1.
Different Effects of Intravenous, Topical and Combined Application of Tranexamic Acid on Patients with Thoracolumbar Fracture
Wang X, Yang R, Sun H, Zhang Y
World neurosurgery. 2019
Abstract
OBJECTIVE To observe the efficacy of intravenous, topical and combined application of tranexamic acid (TXA) in patients with thoracolumbar fracture fixed with percutaneous pedicle screw, and to identify the optimal application method of TXA. METHODS A total of 181 thoracolumbar fracture patients treated with percutaneous pedicle screw fixation were enrolled in the current randomized controlled clinical trial, and were randomly classified as three groups, including group A (intravenous group), group B (topical group), and group C (combined group). At the same time, the total blood loss (TBL), hidden blood loss (HBL), intraoperative blood loss (IBL), preoperative d-dimer, postoperative d-dimer, incidence of deep vein thrombosis (DVT) and other complications were compared and analyzed among these three groups. RESULTS TBL, HBL and IBL in topical group 24 h after operation were higher (P<0.05) than those in intravenous group and combined group, while the difference between intravenous group and combined group was not statistically significant. Meanwhile, there was no statistically significant difference in operation time, preoperative d-dimer and postoperative d-dimer among these three groups (P>0.05), but d-dimer in all the three groups at 72 h after surgery was higher than that before surgery. No DVT or other complication was observed in all patients. CONCLUSIONS Preoperative intravenous drip of TXA can remarkably reduce the intraoperative HBL and IBL in thoracolumbar fracture patients fixed with percutaneous pedicle screw. Nonetheless, intraoperative topical application of TXA before wound closure is not recommended.