Asian Spine J.  2019 Feb;13(1):146-154. 10.31616/asj.2018.0125.

A Randomized Controlled Trial of Topical Application of Tranexamic Acid in Patients with Thoracolumbar Spine Trauma Undergoing Long-Segment Instrumented Posterior Spinal Fusion

• Sudprasert W
• Tanaviriyachai T
• Choovongkomol K
• Jongkittanakul S
• Piyapromdee U

• KMID: 2441549
• DOI: http://doi.org/10.31616/asj.2018.0125

Abstract

STUDY DESIGN: Prospective, randomized controlled trial. PURPOSE: To evaluate the effect of topically applied tranexamic acid (TXA) on postoperative blood loss of neurologically intact patients with thoracolumbar spine trauma. OVERVIEW OF LITERATURE: Few articles exist regarding the use of topical TXA for postoperative bleeding and blood transfusion in spinal surgery.
METHODS
A total of 57 patients were operated on with long-segment instrumented fusion without decompression. In 29 patients, a solution containing 1 g of TXA (20 mL) was applied to the site of surgery via a drain tube after the spinal fascia was closed, and then the drain was clamped for 2 hours. The 28 patients in the control group received the same volume of normal saline, and clamping was performed using the same technique. The groups were compared for postoperative packed red cells (PRC) transfusion rate and drainage volume.
RESULTS
The rate of postoperative PRC transfusion was significantly lower in the topical TXA group than in the control group (13.8% vs. 39.3%; relative risk, 0.35; 95% confidence interval, 0.13 to 0.97; p=0.03). The mean total drainage volume was significantly lower in the topical TXA group than in the control group (246.7±125 mL vs. 445.7±211.1 mL, p < 0.01). No adverse events or complications were recorded in any patient during treatment over a mean follow-up period of 27.5 months.
CONCLUSIONS
The use of topically administered 1 g TXA in thoracic and lumbar spinal trauma cases effectively decreased postoperative transfusion requirements and minimized postoperative blood loss, as determined by the total drainage volume.

Keyword

Tranexamic acid; Postoperative hemorrhage; Spinal fusion; Pedicle screws; Spinal injuries

MeSH Terms

Blood Transfusion
Constriction
Decompression
Drainage
Fascia
Follow-Up Studies
Hemorrhage
Humans
Pedicle Screws
Postoperative Hemorrhage
Prospective Studies
Spinal Fusion*
Spinal Injuries
Spine*
Tranexamic Acid*
Tranexamic Acid