Does Perioperative Subcutaneous Heparin or Intravenous Tranexamic Acid Affect the Rate of Vascular Complications in Anterior Lumbar Interbody Fusion Procedures?

Introduction Anterior lumbar interbody fusion (ALIF) is a surgical technique commonly used to treat degenerative disk disease in the lower lumbar spine. As the procedure commonly involves retraction of the iliac arteries and veins, potential complications include deep vein thrombosis (DVT) and hemorrhagic vessel injuries. The goal of this retrospective review is to assess whether the use of intraoperative intravenous tranexamic acid (TXA), subcutaneous heparin (SCH), or neither is associated with clinical complications and surgical outcomes. Methods All patients undergoing ALIF from 2015 to 2023 at a tertiary academic medical center were reviewed. Intraoperative use of prothrombotic or anticoagulant and short- and long-term outcomes were assessed. Results One hundred seventy-nine patients were included; there were 81 (45.3%) female patients and an average age of 58.96 ± 13.34 years. Twenty-eight patients received SCH, 34 patients received TXA, and 117 received neither. The use of perioperative SCH or TXA in ALIF procedures did not result in statistically significant differences in complication rates or pain scores. Statistically significant differences were found with the use of coagulative intervention and blood transfusions, with the TXA requiring the fewest transfusions and the no-intervention group requiring the most. Patients receiving TXA were more likely to be discharged home without the need for any other services. Although not statistically significant, there was a trend of decreasing estimated blood loss (EBL) between the coagulation intervention groups, with no intervention having the highest EBL, followed by SCH and TXA. Conclusion The use of perioperative coagulative intervention in ALIF procedures did not result in a significant change in complication rates, hospital stays, or pain outcomes. The TXA group had a trend toward lower blood loss, no patients requiring a blood transfusion, a higher likelihood of being discharged home without any supplemental services, and the best neurologic outcomes. As such, further large and prospective trials should be performed to study the effect of TXA in ALIF patients further to determine whether patients undergoing ALIFs would benefit from TXA administration.