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Hiroshi Kageyama, Terushige Toyooka, Nobusuke Tsuzuki and Kazunari Oka

studies have shown that hyperfibrinolytic activities play a major role in the liquefaction and enlargement of CSDH. 4 , 6 We hypothesized that tranexamic acid, an antifibrinolytic agent that has fewer side effects than other agents and is widely used for hemostasis, 2 would inhibit the hyperfibrinolytic activity of CSDH. Therefore, we assessed the effects of tranexamic acid on CSDH volume. Methods Patient Population We identified patients by retrospective analysis of the medical records and neuroradiographic studies for all patients seen at the Department of

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Bhargav D. Desai, Davis G. Taylor, Ching-Jen Chen, Thomas J. Buell, Jeffrey P. Mullin, Bhiken I. Naik, Justin S. Smith and Christopher I. Shaffrey

correlated with improving patient outcomes by decreasing postoperative hemorrhagic complications, associated coagulopathies, and anemias. 37 Currently, there are limited techniques to decrease intraoperative surgical site bleeding. 3 , 10 , 21 , 22 , 26 , 37 Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has been shown to reduce surgical site bleeding in orthopedic and cardiac procedures as well as several short-segment spine series. 6 , 11 , 13 , 25 , 35 , 36 However, contraindications to systemic TXA (through either oral or intravenous [IV] routes) exist

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J. A. Alvarez Garijo, J. J. Vilches and J. A. Aznar

3rd week after SAH or later. Lumbar punctures were performed every 6 days in order to determine levels of FSP, which reflect fibrinolysis. Levels of FSP were simultaneously determined in plasma. The fibrinolysis-inhibitor agent we employed was tranexamic acid (transaminoethylcyclohexane carboxylic acid, AMCA), administered intravenously in doses of 500 mg every 6 hours during the first 6 days of treatment, followed by oral doses up to the time of the operation. The therapy was started immediately after the first FSP determination. A control group consisted of 12

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Junichi Kushioka, Tomoya Yamashita, Shinya Okuda, Takafumi Maeno, Tomiya Matsumoto, Ryoji Yamasaki and Motoki Iwasaki

blood loss may increase the formation of epidural hematomas that cause neurological disorders, coagulopathy, and anemia, which delay postoperative recovery and prolong patient hospitalization. Fibrinolysis transiently increases during surgery, 4 and increased fibrinolysis contributes to perioperative blood loss during spine surgery. 7 Tranexamic acid (TXA; Daiichi Sankyo Co.) is a synthetic antifibrinolytic drug that competitively blocks the lysine binding sites of plasminogen, plasmin, and tissue plasminogen activator. TXA can delay fibrinolysis and blood clot

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Jeff Ehresman, Zach Pennington, Andrew Schilling, Ravi Medikonda, Sakibul Huq, Kevin R. Merkel, A. Karim Ahmed, Ethan Cottrill, Daniel Lubelski, Erick M. Westbroek, Salia Farrokh, Steven M. Frank and Daniel M. Sciubba

studied to achieve this goal, including the use of alternative surgical positioning designed to reduce intraabdominal pressure (e.g., Jackson frame, Wilson frame), intraoperative cell salvage, controlled hypotensive anesthesia, topical hemostatic agents, and systemic antifibrinolytic agents such as tranexamic acid (TXA). Of these, the best evidence exists for the use of antifibrinolytics, with multiple small randomized trials showing reductions in intraoperative and total blood loss with use of TXA. 9–11 The question remains, however, regarding how the cost of TXA

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Mark N. Pernik, Luke J. Dosselman, Salah G. Aoun, Adrienne D. Walker, Kristen Hall, Valery Peinado Reyes, David L. McDonagh and Carlos A. Bagley

case, and can be taxing on hospital resources, specifically the blood bank, given the need for significant transfusion volumes. 2 , 7 , 9 , 21 , 29 , 30 To reduce the morbidity and need for poly-transfusions inherent to degenerative deformity spine surgery, several pharmacological approaches have been explored. 30 The intraoperative use of tranexamic acid (TXA), an antifibrinolytic agent, has been shown to reduce the need for blood transfusion and intraoperative surgical blood loss across several specialties, including cardiac, orthopedic, and hepatic surgery. 4

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Signe Elmose, Mikkel Ø. Andersen, Else Bay Andresen and Leah Yacat Carreon

B leeding is an inevitable part of any spinal surgical procedure, and its control is an essential part of safe practice. Absence of hemostasis can lead to poor intraoperative visibility and prolonged duration of surgery. Different techniques are applied to secure hemostasis, including electrical cauterization, infiltration with epinephrine, administration of local hemostatic agents (e.g., tissue adhesives), and administration of antifibrinolytic medication. The antifibrinolytic agent tranexamic acid (trans-4-aminomethyl-cyclohexane-1-carboxylic acid, TXA) is a

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Jan Hillman, Steen Fridriksson, Ola Nilsson, Zhengquan Yu, Hans Säveland and Karl-Erik Jakobsson

, 48, 52 The object of this randomized prospective study was to assess the efficacy of short-term antifibrinolytic treatment with tranexamic acid in preventing rebleeding. 32 Clinical Material and Methods Patients, Methods, and Statistics This prospective study was undertaken during the 30 month period from September 1997 to March 2000 in collaboration among the neurosurgical departments of the university hospitals in Linköping, Lund, and Gothenburg. The ethics committees of the universities involved approved the study. These three centers serve a

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Russel H. Patterson Jr. and Peter Harpel

prevent recurrent hemorrhage. The present report describes the evolution in strength and size of the thrombus that forms in a blind arterial sac created in the rat and how the administration of the antifibrionolytic agents, epsilon aminocaproic acid (EACA) and tranexamic acid (trans-AMCHA; trans-4 amino-methylcyclohexane-1-carboxylic acid) modify the process. Material and Methods Pairs of rats of Sprague-Dawley stock were matched for weight within 10 gm over a range of 230 to 290 gm. One of each pair received drinking water containing either 5% EACA, 1% trans

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Lee A. Tan and Peter D. Angevine

TO THE EDITOR: We read with great interest the recent article by Kushioka et al. 1 ( Kushioka J, Yamashita T, Okuda S, et al: High-dose tranexamic acid reduces intraoperative and postoperative blood loss in posterior lumbar interbody fusion. J Neurosurg Spine 26:363–367, March 2017 ) regarding the use of intravenous tranexamic acid (TXA) for single-level posterior lumbar interbody fusions (PLIFs). The authors conducted a nonrandomized, retrospective, comparative cohort study with 30 patients in each group and found that patients who received intravenous TXA