Department of Orthopedics, The Affiliated Lianyungang Hospital of Xuzhou Medical University, 6 Zhenhua East Rd, Lianyungang 221000, China.
Department of Orthopedics, The First People's Hospital Of Lianyungang, 6 Zhenhua East Rd, Lianyungang 221000, China.
Clin Neurol Neurosurg. 2024 Nov;246:108607. doi: 10.1016/j.clineuro.2024.108607. Epub 2024 Oct 21.
Tranexamic acid (TXA) can effectively reduce intraoperative blood loss and transfusion rates. However, in spinal surgery, the number of surgical levels can significantly influence intraoperative and postoperative bleeding, particularly among the elderly, contributing to the persistently high rate of transfusion during the perioperative period. To verify the safety and efficacy of different application methods of TXA in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF), a prospective cohort study was conducted.
A total of 958 patients undergoing TLIF were randomly assigned to receive 2 g of oral TXA two hours before surgery or 15 mg/kg of intravenous TXA 30 min before surgery, or to a control group. The samples were further divided into three categories based on the number of fused segments (one-level fusion, two-level fusion, and three-level fusion). The primary outcomes were the total blood loss and transfusion rate. Secondary outcomes included intraoperative blood loss, postoperative blood loss, drainage volume, time until drain removal, perioperative transfusion volume, length of stay, thrombotic events, and other adverse events.
336 patients received intravenous TXA and 314 patients were received oral TXA. Patient demographic factors were similar between groups. In the one-level fusion surgery cohort, comparisons across the three groups revealed no statistically significant disparities in total blood loss, transfusion rates, or drainage volumes (P > 0.05). In both two-level and three-level fusion surgeries, patients administered with TXA experienced a notably reduced perioperative bleeding compared to the control group (P < 0.01). Interestingly, a significant disparity was observed in the drainage volumes between the intravenous and oral administration groups (P = 0.026), specifically within the context of two and three-level fusion procedures.
In elderly patients undergoing TLIF surgery, both intravenous and oral administrations of TXA are safe and effective. Oral TXA, being more economical and non-invasive compared to intravenous injection, holds promise for clinical use.
氨甲环酸（TXA）可有效减少术中失血量和输血率。然而，在脊柱手术中，手术节段数量会显著影响术中及术后出血，尤其是老年人，这导致围手术期输血率一直居高不下。为了验证 TXA 在接受经椎间孔腰椎体间融合术（TLIF）的老年患者中的不同应用方法的安全性和有效性，进行了一项前瞻性队列研究。
将 958 例行 TLIF 的患者随机分为术前 2 小时口服 TXA2g 组、术前 30 分钟静脉注射 TXA15mg/kg 组或对照组。根据融合节段数（单节段融合、双节段融合和三节段融合）进一步将样本分为三组。主要结局是总失血量和输血率。次要结局包括术中失血量、术后失血量、引流量、拔管时间、围术期输血量、住院时间、血栓事件和其他不良事件。
336 例患者接受静脉 TXA 治疗，314 例患者接受口服 TXA 治疗。各组患者的人口统计学因素相似。在单节段融合手术队列中，三组间总失血量、输血率和引流量无统计学差异（P>0.05）。在双节段和三节段融合手术中，与对照组相比，接受 TXA 治疗的患者围术期出血明显减少（P<0.01）。有趣的是，静脉和口服给药组的引流量存在显著差异（P=0.026），特别是在双节段和三节段融合手术中。
在接受 TLIF 手术的老年患者中，静脉和口服 TXA 给药均安全有效。与静脉注射相比，口服 TXA 更经济、非侵入性，具有临床应用前景。
