Effectiveness and safety of batroxobin, tranexamic acid and a combination in reduction of blood loss in lumbar spinal fusion surgery
Mn R, Shetty AP, Dumpa SR, Subarmaniam B, Kanna RM, Shanmuganathan R
STUDY DESIGN A prospective randomized double blind placebo controlled trail OBJECTIVE.: To evaluate and compare the efficacy and safety of Batroxobin (botropase),Tranexamic acid(TXA) and their combination in reduction of perioperative blood loss in lumbar spine single level fusion surgeries. SUMMARY OF BACKGROUND DATA Spinal surgeries are associated with significant blood loss leading to perioperative anaemia and increased need for allogenic transfusion. TXA competitively inhibits plasmin and batroxobin converts fibrinogen to fibrin and theoretically their combination is synergistic .Though TXA is widely studied in controlling blood loss,there is little information on use of batroxobin and their combination. Thus we aimed to study effect and safety of individual drugs and their combination in controlling blood loss in spinal surgery. METHODS Hundred patients were randomised into 4 groups. Group B- receive batroxobin,group T - receive TXA,group BT - receive batroxobin and TXA and group P - receive placebo. Outcomes assessed are intraoperative and postoperative blood loss, haemotocrit, Allogenic blood transfusion and deep vein thrombosis(DVT) postoperatively. RESULT Mean intraoperative blood loss in Group B, T, BT, and P were 268.32 +/- 62.92 ml, 340.72 +/- 182.75 ml, 256.96 +/- 82.64 ml and 448.44 +/- 205.86 ml respectively. Postoperative surgical site drain collection in Group B, T, BT, and P were 218.00 +/- 100.54 ml, 260.40 +/- 100.85 ml, 191.00 +/- 87.84 ml and 320.00 +/- 125.83 ml respectively. Intraoperative blood loss of Group P was statistically higher than Groups B and BT (p < 0.001). Mean postoperative surgical site drain collection was statistically significant (p < 0.001). No statistically significant differences in fluid administration (p = 0.751), blood transfusion (p = 1.000), preoperative and postoperative haemoglobin (p = 0.090, p = 0.134 respectively) and deep vein thrombosis (p = 1.000). CONCLUSION Batroxobin and combination of batroxobin with tranexamic acid significantly reduced perioperative blood loss when compared to placebo. LEVEL OF EVIDENCE 2.