1.
The Efficacy and Safety of Epsilon-Aminocaproic Acid for Perioperative Blood Management in Spinal Fusion Surgery: A systematic review and meta-analysis
Li S, Xing F, Cen Y, Zhang Z
World neurosurgery. 2021
Abstract
BACKGROUND Perioperative blood loss is a major concern in spinal fusion surgery, which often requires blood transfusion. A large amount of perioperative blood loss might increase the risks of various perioperative complications. Recently, there has been a series of clinical studies focusing on the perioperative administration of epsilon-aminocaproic acid (EACA) in spinal fusion surgery. The aim of this review was to evaluate the efficacy and safety of EACA in spinal fusion surgery. METHODS We systematically searched electronic databases (MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials) up to April 2021. The perioperative blood loss, blood transfusion and complication data were extracted and analysed by RevMan Manager 5.3. RESULTS Finally, six randomized controlled studies, involving 398 patients undergoing spinal fusion surgery, were enrolled in this systematic review. Compared with the blank control group, the EACA group had significantly lower total perioperative blood loss, postoperative blood loss, postoperative hemoglobin, postoperative blood transfusion units, total blood transfusion units, and postoperative red blood cell transfusion units. Additionally, no significant differences were observed between the EACA group and control group in intraoperative blood loss, intraoperative blood transfusion units, intraoperative crystalloid administered, hospital stays, operative time, perioperative respiratory complications, and wound bleeding. CONCLUSIONS EACA in patients undergoing spinal fusion surgery is effective in perioperative hemostasis without increasing the incidence of postoperative complications. However, the long-term adverse side of EACA in spinal fusion surgery still need more large-scale trials.
2.
A randomized controlled trial on the effects of collagen sponge and topical tranexamic acid in posterior spinal fusion surgeries
Xu D, Zhuang Q, Li Z, Ren Z, Chen X, Li S
Journal of Orthopaedic Surgery and Research. 2017;12((1)):166.
Abstract
BACKGROUND This is a randomized controlled trial research to assess the hemostatic efficacy of gelatin sponge, collagen sponge, and topical use of tranexamic acid (TXA) on postoperative blood loss in posterior spinal fusion surgeries. METHODS We recruited patients with spinal degenerative diseases into the study from November 2013 to October 2016. All the participants were assigned to 3 groups using a simple, equal-probability randomization scheme: group A is a control group utilizing gelatin sponge, while groups B and C are experimental groups, applying collagen hemostatic sponge and topical TXA respectively. Postoperative blood loss, rates of transfusion, and hospitalization were compared among the 3 groups. RESULTS In our study, the volume of drainage and blood content in drainage on the first postoperative day (POD 1) of patients in the experimental groups were significantly less than those in the control group, as well as rates of transfusion and postoperative hospitalization (P < 0.05). When compared with the control group, the volume of drainage decreased by 22.7% in group B and 56.2% in group C, while the blood content in drainage decreased by 28.8 and 75% respectively. CONCLUSIONS In this study, collagen and topical use of TXA have both proven to be effective and safe for patients undergoing posterior spinal fusion surgeries, while TXA has exhibited better efficacy. The total amount of perioperative blood loss reduced significantly without increasing incidence of related complications. TRIAL REGISTRATION A randomized controlled trial for effects of collagen sponge and topical tranexamic acid in posterior lumbar fusion surgeries. ChiCTR-IIR-17010785.
3.
