1.
A multicenter, prospective, randomized clinical study to evaluate the efficacy and safety of fibrin sealant as an adjunct to sutured dural repair
Yu R, Zhu W, Kocharian R, Ilie B, Wang Z, Kang D, Zhao G, Yang H, Shu K, Liu X, et al
Chinese medical journal. 2022;135(20):2506-2508
2.
Impact of the Tranexamic Acid on Bleeding Amount of Surgical Patient With Degenerative Spinal Disease: A Randomized Blinded Study
Yan L, Yang H, Jiang H, Yu M, Tan J, Su T, Xu G
Frontiers in surgery. 2021;8:655692
Abstract
Objective: This study aims to explore the effectiveness and safety of tranexamic acid (TXA) in reducing the bleeding amount of surgical patients with degenerative spinal disease in the perioperative period. Methods: A total of 80 cases of patients, who underwent elective posterior lumbar interbody fusion surgeries under general anesthesia, were enrolled in this study. The age of these patients ranged within 41-69 years old, and the surgical vertebral body segments were ≥2. The ASA classification was Level I or Level II. These patients were divided into two groups using the random number table (n = 40): TXA group and control group (S group). In the TXA group, the skin was incised after the anesthesia induction, and 20 mg/kg of TXA was immediately injected into the vein. The injection continued at a rate of 10 mg·kg(-1)·h(-1) during the surgery, until the surgery was finished. In the S group, IV and pump injection with an equal amount of normal saline (NS) were performed. Then, the RBC, Hb, HCT, AST, ALT, BUN, Cr, PT, TT, APTT, FIB, and D-dimer were measured before the surgery and at 1 day after the surgery, and the SSFQ, intraoperative bleeding amount, homologous transfusion volume, urine volume, infusion quantity, surgical duration, drainage volume at 24 h after the surgery, total bleeding amount and adverse event occurrence at 1 week after the surgery were recorded. Results: The RBC, Hb and HCT at 1 day after the surgery were higher in TXA group than in the S group (average P < 0.05). Intraoperative bleeding, drainage volume at 24 h after surgery, and total blood loss were lower in the TXA group than in the S group (average P < 0.05). The SSFQ score and length of stay were lesser in the TXA group than in the S group (average P < 0.05). The differences in AST, ALT, BUN, Cr, PT, TT, APTT, FIB, and D-dimer at 1 day after the surgery for these two groups of patients had no statistical significance (average P > 0.05). Conclusion: TXA can reduce the bleeding amount of surgical patients with degenerative spinal disease in the perioperative period and decrease the length of stay, but does not increase the occurrence rate of adverse events, thereby promoting postoperative rehabilitation. Clinical Trial Registration: www.chictr.org.cn/index.aspx, identifier: ChiCTR2000033597.
3.
Does tranexamic acid improve bleeding, transfusion, and hemoglobin level in patients undergoing multi-level spine surgery? A systematic review and meta-analysis
Zhang Y, Liu H, He F, Chen A, Yang H, Pi B
World neurosurgery. 2019
Abstract
OBJECTIVE To investigate the influence of TXA on blood loss and blood transfusion in multiple-level spine surgery and evaluate whether hemoglobin and platelet levels are altered as a result. METHOD This meta-analysis conducted an exhaustive search of literature from Pubmed, Embase, Cochrane Library, Web of Science, and CNKI databases. Stata 11.0 was used to analyze the pooled data. Mean differences (MD) of blood loss, transfusion volume, hemoglobin and platelet levels, as well as odds ratio (OR) of proportion of transfusion were extracted and compared between the TXA group and controls. Publication bias and sensitive analysis were also performed in this study. RESULT A total of 11 studies (6 RCTs and 5 retrospective studies) were enrolled in this meta-analysis according to the inclusion criteria. The data showed that administration of TXA can decrease intraoperative blood loss and perioperative blood transfusion compared to controls (SMD = -0.50; 95 % CI: -0.84, -0.16; I(2) = 52.9 %; p = 0.004) (OR = 0.48; 95 % CI: 0.29, 0.78; I(2) = 0 %; p = 0.003). Moreover, TXA can maintain a superior hemoglobin level after surgery than control group (SMD = -0.27; 95 % CI: 0.07, 0.47; I(2) = 0 %; p = 0.009). The above results were also observed and verified after accounting for publication bias and sensitive analysis. CONCLUSION The application of TXA can effectively reduce intraoperative blood loss and perioperative blood transfusion in patients undergoing multiple-level spine surgery, as well as restore hemoglobin levels after surgery.