A Clinical study on the Application of Tranexamic Acid in Posterior Lumbar Fusion_West China Medical Journal

Authors：

 LIQing ,  ZENGJian-cheng

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZENGJian-cheng, Email: tomzeng5@163.com

Keywords：

Tranexamic acid; Posterior lumbar fusion surgery; Blood loss; Retrospective study

DOI：

10.7507/1002-0179.20150352

Video：

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Objective To discuss the effectiveness and safety of intravenous application of tranexamic acid in reducing the blood loss in the perioperative period of lumbar fusion surgery. Methods A retrospective study of 68 patients with degenerative lumbar spinal stenosis with lumbar instability who were treated with lumbar fusion surgery from March 2013 to March 2014 in West China Hospital was carried out. The patients were divided into tranexamic acid group and control group according to whether tranexamic acid was used. After induction of anesthesia, tranexamic acid was given by intravenous drop to patients in the tranexamic acid group, while the control group did not receive any hemostatic drug. The red blood cell count, hemoglobin, mean corpuscular volume, prothrombin time, activated partial thromboplastin time, fibrinogen metaglobulin, intraoperative blood loss, postoperative blood loss, and blood transfusion volume before and after operation were compared. And we also observed whether there was pulmonary embolism or deep vein thrombosis incident. Results It showed no significant difference in intraoperative blood loss between the two groups, but the tranexamic acid group had less blood loss after operation than that of the control group (P<0.05). The tranexamic acid group had a higher red blood cell count, hemoglobin and mean corpuscular volume after operation than that of the control group (P<0.05). There was no significant difference between the two groups in prothrombin time, activated partial thromboplastin time, fibrinogen metaglobulin before and after operation (P>0.05). The pulmonary embolism and deep vein thrombosis were not found in the two groups. Conclusion Intravenous application of tranexamic acid is safe and effective in posterior lumbar fusion surgery. It can reduce the postoperative blood loss significantly, without increasing the risk of pulmonary embolism and deep vein thrombosis.

Citation： LIQing, ZENGJian-cheng. A Clinical study on the Application of Tranexamic Acid in Posterior Lumbar Fusion. West China Medical Journal, 2015, 30(7): 1222-1225. doi: 10.7507/1002-0179.20150352 Copy

1.	Issack PS, Cunningham ME, Pumberger M, et al. Degenerative lumbar spinal stenosis:evaluation and management[J]. J Am Acad Orthop Surg, 2012, 20(8):527-535.
2.	Chen H, Kelling J. Mild procedure for lumbar decompression:a review[J]. Pain Pract, 2013, 13(2):146-153.
3.	Kalff R, Ewald C, Waschke A, et al. Degenerative lumbar spinal stenosis in older people:current treatment options[J]. Dtsch Arztebl Int, 2013, 110(37):613-623; quiz 624.
4.	Lakshmanan P, Ahuja S, Lewis M, et al. Achieving 360°fusion in high-grade spondylolisthesis using HMA screws[J]. Surg Technol Int, 2009, 18(8):219-222.
5.	Kovesi T, Royston D. Pharmacological approaches to reducing allogeneic blood exposure[J]. Vox Sang, 2003, 84(1):2-10.
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7.	Mangano DT, Tudor IC, Dietzel C, et al. The risk associated with aprotinin in cardiac surgery[J]. N Engl J Med, 2006, 354(4):353-365.
8.	Brown M, Birkmeyer NJ, O' Connor GT. Meta-analysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery[J]. Circulation, 2007, 115(22):2801-2813.
9.	Békássy Z, Astedt B. Treatment with the fibrinolytic inhibitor tranexamic acid——risk for thrombosis?[J]. Acta Obstet Gynecol Scand, 1990, 69(4):353-354.
10.	Ker K, Beecher D, Roberts I. Topical application of tranexamic acid for the reduction of bleeding[J]. Cochrane Database Syst Rev, 2013, 7:CD010562.
11.	Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss[J]. Br J Surg, 2013, 100(10):1271-1279.
12.	Casati V, Bellotti F, Gerli C, et al. Tranexamic acid administration after cardiac surgery:a prospective, randomized, double-blind, placebo-controlled study[J]. Anesthesiology, 2001, 94(1):8-14.
13.	Verstraete M. Clinical application of inhibitors of fibrinolysis[J]. Drugs, 1985, 29(3):236-261.
14.	Gillette BP, Desimone LJ, Trousdale RT, et al. Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty[J]. Clin Orthop Relat Res, 2013, 471(1):150-154.
15.	Gandhi R, Evans HM, Mahomed SR, et al. Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty:a metaanalysis[J]. BMC Res Notes, 2013, 6:184.
16.	Kelley TC, Tucker KK, Adams MJ, et al. Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty[J]. Transfusion, 2014, 54(1):26-30.
17.	Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty[J]. J Arthroplasty, 2013, 28(7):1080-1083.
18.	Grant JA, Howard J, Luntley J, et al. Perioperative blood transfusion requirements in pediatric scoliosis surgery:the efficacy of tranexamic acid[J]. J Pediatr Orthop, 2009, 29(3):300-304.
19.	Florentino-Pineda I, Thompson GH, Poe-Kochert C, et al. The effect of amicar on perioperative blood loss in idiopathic scoliosis:the results of a prospective, randomized double-blind study[J]. Spine (Phila Pa 1976), 2004, 29(3):233-238.

