group C was statistically significant. The IBL was significantly lower in Group A and Group B than that of Group C. However, there was no significantly difference among the three groups in live and renal function, coagulation function, prethrombotic state molecular markers, transfusion rate and complications during the perioperative period. There was significantly lower level of interleukin-6 (IL-6) in Group A than Group C at the day after surgery, and lower level of C-reactive protein (CRP) at the third day after surgery. CONCLUSIONS Intravenous TXA used in the treatment of thoracolumbar burst fracture underwent pedicle screw fixation via Wiltse approach is effective and safe in decreasing perioperative blood loss. The two-dose TXA regimen can further reduce blood loss and alleviate post-operative inflammation response, without affecting prethrombotic state molecular marks and without increasing the risk of complications.
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Affiliation(s)
- Feng Wang
- Department of Orthopedics, Dalian Medical University, Dalian, 116000, China; Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Liping Nan
- Department of Orthopedics, Dalian Medical University, Dalian, 116000, China; Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Xinmin Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Yongxiang Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Jiandong Yang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Yuping Tao
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Xiaofei Cheng
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, 200011, China
| | - Shengfei Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China.
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Houston BL, Uminski K, Mutter T, Rimmer E, Houston DS, Menard CE, Garland A, Ariano R, Tinmouth A, Abou-Setta AM, Rabbani R, Neilson C, Rochwerg B, Turgeon AF, Falk J, Breau RH, Fergusson DA, Zarychanski R. Efficacy and Safety of Tranexamic Acid in Major Non-Cardiac Surgeries at High Risk for Transfusion: A Systematic Review and Meta-Analysis. Transfus Med Rev 2020; 34:51-62. [DOI: 10.1016/j.tmrv.2019.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/06/2019] [Accepted: 10/02/2019] [Indexed: 12/14/2022]
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Mikhail C, Pennington Z, Arnold PM, Brodke DS, Chapman JR, Chutkan N, Daubs MD, DeVine JG, Fehlings MG, Gelb DE, Ghobrial GM, Harrop JS, Hoelscher C, Jiang F, Knightly JJ, Kwon BK, Mroz TE, Nassr A, Riew KD, Sekhon LH, Smith JS, Traynelis VC, Wang JC, Weber MH, Wilson JR, Witiw CD, Sciubba DM, Cho SK. Minimizing Blood Loss in Spine Surgery. Global Spine J 2020; 10:71S-83S. [PMID: 31934525 PMCID: PMC6947684 DOI: 10.1177/2192568219868475] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN Broad narrative review. OBJECTIVE To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery. METHODS A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery. RESULTS There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements. CONCLUSION As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.
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Affiliation(s)
| | | | - Paul M. Arnold
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Norman Chutkan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - John G. DeVine
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Daniel E. Gelb
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Fan Jiang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Brian K. Kwon
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas E. Mroz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ahmad Nassr
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K. Daniel Riew
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lali H. Sekhon
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | | | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Samuel K. Cho, Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY 10029, USA.
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Bai J, Zhang P, Liang Y, Wang J, Wang Y. Efficacy and safety of tranexamic acid usage in patients undergoing posterior lumbar fusion: a meta-analysis. BMC Musculoskelet Disord 2019; 20:390. [PMID: 31470844 PMCID: PMC6717333 DOI: 10.1186/s12891-019-2762-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/14/2019] [Indexed: 12/26/2022] Open
Abstract
Background The purpose of this meta-analysis is to evaluate the efficacy and safety of tranexamic acid (TXA) for patients with degenerative lumbar disc herniation, stenosis or instability undergoing posterior lumbar fusion (PLF) surgery. Methods We searched PubMed, Embase, and Cochrane Library until May 1, 2018. Two reviewers selected studies, assessed quality, extracted data, and evaluated the risk of bias independently. Weighted mean difference (WMD) and relative risk (RR) were calculated as the summary statistics for continuous data and dichotomous data, respectively. We chose fixed-effects or random-effects models based on I2 statistics. RevMan 5.0 and STATA 14.0 software were used for data analysis. Results Nine studies enrolling 713 patients for the study. The pooled outcomes demonstrated that TXA can decrease total blood loss (TBL) in patients underwent PLF surgery [WMD = -250.68, 95% CI (− 325.06, − 176.29), P<0.001], intraoperative blood loss (IBL) [WMD = -72.57, 95% CI (− 103.94, − 41.20), P<0.001], postoperative blood loss (PBL) [WMD = -127.57, 95% CI (− 149.39, − 105.75), P<0.001], and the loss of hemoglobin (Hb) in postoperative 24 h [WMD = -0.31, 95% CI (− 0.44, − 0.18), P<0.001]. However, there is no significant difference between two groups in transfusion rate [RR =0.34, 95% CI (0.09, 1.28), P = 0.11], and none thrombotic event was happened in the two groups. Conclusion Our meta-analysis demonstrated that TXA can decrease the Hb loss, TBL, IBL, PBL, and without increasing the risk of thrombotic event in patients with degenerative lumbar disc herniation, stenosis or instability underwent PLF surgery. However, there was no significant difference in blood transfusion rates between the two groups.
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Affiliation(s)
- Jianzhong Bai
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Nantong West Road 98, Yangzhou, 225001, China.,Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Pei Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Nantong West Road 98, Yangzhou, 225001, China
| | - Yuan Liang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Nantong West Road 98, Yangzhou, 225001, China
| | - Jingcheng Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Nantong West Road 98, Yangzhou, 225001, China.
| | - Yongxiang Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Nantong West Road 98, Yangzhou, 225001, China.
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Damade C, Tesson G, Gilard V, Vigny S, Foulongne E, Gauthé R, Ould-Slimane M. Blood loss and perioperative transfusions related to surgery for spinal tumors. Relevance of tranexamic acid. Neurochirurgie 2019; 65:377-381. [PMID: 31202780 DOI: 10.1016/j.neuchi.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/12/2019] [Accepted: 05/17/2019] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Tranexamic acid (TXA) has been shown to reduce bleeding. Patients with spinal tumors are fragile and acute anemia may be harmful. Tumor excision surgery is reputed to be hemorrhagic and treatment may increase thromboembolic complications. The aim of this study was to compare blood loss with or without perioperative TXA injection. The transfusion-related and postoperative complications were documents. METHOD This retrospective analysis of prospectively collected data involved 83 patients with spinal tumors who underwent decompressive surgery associated with bone fixation. Tranexamic acid was used arbitrarily in 36 of them, while the other 47 did not receive TXA. The overall, intraoperative and postoperative blood loss was recorded. Blood loss was reported relative to the number of fixed levels and the number of levels decompressed by laminectomy. Transfusions were quantified in number of red blood cell packets and erythrocyte volume. Postoperative complications were documented. RESULTS Epidemiological and morphological data were similar between groups. There were no significant differences between the two groups in the overall, intraoperative, and postoperative blood loss. A significant reduction in postoperative bleeding was found in the TXA group when the volume was related to the number of decompressed levels. A significant reduction (P<0.05) in the volume of transfused blood was identified in the treated group. No predictor of blood loss was identified, and no additional complications occurred. CONCLUSION The efficacy of TXA appears to be moderate during spinal tumor surgery since it does not lead to a reduction in perioperative bleeding. However, a significant reduction in transfusion volume was found without an increase in complications.
