title: Tranexamic acid reduces perioperative blood loss of posterior lumbar surgery for stenosis or spondylolisthesis: A randomized trial.
abstract: BACKGROUND
  A prospective, randomized, double-blind, placebo-controlled study was performed. The routine usage of TA in spinal surgery is controversial. Only a few studies have focused on patients undergoing posterior lumbar surgery for stenosis or spondylolisthesis, although a large clinical cohort exists in the population. This study aimed to evaluate the effect and safety of TA in reducing perioperative blood loss in posterior lumbar surgery for stenosis or spondylolisthesis.
  
  
  METHODS
  100 eligible patients out of 126 were randomized to receive either a bolus dose of 30 mg/kg TA i.v, a maintenance dosage of 2 mg/kg/h TA, or an equivalent volume of normal saline. The pedicle screw system was used for fixing in all the patients, followed by decompression and posterior lumbar interbody fusion. The primary outcomes were intraoperative estimated blood loss and total blood loss. The secondary outcomes were receiving packed red blood cells and postoperative hemoglobin and hematocrit levels.
  
  
  RESULTS
  In total, 4 patients were excluded from the analyses, 50 patients were in the TA group, and 46 in the placebo group. The demographic and baseline data between the groups were not statistically different. The intraoperative estimated blood loss and the total blood loss were 33% and 41% lower in the TA group than the placebo group, respectively. The blood transfusion rate did not vary significantly (P = 0.191). Except a patient with a dural tear in the placebo group, no other complications were observed.
  
  
  CONCLUSIONS
  TA significantly reduced the perioperative blood loss in patients undergoing posterior lumbar surgery for stenosis or spondylolisthesis.
authors.affiliation: Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Houyin
authors.initials: H
authors.lastname: Shi
authors.forename: Yunsheng
authors.initials: Y
authors.lastname: Ou
authors.forename: Dianming
authors.initials: D
authors.lastname: Jiang
authors.forename: Zhengxue
authors.initials: Z
authors.lastname: Quan
authors.forename: Zenghui
authors.initials: Z
authors.lastname: Zhao
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D019299:Decompression, Surgical; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000601:surgery; D013168:Spondylolisthesis / Q000601:surgery; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid