Tranexamic Acid in Reducing Perioperative Blood Loss in Lumbar Spinal Stenosis Surgery: A Double-Blind Randomized Controlled Trial
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Published:
Mar 22, 2019
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Abstract
Objective: To compare peri-operative surgical blood loss in laminectomy with spinal fusion surgery, using tranexamic acid (TXA) in one group, versus a control group given a placebo.
Methods: A prospective double-blind randomized controlled trial studied lumbar spinal stenosis patients who underwent decompressive laminectomy with spinal fusion at Maharat Nakorn Ratchasima Hospital from 2009 to 2010.
Results: Forty three patients were included in the study. The intra-operative and peri-operative blood loss was insignificantly reduced in the TXA group versus placebo group (mean: 493.2 ml. VS 526.2 ml. p=0.74) (mean: 932.9 ml. VS 1127.6 ml. p=0.19), respectively. However, post-operative blood loss was reduced significantly in the TXA group compared to placebo group (mean: 439.8 ml. VS 601.2 ml. p=0.04). However, there was no difference in blood transfusion requirements between the two groups. The number of decompressed levels and surgical duration were two factors related to perioperative blood loss.
Conclusions: Intravenous tranexamic acid connot significantly reduce total peri-operative blood loss in laminectomy and spinal fusion surgery. It does however, significantly reduce post-operative blood loss. We found no difference in the number of blood transfusions required between the TXA and placebo groups.
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References
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28. Regan JJ, Yuan H, McAfee PC. Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery: a prospective multicenter study evaluating open, and laparoscopic lumbar fusion. Spine (Phila Pa 1976). 1999; 24(4): 402-11.
29. Gill JB, Chin Y, Levin A, Feng D. The use of antifibrinolytic agents in spine surgery. A meta-analysis. J Bone Joint Surg Am. 2008; 90: 2399-407.
30. Krohn CD, Sørensen R, Lange JE, Riise R, Bjørnsen S, Brosstad F. Tranexamic acid given into the wound reduces postoperative blood loss by half in major orthopaedic surgery. Eur J Surg Suppl. 2003(588): 57-61.
31. Wong J, Hossam E, Suntheralingam Y, Rampersaud R, Chung F. Tranexamic acid reduces blood loss and transfusion in adult patients having spinal fusion surgery. Can J Anesth. 2006; 53(Suppl 1): 26385.
2. Abul-Azm A, Abdullah KM. Effect of topical tranexamic acid in open heart surgery. Eur J Anaesthesiol. 2006; 23(5): 380-4.
3. Baric D, Biocina B, Unic D, Sutlic Z, Rudez I, Vrca VB, et al. Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study. European Journal of Cardio-Thoracic Surgery. 2007; 31(3): 366-71.
4. Coetzee MJ. The use of topical crushed tranexamic acid tablets to control bleeding after dental surgery and from skin ulcers in haemophilia. Haemophilia. 2007; 13(4): 443-4.
5. Patatanian E, Fugate SE. Hemostatic mouthwashes in anticoagulated patients undergoing dental extraction. Annals of Pharmacotherapy. 2006; 40(12): 2205-10.
6. Sarris I, Arafa A, Konaris L, Kadir RA. Topical use of tranexamic acid to control perioperative local bleeding in gynaecology patients with clotting disorders: two cases. Haemophilia. 2007; 13(1): 115-6.
7. Henry DA, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, McClelland B, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2007; 17(4): CD001886.
8. Laupacis A, Fergusson D. Drugs to minimize perioperative blood loss in cardiac surgery: meta-analyses using perioperative blood transfusion as the outcome. Anesth Analg. 1997; 85(6): 1258-67.
9. Fraser IS, Porte RJ, Kouides PA, Lukes AS. A benefit-risk review of systemic haemostatic agents. Drug Safety. 2008; 31(3): 217-30.
10. Astedt B. Clinical pharmacology of tranexamic acid. Scand J Gastroenterol Suppl. 1987; 137: 22-5.
11. Sperzel M, Huetter J. Evaluation of aprotinin and tranexamic acid in different in vitro and in vivo models of fibrinolysis, coagulation and thrombus formation. J Thromb Haemost. 2007; 5(10): 2113-8.
12. Wong J, El Beheiry H, Rampersaud YR, Lewis S, Ahn H, De Silva Y, et al. Tranexamic Acid reduces perioperative blood loss in adult patients having spinal fusion surgery. Anesth Analg. 2008; 107(5): 1479-86.
13. Neilipovitz DT, Murto K, Hall L, Barrowman NJ, Splinter WM. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg. 2001; 93(1): 82-7.
14. Sethna NF, Zurakowski D, Brustowicz RM, Bacsik J, Sullivan LJ, Shapiro F. Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology. 2005; 102(4): 727-32.
15. Shapiro F, Zurakowski D, Sethna NF. Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis. Spine (Phila Pa 1976). 2007; 32(20): 2278-83.
16. Elwatidy S, Jamjoom Z, Elgamal E, Zakaria A, Turkistani A, El-Dawlatly A. Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebo-controlled study. Spine (Phila Pa 1976). 2008; 33(24): 2577-80.
17. Centre for Reviews and D. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials (Structured abstract). Database of Abstracts of Reviews of Effects. 2008(1).
18. Centre for Reviews and D. Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis (Structured abstract). Database of Abstracts of Reviews of Effects. 2008(1).
19. Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, et al. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology. 2006; 105(5): 1034-46.
20. Bednar D, Bednar A, Chaudhary A, Farrokhyar F. Tranexamic acid for hemostasis in the surgical treatment of metastatic tumors of the spine. Spine (Phila Pa 1976). 2006; 31(8): 954-7.
21. Kim MO, Bae SW. Tranexamic acid versus a placebo in decreasing blood loss in patients undergoing spine surgery. Korean J Anesthesiol. 2000; 39: 645-50.
22. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999; 57: 1005-32.
23. Brown JR, Birkmeyer NJO, O’Conner GT. Meta-analysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery. Circulation. 2007; 115: 2801-13.
24. Block JE. Severe blood loss during spinal reconstructive procedures: the potential usefulness of topical hemostatic agents. Med Hypotheses 2005; 65(3): 617-21.
25. Dekutoski MB. Blood loss and transfusion management in spinal surgery. Orthopedics. 1999; 22(1 Suppl): 155-7.
26. Tate DE Jr, Friedman RJ. Blood conservation in spinal surgery. Review of current techniques. Spine (Phila Pa 1976). 1992; 17(12): 1450-6.
27. Zheng F, Cammisa FP Jr, Sandhu HS, Girardi FP, Khan SN. Factors predicting hospital stay, operative time, blood loss and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine. 2002; 27: 818-24.
28. Regan JJ, Yuan H, McAfee PC. Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery: a prospective multicenter study evaluating open, and laparoscopic lumbar fusion. Spine (Phila Pa 1976). 1999; 24(4): 402-11.
29. Gill JB, Chin Y, Levin A, Feng D. The use of antifibrinolytic agents in spine surgery. A meta-analysis. J Bone Joint Surg Am. 2008; 90: 2399-407.
30. Krohn CD, Sørensen R, Lange JE, Riise R, Bjørnsen S, Brosstad F. Tranexamic acid given into the wound reduces postoperative blood loss by half in major orthopaedic surgery. Eur J Surg Suppl. 2003(588): 57-61.
31. Wong J, Hossam E, Suntheralingam Y, Rampersaud R, Chung F. Tranexamic acid reduces blood loss and transfusion in adult patients having spinal fusion surgery. Can J Anesth. 2006; 53(Suppl 1): 26385.