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Affiliation(s)
- C Damade
- University hospital of Bordeaux, spine unit 1, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - G Tesson
- University hospital of Rouen, spine unit, department of orthopedic surgery, 1, rue de Germont, 76000 Rouen, France
| | - V Gilard
- University hospital of Rouen, spine unit, department of orthopedic surgery, 1, rue de Germont, 76000 Rouen, France; University hospital of Rouen, spine unit, department of neurosurgery, 1, rue de Germont, 76000 Rouen, France
| | - S Vigny
- University hospital of Rouen, spine unit, department of orthopedic surgery, 1, rue de Germont, 76000 Rouen, France
| | - E Foulongne
- University hospital of Rouen, spine unit, department of orthopedic surgery, 1, rue de Germont, 76000 Rouen, France
| | - R Gauthé
- University hospital of Rouen, spine unit, department of orthopedic surgery, 1, rue de Germont, 76000 Rouen, France.
| | - M Ould-Slimane
- University hospital of Rouen, spine unit, department of orthopedic surgery, 1, rue de Germont, 76000 Rouen, France
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Abstract
Background: Significant blood loss is still one of the most frequent complications in spinal surgery, which often necessitates blood transfusion. Massive perioperative blood loss and blood transfusion can create additional risks. Aprotinin, tranexamic acid (TXA), and epsilon-aminocaproic acid (EACA) are antifibrinolytics currently offered as prophylactic agents to reduce surgery-associated blood loss. The aim of this study was to evaluate the efficacy and safety of aprotinin, EACA, and low/high doses of TXA in spinal surgery, and assess the use of which agent is the most optimal intervention using the network meta-analysis (NMA) method. Methods: Five electronic databases were searched, including PubMed, Cochrane Library, ScienceDirect, Embase, and Web of Science, from the inception to March 1, 2018. Trials that were randomized and compared results between TXA, EACA, and placebo were identified. The NMA was conducted with software R 3.3.2 and STATA 14.0. Results: Thirty randomized controlled trial (RCT) studies were analyzed. Aprotinin (standardized mean difference [SMD]=−0.65, 95% credibility intervals [CrI;−1.25, −0.06]), low-dose TXA (SMD = −0.58, 95% CrI [−0.92, −0.25]), and high-dose TXA (SMD = −0.70, 95% CrI [−1.04, −0.36]) were more effective than the respective placebos in reducing intraoperative blood loss. Low-dose TXA (SMD = −1.90, 95% CrI [−3.32, −0.48]) and high-dose TXA (SMD = −2.31, 95% CrI [−3.75, −0.87]) had less postoperative blood loss. Low-dose TXA (SMD = −1.07, 95% CrI [−1.82, −0.31]) and high-dose TXA (SMD = −1.07, 95% CrI [−1.82, −0.31]) significantly reduced total blood loss. However, only high-dose TXA (SMD = −2.07, 95% CrI [−3.26, −0.87]) was more effective in reducing the amount of transfusion, and was significantly superior to low-dose TXA in this regard (SMD = −1.67, 95% CrI [−3.20, −0.13]). Furthermore, aprotinin (odds ratio [OR] = 0.16, 95% CrI [0.05, 0.54]), EACA (OR = 0.46, 95% CrI [0.22, 0.97]) and high dose of TXA (OR = 0.34, 95% CrI [0.19, 0.58]) had a significant reduction in transfusion rates. Antifibrinolytics did not show a significantly increased risk of postoperative thrombosis. Results of ranking probabilities indicated that high-dose TXA had the greatest efficacy and a relatively high safety level. Conclusions: The antifibrinolytic agents are able to reduce perioperative blood loss and transfusion requirement during spine surgery. And the high-dose TXA administration might be used as the optimal treatment to reduce blood loss and transfusion.
