The effectiveness of tranexamic acid on operative and perioperative blood loss in long-segment spinal fusions: a consecutive series of 119 primary procedures

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  • 1 Departments of Neurological Surgery and
  • 2 Anesthesiology and Pain Management, UT Southwestern Medical Center Dallas, Texas
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OBJECTIVE

The aim of this study was to determine if the use of tranexamic acid (TXA) in long-segment spinal fusion surgery can help reduce perioperative blood loss, transfusion requirements, and morbidity.

METHODS

In this retrospective single-center study, the authors included 119 consecutive patients who underwent thoracolumbar fusion spanning at least 4 spinal levels from October 2016 to February 2019. Blood loss, transfusion requirements, perioperative morbidity, and adverse thrombotic events were compared between a cohort receiving intravenous TXA and a control group that did not.

RESULTS

There was no significant difference in any measure of intraoperative blood loss (1514.3 vs 1209.1 mL, p = 0.29) or transfusion requirement volume between the TXA and control groups despite a higher number of pelvic fusion procedures in the TXA group (85.9% vs 62.5%, p = 0.003). Postoperative transfusion volume was significantly lower in TXA patients (954 vs 572 mL, p = 0.01). There was no difference in the incidence of thrombotic complications between the groups.

CONCLUSIONS

TXA appears to provide a protective effect against blood loss in long-segment spine fusion surgery specifically when pelvic dissection and fixation is performed. TXA also seems to decrease postoperative transfusion requirements without increasing the risk of adverse thrombotic events.

ABBREVIATIONS DVT = deep venous thrombosis; EBL = estimated blood loss; LOS = length of stay; PRBC = packed red blood cell; TXA = tranexamic acid.

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Contributor Notes

Correspondence Salah G. Aoun: The University of Texas Southwestern, Dallas, TX. salah.aoun@phhs.org; salahaoun@hotmail.com.

INCLUDE WHEN CITING Published online January 24, 2020; DOI: 10.3171/2019.11.SPINE191174.

Disclosures Dr. McDonagh: support of non–study-related clinical or research effort from Lungpacer Medical Inc.

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