Department of Neurosurgery, University of Health Sciences, Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey.
Department of Orthopedics, Sportoteam Sport and Spine Center, Istanbul, Turkey.
J Neurol Surg A Cent Eur Neurosurg. 2022 Jan;83(1):46-51. doi: 10.1055/s-0041-1731751. Epub 2021 Nov 18.
Multilevel posterior spinal fusion surgery in adults is associated with significant intra- and postoperative blood loss. Tranexamic acid (TXA) is an antifibrinolytic agent for reducing blood loss and allogenic blood transfusion. The purpose of this study was to evaluate the efficiency of TXA in reducing blood loss and improving hematologic parameters in adult patients undergoing posterior thoracic/lumbar instrumented spinal fusion surgery.
This is a retrospective observational study comparing the intra- and postoperative hemodynamic findings of two groups treated with and without TXA. The study included 112 adult patients receiving elective posterior thoracic/lumbar instrumented spinal fusion surgery. The patients were evaluated in terms of age, gender, type of surgery, intraoperative blood loss, pre- and postoperative hemoglobin (Hb) and hematocrit values, postoperative systemic anticoagulant use, intra- and postoperative use of blood products, and the volume of the drainage fluid as an indicator of postoperative blood loss. The TXA group received preoperative 10 mg/kg intravenous TXA, another dose of 10 mg/kg/h in isotonic solution during the operation, and local administration of TXA before the closure of the surgical site (1g in patients undergoing surgery in ≤3 segments, and 2g in patients undergoing surgery in ≥4 segment group).
Intra- and postoperative blood loss and need for transfusion were significantly lower in the TXA group. Fifty-three of 112 patients required intra- and postoperative transfusion, and postoperative anticoagulants were given to 25/112 patients. The postoperative Hb level was lower, and the difference of pre- and postoperative Hb values was higher in the non-TXA group (not significant).
Simultaneous systemic and topical application of TXA is a safe and efficient blood conservation strategy for adult patients undergoing major multilevel spinal surgery.
成人多节段后路脊柱融合术术中及术后出血量较大。氨甲环酸（TXA）是一种抗纤维蛋白溶解剂，可减少出血量和异体输血。本研究旨在评估 TXA 在减少成人后路胸腰椎后路融合手术患者出血量和改善血液学参数方面的有效性。
这是一项回顾性观察研究，比较了使用和未使用 TXA 的两组患者的术中及术后血流动力学发现。该研究纳入了 112 例接受择期后路胸腰椎后路融合手术的成年患者。评估患者的年龄、性别、手术类型、术中出血量、术前和术后血红蛋白（Hb）和红细胞压积值、术后全身抗凝剂使用、术中及术后血液制品使用以及引流液量（作为术后出血量的指标）。TXA 组患者术前静脉给予 10mg/kg TXA，术中给予 10mg/kg/h 等渗溶液，手术部位关闭前局部给予 TXA（手术节段数≤3 者给予 1g，手术节段数≥4 者给予 2g）。
TXA 组患者术中及术后出血量和输血需求显著降低。112 例患者中有 53 例需要术中及术后输血，25 例患者接受术后抗凝治疗。TXA 组患者术后 Hb 水平较低，术前和术后 Hb 值的差异较大（无统计学意义）。
对行多节段脊柱大手术的成人患者同时进行全身和局部 TXA 应用是一种安全有效的血液保护策略。
