Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion

Jianjiang Li,Tao Bai,Yifei Huang,Yanlu Liu,Long Wang

doi:10.1186/s13018-020-01758-8

Jianjiang Li, Tao Bai + Show 3 more

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https://doi.org/10.1186/s13018-020-01758-8

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Abstract

PurposeThe 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.MethodsTwo 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.ResultsThe 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.ConclusionsThe 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.

Highlights

Patients diagnosed with degenerative lumbar spine diseases such as lumbar spinal stenosis, disc herniation, and lumbar spondylolisthesis are generally required lumbar spinal fusion surgery [1, 2]
These procedures lead to relatively long operation time, especially for multi-level lumbar fusion cases, which are accompanied by a large incision and considerable blood loss
total blood loss (TBL) was 635.49 ± 143.60 mL in the combined group, which was considerably lower than the TBL of the IV group (892.62 ± 166.85 mL), the topical group (901.11 ± 186.25 mL), and the control group (1225.11 ± 186.25)

Summary

Introduction

Patients diagnosed with degenerative lumbar spine diseases such as lumbar spinal stenosis, disc herniation, and lumbar spondylolisthesis are generally required lumbar spinal fusion surgery [1, 2]. Lumbar spinal fusion surgery procedures were usually processed with the decompression, instrumentation, correction, and fusion procedures step by step These procedures lead to relatively long operation time, especially for multi-level lumbar fusion cases, which are accompanied by a large incision and considerable blood loss. It was reported the average blood loss in noninstrumented lumbar fusion surgery was 800 mL, while the total blood loss of instrumented fusions could reach up to 1517 mL [3]. Allogeneic blood transfusions could prevent the patients from suffering the above life-threatening complications, blood transfusions are usually limited with blood supply, potential risk of immunologic reaction, and infectious disease transmission [7]

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Conclusion