Application of Topical Tranexamic Acid Reduces Postoperative Blood Loss after Posterior Spinal Fusion with Instrumentation in Patients with Adolescent Idiopathic Scoliosis
Keywords:Tranexamic acid, postoperative hemorrhage, adolescent idiopathic scoliosis, spinal fusion, hybrid instrumentation, pedicle screw instrumentation
Purpose: There is limited literature regarding the topical use of tranexamic acid (TXA) to control postoperative bleeding during spinal deformity correction and fusion procedures, which often require blood transfusions. This study aimed to evaluate the effect of topical TXA on postoperative blood loss in patients undergoing deformity correction and posterior spinal fusion (PSF) surgeries.
Methods: A retrospective study was conducted between January 2011 and April 2017 in 51 patients with adolescent idiopathic scoliosis who underwent long-segment PSF with hybrid thoracic-hook pedicle screw instrumentation or pedicle-screw-alone constructs. Twenty-five patients were assigned to receive topical TXA (1 g/20 mL), and the drain was clamped for 2 h. Twenty-six patients in the control group were treated with antifibrinolytic agents.
Results: Median drainage blood loss, median day of drain removal, and median postoperative hospitalization were significantly lower in the topical TXA group (all p <0.05). The postoperative packed red cell transfusion rate was significantly lower in the topical TXA group than that in the control group (15 of 25, 60% vs. 23 of 26, 88.5%; p=0.02; risk ratio, 0.68; 95% confidence interval, 0.48–0.96).
Conclusions: The use of topically administered 1 g TXA in AIS patients undergoing instrumented PSF effectively reduced postoperative transfusion requirements, decreased the total amount of drainage blood loss, reduced the time till drain removal, and shortened the length of postoperative hospitalization.
Sethna NF, Zurakowski D, Brustowicz RM, et al. Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology 2005;102:727-32. DOI: https://doi.org/10.1097/00000542-200504000-00006
Luban NL. Transfusion safety: Where are we today?. Ann N Y Acad Sci 2005;1054:325-41. DOI: https://doi.org/10.1196/annals.1345.040
Roback JD, Su L, Zimring JC, et al. Transfusion- transmitted cytomegalovirus: lessons from a murine model. Transfus Med Rev 2007;21:26-36. DOI: https://doi.org/10.1016/j.tmrv.2006.08.005
Lin ZX, Woolf SK. Safety, efficacy, and cost-effectiveness of tranexamic acid in orthopedic surgery. Orthopedics 2016;39:119-30. DOI: https://doi.org/10.3928/01477447-20160301-05
Wong J, El Beheiry H, Rampersaud YR, et al. Tranexamic Acid reduces perioperative blood loss in adult patients having spinal fusion surgery. Anesth Analg 2008;107:1479-86. DOI: https://doi.org/10.1213/ane.0b013e3181831e44
Elwatidy S, Jamjoom Z, Elgamal E, et al. Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebo-controlled study. Spine (Phila Pa 1976) 2008;33:2577-80. DOI: https://doi.org/10.1097/BRS.0b013e318188b9c5
Ker K, Beecher D, Roberts I. Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database Syst Rev 2013;(7):CD010562. DOI: https://doi.org/10.1002/14651858.CD010562
Pateder DB, Gonzales RA, Kebaish KM, et al. Pulmonary embolism after adult spinal deformity surgery. Spine (Phila Pa 1976) 2008;33:301-5. DOI: https://doi.org/10.1097/BRS.0b013e31816245e1
Takahashi H, Yokoyama Y, Iida Y, et al. Incidence of venous thromboembolism after spine surgery . J Orthop Sci 2012;17:114-7. DOI: https://doi.org/10.1007/s00776-011-0188-2
Yoshioka K, Murakami H, Demura S, et al. Comparative study of the prevalence of venous thromboembolism after elective spinal surgery. Orthopedics 2013;36:e223-8. DOI: https://doi.org/10.3928/01477447-20130122-26
Chotigavanichaya C, Ruangchainikom M, Piyavanno C, et al. Incidence of symptomatic pulmonary embolism in spinal surgery . J Med Assoc Thai 2014;97 Suppl 9:S73-7.
Raman T, Varlotta C, Montes DV, et al. The use of tranexamic acid in adult spinal deformity: is there an optimal dosing strategy?. Spine J 2019;19:1690-97. DOI: https://doi.org/10.1016/j.spinee.2019.06.012
Winter SF, Santaguida C, Wong J, et al. Systemic and topical use of tranexamic acid in spinal surgery: a systematic review. Global Spine J 2016;6:284-95. DOI: https://doi.org/10.1055/s-0035-1563609
Saberi HO, Miri SM, Namdar MP. The effects of topically applied tranexamic acid on reduction of post-laminectomy hemorrhage. Tehran Univ Med J 2010;68:527-33.
Krohn CD, Sørensen R, Lange JE, et al. Tranexamic acid given into the wound reduces postoperative blood loss by half in major orthopaedic surgery. Eur J Surg Suppl 2003;(588):57-61.
Neilipovitz DT, Murto K, Hall L, et al. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg 2001;93:82-7. DOI: https://doi.org/10.1097/00000539-200107000-00018
Wong-Aek J, Lewsirirat S, Piyapromdee U. Blood utilization for elective orthopaedic surgeries at Maharat Nakhon Ratchasima hospital. JRCOST 2015;20:17-24.
Zufferey P, Merquiol F, Laporte S, et al. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology 2006;105:1034-46. DOI: https://doi.org/10.1097/00000542-200611000-00026
Chen Y, Chen Z, Cui S, et al. Topical versus systemic tranexamic acid after total knee and hip arthroplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2016;95:e4656. DOI: https://doi.org/10.1097/MD.0000000000004656
Vaněk T, Straka Z. Topical use of tranexamic acid in cardiac surgery—A review and meta-analysis of four randomized controlled trials. Cor et Vasa 2013;55:e184-9. DOI: https://doi.org/10.1016/j.crvasa.2012.10.002
Yeh H-M, Lau H-P, Lin P-L, et al. Convulsions and refractory ventricular fibrillation after intrathecal injection of a massive dose of tranexamic acid. Anesthesiology 2003;98:270-2. DOI: https://doi.org/10.1097/00000542-200301000-00042
Murkin JM, Falter F, Granton J, et al. High-dose tranexamic Acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg 2010;110:350-3. DOI: https://doi.org/10.1213/ANE.0b013e3181c92b23
Sudprasert W, Tanaviriyachai T, Choovongkomol K, et al. Topical tranexamic acid reduces postoperative blood loss in posterior spinal fusion with instrumentation: a retrospective clinical study of patients with thoracolumbar spine injury. J Med Assoc Thai 2018;101:15-22.
Weissmann KA, Lafage V, Pitaque CB, et al. Efficacy of topical versus intravenous tranexamic acid in spinal deformity. Eur Spine J 2020;29:3044-50. DOI: https://doi.org/10.1007/s00586-020-06572-8
McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs 2012;72:585-617. DOI: https://doi.org/10.2165/11209070-000000000-00000
How to Cite
Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.