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Intravenous and Oral Tranexamic Acid Are Equivalent at Reducing Blood Loss in Thoracolumbar Spinal Fusion: A Prospective Randomized Trial. Spine (Phila Pa 1976) 2019; 44:755-761. [PMID: 30540715 DOI: 10.1097/brs.0000000000002954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective randomized trial of patients enrolled at a university affiliated tertiary medical center between February and December 2017. OBJECTIVE To compare perioperative blood loss in patients undergoing elective posterior thoracolumbar fusion who were treated with intravenous (IV) versus oral (PO) tranexamic acid (TXA). SUMMARY OF BACKGROUND DATA The use of antifibrinolytic agents such as TXA to decrease operative blood loss and allogenic blood transfusions is well documented in the literature. While evidence supports the use of IV and topical formulations of TXA in spine surgery, the use of PO TXA has not been studied. METHODS Eighty-three patients undergoing thoracolumbar fusion were randomized to receive 1.95 g of PO TXA 2 hours preoperatively or 2 g IV TXA (1 g before incision and 1 g before wound closure) intraoperatively. The sample was further stratified into three categories based on number of levels fused (1-2 level fusions, 3-5, and >5). The primary outcome was the reduction of hemoglobin. Secondary outcomes included calculated blood loss, drain output, postoperative transfusion, complications, and length of hospital stay. Equivalence analysis was performed with a two one-sided test (TOST). A P-value of <0.05 suggested equivalence between treatments. RESULTS Fourty three patients received IV TXA and 40 patients received PO TXA. Patient demographic factors were similar between groups except for body mass index (BMI). The mean reduction of hemoglobin was similar between IV and PO groups (3.36 g/dL vs. 3.43 g/dL, respectively; P = 0.01, equivalence). Similarly, the calculated blood loss was equivalent (1235 mL vs. 1312 mL, respectively; P = 0.02, equivalence). Eight patients (19%) in IV TXA group received a transfusion compared with five patients in PO TXA group (13%) (P = 0.44). One patient (2% and 3% in IV and PO, respectively) in each group experienced a deep venous thrombosis/pulmonary embolism (P = 0.96). CONCLUSION Patients treated with IV and PO TXA experienced the same perioperative blood loss after spinal fusions. Given its lower cost, PO TXA represents an excellent alternative to IV TXA in patients undergoing elective posterior thoracolumbar fusion and may improve healthcare cost-efficiency in the studied population. LEVEL OF EVIDENCE 1.
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The Efficacy and Safety of Prophylactic Intravenous Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Posterior Lumbar Interbody Fusion. World Neurosurg 2019; 125:e198-e204. [DOI: 10.1016/j.wneu.2019.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 12/19/2022]
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Lee D, Choi SJ, Lee WY, Kim KM, Kim MC, Lee S. Effect of intravenous tranexamic acid on perioperative bleeding and transfusion in spine surgery: systematic review and meta-analysis of randomized controlled trials. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Dongreul Lee
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Si Jin Choi
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Woo Yong Lee
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kye-Min Kim
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Mun-Cheol Kim
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Sun H, Deng J, Ning X, Wu F, Shang X, Yang H. Letter to the Editor Regarding "The Efficacy of Tranexamic Acid on Blood Loss of Lumbar Spinal Fusion Surgery: A Meta-Analysis of Randomized Controlled Trials". World Neurosurg 2019; 122:708. [PMID: 30716871 DOI: 10.1016/j.wneu.2018.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Hong Sun
- Department of Orthopedics, Affiliated Hospital of Gui zhou Medical University, Guiyang, Guizhou Province, PR China.
