Effect Analysis of Preoperative Intravenous Tranexamic Acid Combined With Intraoperative Immersion in Reducing Perioperative Blood Loss of One Stage Posterior Thoracolumbar Tuberculosis

Overview

Journal Front Surg

Specialty General Surgery

Date 2022 Jul 11

PMID 35813048

Authors

Bowen Zheng

Boyv Zheng

Huaqing Niu

Xiaobin Wang

Guohua Lv

Jing Li

Jingyu Wang

Affiliations

Soon will be listed here.

Abstract

Background: To investigate the efficacy and safety of preoperative intravenous tranexamic acid (TXA) combined with intraoperative immersion in reducing perioperative blood loss in one-stage posterior thoracolumbar tuberculosis.

Methods: All patients were divided into four groups: Group A received an intravenous drip of TXA before surgery, group B received multiple local immersions during the operation, group C received an intravenous drip combined with multiple local immersions, and the control group (group CG) were not treated with TXA during the same period. The total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), postoperative drainage volume, maximum hemoglobin drop value (max Hb drop), liver and kidney function, coagulation indexes, blood transfusion rate, hospital stay and incidence of complications were compared among the four groups.

Results: TBL, IBL, HBL, max Hb drop, POD1 drainage, and POD2 drainage in group A, group B, and group C were significantly lower than those in group CG. TBL, IBL, HBL and max Hb drop were group C < group A < group B < group CG. The drainage volume of group C was significantly lower than that of the other groups. There was no significant difference in blood coagulation index (PT, D-D) or liver and kidney function (ALT, Cr) among the four groups. There was no difference in postoperative hospital stay between group A and group B, but it was significantly lower in group C than in the other three groups. All patients achieved satisfactory bone graft fusion at the last follow-up.

Conclusion: Preoperative intravenous drip of TXA combined with intraoperative multiple immersion can effectively reduce perioperative blood loss while not increasing the risk of thrombosis without affecting liver and kidney function, coagulation function or tuberculosis prognosis.

Citing Articles

Hidden blood loss of minimally invasive hybrid lumbar interbody fusion: an analysis of influencing factors.

Dai Z, Feng D, Wu K, Zhu J, Li Z BMC Musculoskelet Disord. 2022; 23(1):1099.

PMID: 36522729 PMC: 9753421. DOI: 10.1186/s12891-022-06079-x.

References

Yin X, Liu S, Li J, Chen Y, Hu X, Zeng K . The role of costotransverse radical debridement, fusion and postural drainage in the surgical treatment of multisegmental thoracic spinal tuberculosis: a minimum 5-year follow-up. Eur Spine J. 2015; 25(4):1047-55. DOI: 10.1007/s00586-015-4283-5. View

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. DOI: 10.1097/BRS.0b013e318188b9c5. View

Wang Q, Liu J, Fan R, Chen Y, Yu H, Bi Y . Tranexamic acid reduces postoperative blood loss of degenerative lumbar instability with stenosis in posterior approach lumbar surgery: a randomized controlled trial. Eur Spine J. 2013; 22(9):2035-8. PMC: 3777047. DOI: 10.1007/s00586-013-2836-z. View

Luo W, Sun R, Jiang H, Ma X . The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis. J Orthop Surg Res. 2018; 13(1):96. PMC: 5937828. DOI: 10.1186/s13018-018-0815-0. View

Sun H, Deng L, Deng J, Wang J, Zhang H, Chen K . The Efficacy and Safety of Prophylactic Intravenous Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Posterior Lumbar Interbody Fusion. World Neurosurg. 2019; 125:e198-e204. DOI: 10.1016/j.wneu.2019.01.040. View

Xu D, Zhuang Q, Li Z, Ren Z, Chen X, Li S . A randomized controlled trial on the effects of collagen sponge and topical tranexamic acid in posterior spinal fusion surgeries. J Orthop Surg Res. 2017; 12(1):166. PMC: 5674845. DOI: 10.1186/s13018-017-0672-2. View

Wang S, Gao X, An Y . Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials. Int Orthop. 2016; 41(4):739-748. DOI: 10.1007/s00264-016-3296-y. View

Katsumata S, Nagashima M, Kato K, Tachihara A, Wauke K, Saito S . Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism. Acta Anaesthesiol Scand. 2005; 49(4):510-6. DOI: 10.1111/j.1399-6576.2005.00621.x. View

Cheriyan T, Maier 2nd S, Bianco K, Slobodyanyuk K, Rattenni R, Lafage V . Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis. Spine J. 2015; 15(4):752-61. DOI: 10.1016/j.spinee.2015.01.013. View

10.

Yerneni K, Burke J, Tuchman A, Li X, Metz L, Lehman Jr R . Topical tranexamic acid in spinal surgery: A systematic review and meta-analysis. J Clin Neurosci. 2018; 61:114-119. DOI: 10.1016/j.jocn.2018.10.121. View

11.

Ou Y, Wei J, Li R, Liang B, Qiu D, Wei M . Clinical Research of Combined Intravenous Administration and Topical Application of Tranexamic Acid to a Surgical Wound During Posterior Lumbar Fusion. Surg Innov. 2018; 25(2):128-135. DOI: 10.1177/1553350617751449. View

12.

Wang X, Yang R, Sun H, Zhang Y . Different Effects of Intravenous, Topical, and Combined Application of Tranexamic Acid on Patients with Thoracolumbar Fracture. World Neurosurg. 2019; 127:e1185-e1189. DOI: 10.1016/j.wneu.2019.04.095. View

13.

Nadler S, Hidalgo J, Bloch T . Prediction of blood volume in normal human adults. Surgery. 2011; 51(2):224-32. View

14.

Bagoly Z, Ariens R, Rijken D, Pieters M, Wolberg A . Clot Structure and Fibrinolysis in Thrombosis and Hemostasis. Biomed Res Int. 2017; 2017:4645137. PMC: 5705862. DOI: 10.1155/2017/4645137. View

15.

Raman T, Varlotta C, Vasquez-Montes D, Buckland A, Errico T . The use of tranexamic acid in adult spinal deformity: is there an optimal dosing strategy?. Spine J. 2019; 19(10):1690-1697. DOI: 10.1016/j.spinee.2019.06.012. View

16.

Tang Y, Wu W, Yang S, Wang D, Zhang Q, Liu X . Surgical treatment of thoracolumbar spinal tuberculosis-a multicentre, retrospective, case-control study. J Orthop Surg Res. 2019; 14(1):233. PMC: 6651955. DOI: 10.1186/s13018-019-1252-4. View

17.

McCormack P . Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012; 72(5):585-617. DOI: 10.2165/11209070-000000000-00000. View

18.

Vamvakas E, Blajchman M . Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood. 2009; 113(15):3406-17. DOI: 10.1182/blood-2008-10-167643. View

19.

Franchini M, Mengoli C, Marietta M, Marano G, Vaglio S, Pupella S . Safety of intravenous tranexamic acid in patients undergoing majororthopaedic surgery: a meta-analysis of randomised controlled trials. Blood Transfus. 2018; 16(1):36-43. PMC: 5770313. DOI: 10.2450//2017.0219-17. View

20.

Zaid H, Yang D, Tollefson M, Frank I, Winters J, Thapa P . Efficacy and Safety of Intraoperative Tranexamic Acid Infusion for Reducing Blood Transfusion During Open Radical Cystectomy. Urology. 2016; 92:57-62. DOI: 10.1016/j.urology.2016.02.044. View