Minimal Dose of Tranexamic Acid Is Effective in Reducing Blood Loss in Complex Spine Surgeries: A Randomized Double-Blind Placebo Controlled Study

Shakeri, Moslem; Salehpour, Firooz; Shokouhi, Ghaffar; Aeinfar, Kamkar; Aghazadeh, Javad; Mirzaei, Farhad; Alavi, Seyed Ahmad Naseri

Abstract

STUDY DESIGN: A randomized double-blind placebo controlled study. PURPOSE: In the present study, we aimed to assess the efficacy of tranexamic acid (TXA) in reducing blood loss after laminectomy and posterolateral fusion of the spine. OVERVIEW OF LITERATURE: Blood loss is the most significant complication involved with surgery, especially in spinal surgery. Multi-level laminectomy and laminectomy with instrumentation (pedicle screws and rods) are complex spine surgeries and are considered as medium-risk procedures for bleeding. Recent reports have demonstrated that the use of antifibrinolytic drugs during surgery may reduce the risk of postoperative bleeding and one of the most frequently used antifibrinolytics is TXA.
METHODS
In this randomized clinical trial, 50 patients eligible for laminectomy (for â‰¥2 level) with postero-lateral fusion with a pedicular screw (laminectomy and posterior spinal fusion) were randomly assigned to receive preoperative single doses of intravenous TXA (15 mg/kg) or 0.9% normal saline.
RESULTS
Of the 50 patients, 30 (60%) were female and 20 (40%) were male. Between-group difference with respect to the total volume of blood loss during surgery was statistically significant.
CONCLUSIONS
The findings of this study suggest that TXA can reduce both intraoperative and immediate postoperative blood loss, decrease the need for packed cell transfusion, and reduce the duration of hospitalization after complex spinal surgeries. No adverse events related to the use of TXA were encountered in this study.