| | - Jin Deng
- Department of Emergency Medicine, Affiliated Hospital of Gui zhou Medical University, Guiyang, Guizhou Province, PR China
| | - Xu Ning
- Department of Orthopedics, Affiliated Hospital of Gui zhou Medical University, Guiyang, Guizhou Province, PR China
| | - Fengchang Wu
- Clinical Medical College of Gui zhou Medical University, Guiyang, Guizhou Province, PR China
| | - Xianwen Shang
- Department of Orthopedics, Affiliated Hospital of Gui zhou Medical University, Guiyang, Guizhou Province, PR China
| | - Hua Yang
- Department of Orthopedics, Affiliated Hospital of Gui zhou Medical University, Guiyang, Guizhou Province, PR China
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Gong M, Liu G, Chen L, Chen R, Xiang Z. The Efficacy and Safety of Intravenous Tranexamic Acid in Reducing Surgical Blood Loss in Posterior Lumbar Interbody Fusion for the Adult: A Systematic Review and a Meta-Analysis. World Neurosurg 2019; 122:559-568. [DOI: 10.1016/j.wneu.2018.09.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/12/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
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Predictors of Postoperative Complications After Surgery for Lumbar Spinal Stenosis and Degenerative Lumbar Spondylolisthesis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 2:e085. [PMID: 30680370 PMCID: PMC6336577 DOI: 10.5435/jaaosglobal-d-18-00085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The aim of this study was to determine the predictors of 30-day postoperative complications for surgical treatment of lumbar spinal stenosis with degenerative spondylolisthesis (LSSDS) in patients undergoing decompression and fusion or decompression alone. Methods: A retrospective review of 253 unique patients undergoing surgical intervention for LSSDS in the American College of Surgeons National Surgical Quality Improvement Program database was conducted. Results: The overall 30-day postoperative complication rate for the population was 16.6% (95% confidence interval [CI], 12.0% to 21.0%). Transfusions (8.9%), readmissions (5.9%), and unplanned returns to the OR (3.6%) were the most frequently observed complications across the population. ASA score and surgical time were found to be significant predictors of 30-day complications (ASA score: OR = 1.971; 95% CI, 1.077 to 3.609; P = 0.028; surgical time: OR = 1.006; 95% CI, 1.003 to 1.010; P < 0.001). Holding all other variables constant, multilevel cases, the inclusion of a fusion procedure, and body mass index were not found to be significant predictors of 30-day complications (P = 0.917, P = 0.464, and P = 0.572, respectively). Discussion and Conclusions: ASA score and OR time are leading indicators of complications, specifically for the LSSDS patient population. These are two easily attainable data points that are available for all surgical cases and could be used a clinical red flag for potential complications.
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Mu X, Wei J, Wang C, Ou Y, Yin D, Liang B, Qiu D, Li Z. Intravenous Administration of Tranexamic Acid Significantly Reduces Visible and Hidden Blood Loss Compared with Its Topical Administration for Double-Segment Posterior Lumbar Interbody Fusion: A Single-Center, Placebo-Controlled, Randomized Trial. World Neurosurg 2018; 122:e821-e827. [PMID: 30391759 DOI: 10.1016/j.wneu.2018.10.154] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Tranexamic acid (TXA) significantly reduces the visible and hidden blood loss associated with joint replacement. At present, many studies have examined the safety and effectiveness of the intravenous or topical administration of TXA after posterior lumbar surgery. However, randomized and controlled trials examining the presence of differences in the effect of TXA on the visible and hidden blood loss between these 2 modes of administration are lacking. The current study investigated the effects of intravenous and topical administrations of TXA on the visible and hidden blood loss of patients undergoing posterior lumbar interbody fusion (PLIF). METHODS In a single-center, placebo-controlled, randomized design, a total of 150 patients with lumbar degenerative disease who underwent PLIF between September 2015 and August 2017 volunteered for this study. Of these patients, 126 fulfilled the inclusion criteria and were randomly assigned to 1 of 3 groups: the intravenous administration group (n = 45, group A), the topical administration group (n = 39, group B), or the placebo group (n = 42, group C). SPSS, version 17.0, was used to analyze the patient data, their blood biochemical indices, blood loss, and the number of blood transfusions across the 3 groups during the perioperative period. RESULTS The postoperative drainage volume, number of blood transfusions, length of hospital stay, and extubation time significantly differed between group C and both groups A and B (P < 0.05); however, no significant differences were noted between groups A and B (P > 0.05). Intraoperative blood loss and visible or hidden blood loss as well as the levels of postoperative hemoglobin and hematocrit significantly differed among the 3 groups (P < 0.01). The results of the visual analogue scale, prothrombin time, and fibrinogen content did not significantly differ among the 3 groups (P > 0.05). CONCLUSIONS For patients undergoing double-segment PLIF, both administrations of TXA can reduce blood loss, extubation time, and the length of hospital stay. Moreover, intravenous administration can reduce both visible and hidden blood loss more efficiently.
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Affiliation(s)
- Xiaoping Mu
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jianxun Wei
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Chenglong Wang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Yufu Ou
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
| | - Dong Yin
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Bin Liang
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Dezan Qiu
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zhuhai Li
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Lu VM, Ho YT, Nambiar M, Mobbs RJ, Phan K. The Perioperative Efficacy and Safety of Antifibrinolytics in Adult Spinal Fusion Surgery: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976) 2018; 43:E949-E958. [PMID: 30063223 DOI: 10.1097/brs.0000000000002580] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Compare outcomes of adult patients undergoing spinal fusion surgery who receive and do not receive perioperative antifibrinolytics to reduce operative blood loss. SUMMARY OF BACKGROUND DATA The clinical potential for antifibrinolytics such as tranexamic acid and epsilon aminocaproic acid to significantly reduce blood loss during adult spinal fusion surgery remains underexplored. Outcomes for assessment included operative blood loss, and other surgical, clinical, and haematological outcomes. METHODS We followed the recommended Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Electronic database searches identified 2041 for screening. Data were extracted and analyzed using meta-analysis of proportions. RESULTS A total of 11 randomized controlled trials with a total of 937 adult spinal fusion surgery patients were included for analysis. There were 472 (50%) patients who were treated with antifibrinolytics, with 345 of 472 (73%) and 127 of 472 (27%) receiving tranexamic acid and epsilon aminocaproic acid respectively. The use of antifibrinolytics was associated with significantly lower intraoperative (MD -127.08 mL; P = 0.002) and total blood loss (MD -229.76 mL; P < 0.00001), as well as incidence of blood transfusion (OR 0.58; P = 0.04). There was no significant difference with antifibrinolytic use in terms of many surgical parameters, including surgery duration (P = 0.50), overall complications (P = 0.21), and length of stay (P = 0.88). Finally, postoperative haemoglobin was significantly greater (MD 0.30 g/dL; P = 0.02) following antifibrinolytic use, with other haematological parameters mostly unaffected. CONCLUSION Based on the highest level comparative evidence available, the possibility for blood loss reduction in adult spinal fusion surgery with the use of perioperative antifibrinolytics is not unreasonable, as it appears both efficacious and safe. In addition to further, larger investigations to validate the associations found in this study, practical aspects such as cost-benefit analysis, and long-term follow-up will further enhance our understanding. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Victor M Lu
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Yam-Ting Ho
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Mithun Nambiar
- Department of Orthopedic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Clinical School, Randwick, Sydney, Australia
| | - Kevin Phan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Clinical School, Randwick, Sydney, Australia
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Du Y, Feng C. The Efficacy of Tranexamic Acid on Blood Loss from Lumbar Spinal Fusion Surgery: A Meta-Analysis of Randomized Controlled Trials. World Neurosurg 2018; 119:e228-e234. [PMID: 30048786 DOI: 10.1016/j.wneu.2018.07.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The efficacy of tranexamic acid to control blood loss from lumbar spinal fusion surgery remains controversial. We conducted a systematic review and meta-analysis to explore the influence of tranexamic acid on blood loss from lumbar spinal fusion surgery. METHODS We searched PubMed, Embase, Web of Science, EBSCO, and the Cochrane Library databases through March 2018 for randomized controlled trials assessing the effect of tranexamic acid on blood loss from lumbar spinal fusion surgery. A meta-analysis was performed using the random-effect model. RESULTS Six randomized controlled trials involving 394 patients were included in the meta-analysis. Overall, compared with control group for lumbar spinal fusion surgery, tranexamic acid significantly reduced intraoperative blood loss (standard mean difference [Std. MD] -0.32; 95% confidence interval [CI] -0.58 to -0.06; P = 0.02), and drain (Std. MD -1.12; 95% CI -1.59 to -0.64; P < 0.00001) but had no remarkable influence on hemoglobin (Std. MD -0.10; 95% CI -0.56 to 0.37; P = 0.68) and hematocrit (Std. MD -0.34; 95% CI -1.08 to 0.40; P = 0.37) 1 day after surgery and transfusion (risk ratio 0.44; 95% CI 0.16-1.19; P = 0.11). Duration of hospitalization was found to be shortened by tranexamic acid (Std. MD -1.00; 95% CI -1.68 to -0.32; P = 0.004). CONCLUSIONS Tranexamic acid has an important ability to decrease intraoperative blood loss and hospitalization for lumbar spinal fusion surgery.
