Abstract
Tranexamic acid (TXA) protects against endothelial glycocalyx injury in vitro. We aimed to evaluate whether TXA could protect against endothelial glycocalyx degradation in patients undergoing posterior lumbar fusion surgery. Patients aged 30–80 years were enrolled. The TXA group was administered a loading dose of 10 mg/kg, followed by a 1 mg/kg/h infusion. Serum syndecan-1 and heparan sulfate concentrations, which are biomarkers of glycocalyx degradation, were measured at preoperative baseline (T0), immediately post-surgery (T1), and 2 h post-surgery (T2). Postoperative complications were assessed, including hypotension, desaturation, and acute kidney injury. Among the 121 patients who completed the study, 60 received TXA. There were no significant differences in the marker concentrations at each time point. However, the postoperative increase in syndecan-1 levels from baseline was significantly attenuated in the TXA group compared with the control group (median (interquartile range); T1 vs. T0: −1.6 (−5.3–2.6) vs. 2.2 (−0.7–4.8), p = 0.001; T2 vs. T0: 0.0 (−3.3–5.5) vs. 3.6 (−0.1–9.3), p = 0.013). Postoperative complications were significantly associated with the magnitude of the change in syndecan-1 levels (for T2 vs. T0: odds ratio: 1.08, 95% confidence interval: 1.02–1.14, p = 0.006). TXA administration was associated with reduced syndecan-1 shedding in patients undergoing posterior lumbar fusion surgery.
Highlights
Posterior lumbar fusion surgery is a common procedure for the treatment of degenerative spine disease
Our results showed that the enhanced release of syndecan-1 into the plasma, an indirect indicator of endothelial glycocalyx damage, was attenuated immediately and at 2 h post-surgery compared to preoperative levels in the Tranexamic acid (TXA) group
The endothelial glycocalyx is mainly composed of proteoglycans, glycoproteins, and glycosaminoglycans; among these constituents, proteoglycans and glycoproteins play a role in the formation of the backbone of endothelial glycocalyx
Summary
Posterior lumbar fusion surgery is a common procedure for the treatment of degenerative spine disease. Multilevel spinal fusions are associated with substantial blood loss and the increased need for transfusions, and such procedures can be complicated by postoperative morbidity [1]. Surgical trauma and the accompanying inflammatory and immune reactions can result in vascular endothelial injury and the degradation of the glycocalyx [2,3,4]. Endothelial glycocalyx damage increases capillary permeability, causes tissue swelling, and evokes abnormal vascular reactions, as well as the worsening of inflammatory and coagulation reactions [7,8]. The association between endothelial glycocalyx damage and morbidity has been observed in critically ill and surgical patients [9,10,11,12]. There is an increasing interest to protect endothelial glycocalyx as a promising therapy to reduce morbidity after surgery
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