Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 11/2017

01-11-2017 | Original Article

The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study

Authors: Ki-Tack Kim, Cheung-Kue Kim, Yong-Chan Kim, Hyung-Suk Juh, Hyo-Jong Kim, Hyeon-Soo Kim, Se Jung Hong, Hwee Weng Dennis Hey

Published in: European Spine Journal | Issue 11/2017

Login to get access

Abstract

Purpose

Tranexamic acid is a proven drug used for reduction of intraoperative blood loss in spinal surgery. However, optimal dosing considering risk/benefits is not well established owing to the heterogeneity in patient selection and surgical procedures of previous studies. This study aimed to evaluate the effectiveness and safety of various tranexamic acid regimens in reducing perioperative blood loss in single-level posterior lumbar interbody fusion (PLIF).

Methods

Patients were randomly grouped into three different interventions: low-dose tranexamic acid (LD), high-dose tranexamic acid (HD), and placebo-controlled (PC) groups. The HD and LD groups received 10 and 5 mg/kg of bolus loading dose and 2 and 1 mg/kg of continuous infusion until 5 h after surgery, respectively. Data on patient demographics and preoperative and 24-h postoperative laboratory values were collected. Outcome parameters include intraoperative blood loss, 24-h postoperative blood loss, and blood loss during removal of the last drain.

Results

Seventy-two patients (mean age 63.3 ± 7.6 years) showed similar baseline characteristics. Intraoperatively, blood loss was reduced by the administration of tranexamic acid (P = 0.04), contributed predominantly by a difference between the LD and HD groups (123 mL; P < 0.01). The 24-h postoperative blood loss was reduced (P < 0.01), contributed predominantly by a difference between the PC and LD groups (144 mL; P = 0.02). During the removal of the last drain, statistical difference was found between the PC and HD groups (125 mL; P = 0.00). No complications or side effects from tranexamic acid use were noted.

Conclusion

Tranexamic acid administration for single-level PLIF was effective and safe in reducing perioperative blood loss in a dose-dependent manner. An HD regimen comprising 10 mg/kg of bolus loading dose and 2 mg/kg/h of continuous infusion is recommended.