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Affiliation(s)
- Yao Du
- Department of Orthopaedics, The People's Hospital of Qijiang District, Qijiang, Chongqing, P. R. China
| | - Chuancheng Feng
- Department of Orthopaedics, The People's Hospital of Qijiang District, Qijiang, Chongqing, P. R. China.
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Minimal Dose of Tranexamic Acid Is Effective in Reducing Blood Loss in Complex Spine Surgeries: A Randomized Double-Blind Placebo Controlled Study. Asian Spine J 2018; 12:484-489. [PMID: 29879776 PMCID: PMC6002182 DOI: 10.4184/asj.2018.12.3.484] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/14/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022] Open
Abstract
Study Design A randomized double-blind placebo controlled study. Purpose In the present study, we aimed to assess the efficacy of tranexamic acid (TXA) in reducing blood loss after laminectomy and posterolateral fusion of the spine. Overview of Literature Blood loss is the most significant complication involved with surgery, especially in spinal surgery. Multilevel laminectomy and laminectomy with instrumentation (pedicle screws and rods) are complex spine surgeries and are considered as medium-risk procedures for bleeding. Recent reports have demonstrated that the use of antifibrinolytic drugs during surgery may reduce the risk of postoperative bleeding and one of the most frequently used antifibrinolytics is TXA. Methods In this randomized clinical trial, 50 patients eligible for laminectomy (for ≥2 level) with postero-lateral fusion with a pedicular screw (laminectomy and posterior spinal fusion) were randomly assigned to receive preoperative single doses of intravenous TXA (15 mg/kg) or 0.9% normal saline. Results Of the 50 patients, 30 (60%) were female and 20 (40%) were male. Between-group difference with respect to the total volume of blood loss during surgery was statistically significant. Conclusions The findings of this study suggest that TXA can reduce both intraoperative and immediate postoperative blood loss, decrease the need for packed cell transfusion, and reduce the duration of hospitalization after complex spinal surgeries. No adverse events related to the use of TXA were encountered in this study.
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Luo W, Sun RX, Jiang H, Ma XL. The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis. J Orthop Surg Res 2018; 13:96. [PMID: 29690892 PMCID: PMC5937828 DOI: 10.1186/s13018-018-0815-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We conducted a meta-analysis from randomized controlled trials (RCTs) and non-RCTs to assess the efficacy and safety of tranexamic acid (TXA) in spine surgery. METHODS Potentially relevant academic articles were identified from the Cochrane Library, MEDLINE (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), and ScienceDirect (1985-2017.11). Secondary sources were identified from the references of the included literature. The pooled data were analyzed using RevMan 5.1. RESULTS Three RCTs and one non-RCT met the inclusion criteria. There were significant differences in total blood loss (MD = - 267.53, 95% CI - 373.04 to - 106.02, P < 0.00001), drainage volume (MD = - 157.00, 95% CI - 191.17 to - 122.84, P < 0.00001), postoperative hemoglobin level (MD = 0.95, 95% CI 0.44 to 1.47, P = 0.0003), and length of hospital stay (MD = - 1.42, 95% CI - 1.92 to - 0.93, P < 0.00001). No significant differences were found regarding transfusion requirement, deep vein thrombosis (DVT), pulmonary embolism (PE), wound hematoma, and infection between the two groups. CONCLUSIONS The present meta-analysis indicated that the topical application of TXA in spinal surgery decreases the total blood loss and drainage volume and preserves higher postoperative hemoglobin level without increasing the risk of DVT infection, hematoma, DVT, and PE.
