The Effect of Topical Tranexamic Acid in Reduction of Postoperative Blood Loss after Posterior Instrumented Cervical Spinal Fusion: A Retrospective Comparative Study

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Akom Prommahachai, MD


Purpose: to evaluate the efficacy of topical tranexamic acid on postoperative blood loss reduction, risk of blood transfusion and postoperative complications in patients undergone posterior cervical spine surgery compared with a control group. 

Methods: Retrospectively non-randomized observational study was conducted. The clinical data of patients who underwent posterior cervical spine instrumented fusion in Udon Thani hospital from October 2016 to March 2021 were included. Perioperative and postoperative outcomes were analyzed to compare between 20 patients received local tranexamic acid before wound closure and another 20 patients with no tranexamic usage as a control group.

Results: A total of 40 cases undergone posterior cervical spinal instrumented fusion procedure were enrolled, of which male to female ratio was 33:7 and mean age was 55.0±15 years. The mean of drainage volume was significantly lower in the topical tranexamic acid group than in the control group during the first 24 hour after surgery (163.0±78.8 versus 280.5±115.1 ml, p-value 0.001). The mean total drainage volume was significantly lower in the topical tranexamic acid group than in the control group (293.5±126.71 ml versus 456.3±174.56 ml, p-value 0.002). Postoperative blood transfusion rate was lower in the tranexamic acid group (5%) than the control group (35%) (Odd ratio 0.0977, 95% confidence interval 0.0107 to 0.8918; p-value 0.03). The mean duration of postoperative hospitalization was significant shorter in the topical tranexamic acid group (6.8±4.58 days) than the control group (11.6±7.37 days), p-value 0.019.

Conclusion: The local administration of 500 mg of tranexamic acid to the surgical site in posterior instrumented cervical spine fusion reduces postoperative blood loss from drainage output, decreases risk of blood transfusion, and shortens postoperative hospital stay without an increase in the risk of systemic thrombosis or other complications.


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