1.
Intravenous administration of tranexamic acid significantly reduces visible and hidden blood loss compared to its topical administration for double-segment posterior lumbar interbody fusion: A single-center, placebo-controlled, randomized trial
Mu X, Wei J, Wang C, Ou Y, Yin D, Liang B, Qiu D, Li Z
World Neurosurgery. 2018
Abstract
STUDY DESIGN A single-center, placebo-controlled, randomized design. OBJECTIVE The current study investigated the effects of intravenous and topical administrations of Tranexamic acid (TXA) on the visible and hidden blood loss of patients receiving posterior lumbar interbody fusion (PLIF). SUMMARY of Background Data: TXA significantly reduces the visible and hidden blood loss associated with joint replacement. At present, many studies have examined the safety and effectiveness of the intravenous or topical administration of TXA after posterior lumbar surgery. However, randomized and controlled trials examining the presence of differences in the effect of TXA on the visible and hidden blood loss between these two modes of administration are lacking. METHODS A total of 150 patients with lumbar degenerative disease who underwent PLIF between September 2015 and August 2017 volunteered for this study. Of these patients, 126 fulfilled the inclusion criteria and were randomly assigned to one of three groups: the intravenous administration group (n = 45, group A), the topical administration group (n = 39, group B), or the placebo group (n = 42, group C). SPSS 17.0 was used to analyze the patient data, their blood biochemical indices, blood loss, and the number of blood transfusions across the three groups during the perioperative period. RESULTS The postoperative drainage volume, number of blood transfusions, length of hospital stay, and extubation time significantly differed between group C and both groups A and B (P < 0.05); however, no significant differences were noted between groups A and B (P > 0.05). Intraoperative blood loss and visible or hidden blood loss as well as the levels of postoperative hemoglobin (HGB) and hematocrit (HCT) significantly differed among the three groups (P < 0.01). The results of the visual analogue scale (VAS), prothrombin time (PT), and fibrinogen (FIB) content did not significantly differ among the three groups (P > 0.05). CONCLUSIONS For patients undergoing double-segment PLIF, both administrations of TXA can reduce blood loss, extubation time, and the length of hospital stay. Moreover, intravenous administration can reduce both visible and hidden blood loss more efficiently.
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.
Using tranexamic acid soaked absorbable gelatin sponge following complex posterior lumbar spine surgery: a randomized control trial
Liang J, Liu H, Huang X, Xiong W, Zhao H, Chua S, Li Z
Clinical Neurology and Neurosurgery. 2016;147:110-114.
Abstract
OBJECTIVES This paper aims to determine whether the use of Tranexemic Acid (TXA) - soaked absorbable gelatin sponge could more effectively reduce post-operative blood loss and blood transfusion requirements among low-risk adult patients undergoing lumbar spine surgery. METHODS A total of 90 consecutive patients undergoing surgery for multilevel posterior lumbar degenerative procedures were prospectively randomized into one of three groups: - TXA Soaked Gelfoam group, absorbable gelatin sponge group or control group. Demographic distribution, total drain output, blood transfusion requirement, length of hospital stay, the number of readmissions, and postoperative complications were analyzed. RESULTS In the TXA Soaked Gelfoam, Gelfoam, and control groups, the respective hemovac drainage at the first 8h postoperatively was 81.06+/-61.21, 166.73+/-76.76, and 155.67+/-92.94ml respectively. The second 8h period drainage for the same groups postoperatively was 46.67+/-40.09, 55.10+/-43.43, and 82.50+/-56.67ml and 23.73+/-25.56, 32.43+/-25.81 and 44.20+/-32.44ml for the third 8h period postoperatively. The duration of the post-operative drain left in the TXA Soaked Gelfoam group was significantly shorter than the Gelfoam and control groups (p=0.019 and 0.000, respectively). The TXA Soaked Gelfoam and Gelfoam also had a significantly shorter hospital stay than the control group (p=0.014, and 0.036, respectively). No patient developed adverse reactions attributable to the tranexamic acid soaked absorbable gelatin sponge. CONCLUSIONS TXA-soaked absorbable gelatin sponge is a safe, effective treatment for reduction of post-operative blood loss and blood transfusions among low-risk adult patients undergoing lumbar spine surgery.