Title : The effect of topical administration of tranexamic acid on intraoperative and postoperative blood loss during posterior cervical laminectomy and fusion surgery: A retrospective study
Abstract:
Introduction: The effect of systemic tranexamic acid (TXA) administration on blood loss reduction during spine surgeries has been widely published over the past decade. However, topical use of TXA during cervical spine surgery is rarely investigated. We aimed to assess the role of topical administration of TXA on intraoperative and postoperative blood loss in patients who underwent posterior cervical laminectomy and lateral mass screw ?xation (PCLF) and compare the results with a control group.
Material and methods: In this retrospective study, data of 88 patients who had undergone PCLF surgery, including 41 females and 47 males, were included. The intraoperative blood loss (IBL), postoperative blood loss (PBL), amount of blood transfusion, operation time, use of hemostatic agents, length of hospital stay, and time to return to work were extracted from medical records and compared between those who received topical TXA (irrigation of the surgical field with a solution of 3 grams of TXA in 100 ml of normal saline) during surgery and age and sex-matched control group.
Results: Totally, 48 patients in the TXA group and 40 controls were included. There were no significant differences in the baseline measurements and between groups at the level of operation. The results showed that IBL and PBL were significantly lower among TXA group compared to the control group (p= 0.03 and p<0.01, respectively). There were no significant differences in need for blood transfusion, operation time, and hospital stay between two study groups (p>0.05). Moreover, the use of hemostatic materials during surgery and time to return to work were significantly lower in topical TXA group (P= 0.04 and p<0.01, respectively).
Conclusions: Topical TXA efficiently reduces post and intraoperative bleeding in patients who underwent posterior cervical laminectomy and lateral mass screw ?xation (PCLF) surgery. These results need further investigation in future studies to reach a final conclusion.
What will audience learn from your presentation?
• It is reported that in the case of IV administration of TXA, up to 10% of drug molecules cross the blood-brain barrier and concentrate in the Cerebrospinal Fluid. Thereby, in those prone to seizures, TXA administration (with neurotoxic potentials due to its interference with GABA and glycine receptors) should be used with precaution. Venous thromboembolism (VTE), impairment of visual perception, and necrosis of the renal cortex are other possible adverse effects of systemic TXA administration during surgeries. These complications and some dark aspects of the systemic administration of TXA urged the researchers to investigate the efficacy of the topical use of TXA (with minimum possible side effects) to reduce bleeding during surgeries.
• There are controversial reports regarding the role of topical TXA in spine surgeries. While many researchers reported that topical administration of TXA could favorably reduce postoperative blood loss and hospital stay in patients undergoing spine surgeries, a recent meta-analysis showed that topical TXA administration did not significantly reduce intraoperative and postoperative blood loss. Most of the included studies were among patients who underwent lumbar surgeries, and a few studies were conducted among subjects with cervical spinal complaints
• Our results showed that intraoperative blood loss, postoperative blood loss, use of hemostatic materials, and time to return to work were significantly lower among patients who received topical TXA during posterior cervical fusion and laminectomy surgery versus controls in the same center.
• Our results demonstrated that topical administration of TXA might help the patients with systemic comorbidities and those at risk of VTE, seizure, and other possible adverse effects of systemic TXA administration.