1. Issack PS, Cunningham ME, Pumberger M, et al. Degenerative lumbar spinal stenosis:evaluation and management[J]. J Am Acad Orthop Surg, 2012, 20(8):527-535.
2. Chen H, Kelling J. Mild procedure for lumbar decompression:a review[J]. Pain Pract, 2013, 13(2):146-153.
3. Kalff R, Ewald C, Waschke A, et al. Degenerative lumbar spinal stenosis in older people:current treatment options[J]. Dtsch Arztebl Int, 2013, 110(37):613-623; quiz 624.
4. Lakshmanan P, Ahuja S, Lewis M, et al. Achieving 360°fusion in high-grade spondylolisthesis using HMA screws[J]. Surg Technol Int, 2009, 18(8):219-222.
5. Kovesi T, Royston D. Pharmacological approaches to reducing allogeneic blood exposure[J]. Vox Sang, 2003, 84(1):2-10.
6. Dunn CJ, Goa KL. Tranexamic acid:a review of its use in surgery and other indications[J]. Drugs, 1999, 57(6):1005-1032.
7. Mangano DT, Tudor IC, Dietzel C, et al. The risk associated with aprotinin in cardiac surgery[J]. N Engl J Med, 2006, 354(4):353-365.
8. Brown M, Birkmeyer NJ, O' Connor GT. Meta-analysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery[J]. Circulation, 2007, 115(22):2801-2813.
9. Békássy Z, Astedt B. Treatment with the fibrinolytic inhibitor tranexamic acid——risk for thrombosis?[J]. Acta Obstet Gynecol Scand, 1990, 69(4):353-354.
10. Ker K, Beecher D, Roberts I. Topical application of tranexamic acid for the reduction of bleeding[J]. Cochrane Database Syst Rev, 2013, 7:CD010562.
11. Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss[J]. Br J Surg, 2013, 100(10):1271-1279.
12. Casati V, Bellotti F, Gerli C, et al. Tranexamic acid administration after cardiac surgery:a prospective, randomized, double-blind, placebo-controlled study[J]. Anesthesiology, 2001, 94(1):8-14.
13. Verstraete M. Clinical application of inhibitors of fibrinolysis[J]. Drugs, 1985, 29(3):236-261.
14. Gillette BP, Desimone LJ, Trousdale RT, et al. Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty[J]. Clin Orthop Relat Res, 2013, 471(1):150-154.
15. Gandhi R, Evans HM, Mahomed SR, et al. Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty:a metaanalysis[J]. BMC Res Notes, 2013, 6:184.
16. Kelley TC, Tucker KK, Adams MJ, et al. Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty[J]. Transfusion, 2014, 54(1):26-30.
17. Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty[J]. J Arthroplasty, 2013, 28(7):1080-1083.
18. Grant JA, Howard J, Luntley J, et al. Perioperative blood transfusion requirements in pediatric scoliosis surgery:the efficacy of tranexamic acid[J]. J Pediatr Orthop, 2009, 29(3):300-304.
19. Florentino-Pineda I, Thompson GH, Poe-Kochert C, et al. The effect of amicar on perioperative blood loss in idiopathic scoliosis:the results of a prospective, randomized double-blind study[J]. Spine (Phila Pa 1976), 2004, 29(3):233-238.

West China Medical Journal

A Clinical study on the Application of Tranexamic Acid in Posterior Lumbar Fusion

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