Can tranexamic acid conserve blood and save operative time in spinal surgeries? a meta-analysis
Hui S, Xu D, Ren Z, Chen X, Sheng L, Zhuang Q, Li S
Spine Journal: Official Journal of the North American Spine Society. , 2017 Dec 12.. 2017;18((8):):1325-1337
Abstract
BACKGROUND CONTEXT It is widely accepted that tranexamic acid (TXA) effectively reduces blood losses and transfusions in major surgeries. However, limited studies investigated the role of TXA in conserving blood and saving operative time in spine surgeries. Purpose This meta-analysis was conducted to gather scientific evidences for TXA efficacy on conserving blood and saving operative time in spine surgeries. STUDY DESIGN A meta analysis. Patient Sample Eighteen RCTs and 18 non-RCT studies involving 2,572 patients were included in the final analyses, comparing the effectiveness of intravenous TXA with a placebo/no treatment group. Outcome Measures Outcomes of interest include intraoperative, postoperative and perioperative blood losses, allogeneic blood transfusion rates, cell salvage transfusion amounts, operative time and the number of postoperative thrombosis events. METHODS An exhaustive literature search was conducted in the MEDLINE and EMBASE databases from January 2000 through March 2017. Meta analysis was performed using Review Manager (RevMan) version 5.0 (The Cochrane Library, Oxford, United Kingdom). For continuous outcomes, the means and standard deviations were pooled to a mean difference (MD) and 95 % confidence interval (CI). Odds ratios (OR) and 95% confidence interval (CI) were calculated for dichotomous outcomes. The quantity of heterogeneity was assessed using I2 statistics. When there was no statistical evidence of substantial heterogeneity (I2<=50%), a fixedeffect model was adopted; otherwise, a random-effect model was chosen. Subgroup analysis was performed when more than 3 studies were included on one issue, based on low or high dose of TXA. Beijing Talent Fund (2016) was received to support this work. RESULTS Significantly reduced intraoperative [weighted mean difference (WMD) =-280.09.00, P<0.00001], postoperative (WMD=-120.15, P<0.00001), perioperative (WMD=-310.86, P<0.00001) blood losses, cell salvage transfusion amount (WMD=-471.79, P=0.01), perioperative transfusion rate [odds ratio (OR), 0.33 (0.17, 0.65), P=0.001] and operative time (WMD= -4.69, P=0.003) were observed in TXA group. Furthermore, subgroup analysis revealed that high dose TXA could reduce both intraoperative/perioperative allogeneic transfusion rates and operative time, while low dose of the drug does not convey such effects. CONCLUSIONS With the most comprehensive literature inclusion up to the present, this meta-analysis suggests that intravenous TXA use constitutes an important measure for conserving blood and saving operative time in spinal surgeries. High dose TXA significantly reduces intraoperative/ perioperative allogeneic transfusion rates and operative time, while low dose TXA does not convey such efficacies. Larger prospective trials are still required to define ththe optimal regimen and to confirm the safety of TXA use in such surgeries.
4.
A randomized controlled trial on effects of different hemostatic sponges in posterior spinal fusion surgeries
Xu D, Ren Z, Chen X, Zhuang Q, Sheng L, Li S
Bmc Surgery. 2016;16((1)):80.
Abstract
BACKGROUND Spinal fusion surgery is associated with significant blood loss, which may result in potential clinical complications, it is necessary to take safe and effective measures to reduce blood loss in surgery. We perform this study to assess the impact of three different hemostatic materials on perioperative blood loss. METHODS We performed a Randomized Controlled Trial research and recruited patients with lumbar disease into the study between November 2013 and March 2015. All the participants were randomly assigned to 3 groups using a simple equal probability randomization scheme: Group A (Stypro hemostatic sponge), Group B (Collagen hemostatic sponge) and Group C (gelatin sponge). We compared postoperative blood loss between these 3 groups. RESULTS In our study, drainage volume in the first 24 h of patients in Group A and B is significantly smaller, as well as total postoperative volumes of drainage (p < 0.05) during their hospital stay. The drainage volumes in the second 24 h were similar in the 3 groups. We also found that the average drainage Hematocrit (HCT) reduced over time, the average HCT of drainage is 18.04% and 11.72% on the first day and on the second day respectively. CONCLUSIONS Hemostatic collagen sponge demonstrated better hemostasis effects than gelatin sponge with lower volume of postoperative drainage volume and blood loss in posterior spinal fusion surgery. TRIAL REGISTRATION The trial registration number (TRN) of the study is ISRCTN29254316 and date of registration is 25/10/2016. Our trial was registered retrospectively.