title: High-dose tranexamic acid reduces intraoperative and postoperative blood loss in posterior lumbar interbody fusion.
abstract: OBJECTIVE Tranexamic acid (TXA), a synthetic antifibrinolytic drug, has been reported to reduce blood loss in orthopedic surgery, but there have been few reports of its use in spine surgery. Previous studies included limitations in terms of different TXA dose regimens, different levels and numbers of fused segments, and different surgical techniques. Therefore, the authors decided to strictly limit TXA dose regimens, surgical techniques, and fused segments in this study. There have been no reports of using TXA for prevention of intraoperative and postoperative blood loss in posterior lumbar interbody fusion (PLIF). The purpose of the study was to evaluate the efficacy of high-dose TXA in reducing blood loss and its safety during single-level PLIF. METHODS The study was a nonrandomized, case-controlled trial. Sixty consecutive patients underwent single-level PLIF at a single institution. The first 30 patients did not receive TXA. The next 30 patients received 2000 mg of intravenous TXA 15 minutes before the skin incision was performed and received the same dose again 16 hours after the surgery. Intra- and postoperative blood loss was compared between the groups. RESULTS There were no statistically significant differences in preoperative parameters of age, sex, body mass index, preoperative diagnosis, or operating time. The TXA group experienced significantly less intraoperative blood loss (mean 253 ml) compared with the control group (mean 415 ml; p < 0.01). The TXA group also had significantly less postoperative blood loss over 40 hours (mean 321 ml) compared with the control group (mean 668 ml; p < 0.01). Total blood loss in the TXA group (mean 574 ml) was significantly lower than in the control group (mean 1080 ml; p < 0.01). From 2 hours to 40 hours, postoperative blood loss in the TXA group was consistently significantly lower. There were no perioperative complications, including thromboembolic events. CONCLUSIONS High-dose TXA significantly reduced both intra- and postoperative blood loss without causing any complications during or after single-level PLIF.
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine.
authors.forename: Junichi
authors.initials: J
authors.lastname: Kushioka
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital; and.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital; and.
authors.forename: Shinya
authors.initials: S
authors.lastname: Okuda
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital; and.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Maeno
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital; and.
authors.forename: Tomiya
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Orthopaedic Surgery, Osaka Police Hospital, Osaka, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Yamasaki
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital; and.
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000188:drug therapy / Q000517:prevention & control*; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: BMI = body mass index; Hb = hemoglobin; PLIF = posterior lumbar interbody fusion; PLT = platelet; PT-INR = prothrombin time–international normalized ratio; TXA = tranexamic acid; aPTT = activated partial thromboplastin time; antifibrinolytic drug; lumbar degenerative disease; perioperative blood loss; posterior lumbar interbody fusion; spine surgery; surgical technique; tranexamic acid