Level of evidence

Level 1 study according to Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.
Literature
1.
2.
3.
Tsutsumimoto T, Shimogata M, Ohta H et al (2011) Tranexamic acid reduces perioperative blood loss in cervical laminoplasty. Spine (Phila Pa 1976) 36:1913–1918CrossRef
4.
Tse EYW (2011) Reducing perioperative blood loss and allogeneic blood transfusion inpatient undergoing major spine surgery. J Bone Jt Surg Am 93:1268–1277CrossRef
5.
Gill JB, Chin Y, Levin A et al (2008) The use of antifibrinolytic agents in spine surgery: a meta-analysis. J Bone Jt Surg Am 90:2399–2407CrossRef
6.
Sokolowski MJ, Garvey TA, Perl J II et al (2008) Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine 33:108–113CrossRefPubMed
7.
Yang B, Li H, Wang D et al (2013) Systemic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery. PLoS One 8(2):e55436CrossRefPubMedPubMedCentral
8.
9.
Farrokhi MR, Kazemi AP, Eftekharian HR et al (2011) Efficacy of prophylactic low dose of tranexamic acid in spinal fixation surgery: a randomized clinical trial. J Neurosurg Anesthesiol 23:290–296CrossRefPubMed
10.
Lemaire R (2008) Strategies for blood management in orthopaedic and trauma surgery. J Bone Jt Surg Br 90(9):1128–1136CrossRef
11.
Colomina MJ, Koo M, Basora M et al (2017) Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial. Br J Anaesth 118(3):380–390. doi:10.​1093/​bja/​aew434 CrossRefPubMed
12.
Cheriyan T, Maier SP, Bianco K et al (2015) Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis. Spine J 15(4):752–761CrossRefPubMed
13.
Neilipovitz DT, Murto K, Hall L et al (2001) A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg 93:82–87CrossRefPubMed
14.
Wong J, El Beheiry H, Rampersaud YR et al (2008) Tranexamic acid reduces perioperative blood loss in adult patients having spinal fusion surgery. Anesth Analg 107:1479–1496CrossRefPubMed
15.
Raksakietisak M, Sathitkarnmanee B, Srisaen P et al (2015) Two doses of tranexamic acid reduce blood transfusion in complex spine surgery. Spine 40:E1257–E1263CrossRefPubMed
16.
Pilbrant A, Schannong M, Vessman J (1981) Pharmacokinetics and bioavailability of tranexamic acid. Eur J Clin Pharmacol 20(1):65–72CrossRefPubMed
17.
Sethna NF, Zurakowski D, Brustowicz RM et al (2005) Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology 102:727–732CrossRefPubMed
18.
Benoni G, Fredin HA (1996) Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomized, double-blind study of 86 patients. J Bone Jt Surg Br 78(3):434–440
19.
Tanaka N, Sakahashi H, Sato E et al (2001) Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Jt Surg Br 83(5):702–705CrossRef
20.
21.
22.
Li ZJ, Fu X, Xing D et al (2013) Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials. Eur Spine J 22:1950–1957CrossRefPubMedPubMedCentral
23.
Elwatody S, Jamjoom Z, Elgamal E et al (2008) Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery. Spine 33(24):2577–2580CrossRef
24.
Wang Q, Liu J, Fan R et al (2013) Tranexamic acid reduces postoperative blood loss of degenerative lumbar instability with stenosis in posterior approach lumbar surgery: a randomized controlled trial. Eur Spine J 22:2035–2038CrossRefPubMedPubMedCentral
25.
Holte K, Kehlet H (2002) Compensatory fluid administration for preoperative dehydration—does it improve outcome? Acta Anaesthesiol Scand 46(9):1089–1093CrossRefPubMed
26.
Perel P, Roberts I (2007) Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 4:CD000567
27.
Porte RJ, Leebeek FW (2002) Pharmacological strategies to decrease transfusion requirements in patients undergoing surgery. Drugs 62:2193–2211CrossRefPubMed
28.
Neilipovitz DT (2004) Tranexamic acid for major spinal surgery, review article. Eur Spine J 139(suppl 1):S62–S65CrossRef
29.
Abou Diwan C, Sniecinski RM, Szlam F et al (2011) Plasma and cerebral spinal fluid tranexamic acid quantitation in cardiopulmonary bypass patients. J Chromatogr B Analyt Technol Biomed Life Sci 879(78):533–536
30.
Yamasaki S, Masuhara K, Fuji T (2001) Tranexamic acid reduces postoperative blood loss in cement less total hip arthroplasty. J Bone Jt Surg Am 87(4):766–770
31.
Huang Cheng YML (2011) Tranexamic acid for the elderly with multi segmental spinal stenosis perioperative blood loss and the safety assessment of the impact. Chin J Postgrad Med 10:17–22
32.
Ker K, Prieto-Merino D, Roberts I (2013) Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. Br J Surg 100:1271–1279CrossRefPubMed
33.
Zufferey P, Merquiol F, Laporte S et al (2006) Do antifibrinolytics reduce allogeneic blood transfusion in orthopaedic surgery? Anesthesiology 105:1034–1046CrossRefPubMed
Metadata
Title
The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study
Authors
Ki-Tack Kim
Cheung-Kue Kim
Yong-Chan Kim
Hyung-Suk Juh
Hyo-Jong Kim
Hyeon-Soo Kim
Se Jung Hong
Hwee Weng Dennis Hey
Publication date
01-11-2017
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 11/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-017-5230-4

Other articles of this Issue 11/2017

European Spine Journal 11/2017 Go to the issue

Grand Rounds

Acute non-traumatic idiopathic spinal subdural hematoma: radiographic findings and surgical results with a literature review

Original Article

Screw perforation rates in 359 consecutive patients receiving computer-guided pedicle screw insertion along the cervical to lumbar spine

Original Article

Osseointegration improves bone–implant interface of pedicle screws in the growing spine: a biomechanical and histological study using an in vivo immature porcine model

Original Article

Anatomical evaluation of lumbar nerves using diffusion tensor imaging and implications of lateral decubitus for lateral transpsoas approach

Original Article

Two-piece ALIF cage optimizes the bone–implant interface in a 360° setting

Original Article

Comparative study of the efficacy of transdermal buprenorphine patches and prolonged-release tramadol tablets for postoperative pain control after spinal fusion surgery: a prospective, randomized controlled non-inferiority trial