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Affiliation(s)
- Wei Luo
- Department of Orthopedics, Tianjin Hospital, Tianjin, 3002111, People's Republic of China
| | - Ru-Xin Sun
- Department of Gynaecology and Obstetrics, Tianjin Hongqiao Hospital, Tianjin, 300131, People's Republic of China
| | - Han Jiang
- Department of Orthopedics, Tianjin Third Central Hospital, Tianjin, 300170, People's Republic of China
| | - Xin-Long Ma
- Department of Orthopedics, Tianjin Hospital, Tianjin, 3002111, People's Republic of China.
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Primary lower limb joint replacement and tranexamic acid: an observational cohort study. Arthroplast Today 2018; 4:330-334. [PMID: 30186916 PMCID: PMC6123173 DOI: 10.1016/j.artd.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/25/2022] Open
Abstract
Background This work aimed to evaluate the efficacy and safety of routine tranexamic acid (TXA) use in elective orthopaedic lower limb joint replacement surgery. Methods This retrospective cohort study included all primary hip or knee replacement procedures by a single surgeon over a 6-year period. TXA was introduced during the study period as part of an enhanced recovery after surgery strategy. Results Of the 673 procedures, 446 cases (66.3%) received TXA. The median length of stay was 5 days (2-69) and 6 days (3-28) for the TXA and control groups, respectively (P < .001). Blood transfusion was required for 28 (6.3%) of the TXA cases versus 40 (17.6%) controls (P < .001). Complication rates were similar irrespective of TXA status. At multivariate analysis, TXA was significantly and independently associated with fewer blood transfusions (hazard ratio 0.309, 95% confidence interval: 0.168-0.568, P < .001), with a number needed to treat of 9 cases. TXA use was estimated to save between £67.89 and £155.90 per case. Conclusions Routine prophylactic TXA administration for elective primary hip and knee replacement reduces the likelihood of postoperative transfusion with a number needed to treat of 9. Cost savings may be as high as £155.90 per case, and no safety concerns were noted.
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Xu D, Zhuang Q, Li Z, Ren Z, Chen X, Li S. A randomized controlled trial on the effects of collagen sponge and topical tranexamic acid in posterior spinal fusion surgeries. J Orthop Surg Res 2017; 12:166. [PMID: 29110696 PMCID: PMC5674845 DOI: 10.1186/s13018-017-0672-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022] Open
Abstract
Background This is a randomized controlled trial research to assess the hemostatic efficacy of gelatin sponge, collagen sponge, and topical use of tranexamic acid (TXA) on postoperative blood loss in posterior spinal fusion surgeries. Methods We recruited patients with spinal degenerative diseases into the study from November 2013 to October 2016. All the participants were assigned to 3 groups using a simple, equal-probability randomization scheme: group A is a control group utilizing gelatin sponge, while groups B and C are experimental groups, applying collagen hemostatic sponge and topical TXA respectively. Postoperative blood loss, rates of transfusion, and hospitalization were compared among the 3 groups. Results In our study, the volume of drainage and blood content in drainage on the first postoperative day (POD 1) of patients in the experimental groups were significantly less than those in the control group, as well as rates of transfusion and postoperative hospitalization (P < 0.05). When compared with the control group, the volume of drainage decreased by 22.7% in group B and 56.2% in group C, while the blood content in drainage decreased by 28.8 and 75% respectively. Conclusions In this study, collagen and topical use of TXA have both proven to be effective and safe for patients undergoing posterior spinal fusion surgeries, while TXA has exhibited better efficacy. The total amount of perioperative blood loss reduced significantly without increasing incidence of related complications. Trial registration A randomized controlled trial for effects of collagen sponge and topical tranexamic acid in posterior lumbar fusion surgeries. ChiCTR-IIR-17010785.
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Affiliation(s)
- Derong Xu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, No.1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China
| | - Qianyu Zhuang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, No.1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China
| | - Zheng Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, No.1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China
| | - Zhinan Ren
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, No.1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China
| | - Xin Chen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, No.1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China
| | - Shugang Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, No.1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China.
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The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2851-2857. [DOI: 10.1007/s00586-017-5230-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/06/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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