Topical use of tranexamic acid can effectively decrease hidden blood loss during posterior lumbar spinal fusion...

Area of Science:

• Orthopedics
• Surgical Innovation
• Anesthesiology

Background:

• Total blood loss (TBL) in spinal fusion includes visible and hidden blood loss (HBL).
• Limited research exists on topical tranexamic acid's (tTXA) effect on HBL in posterior lumbar spinal fusion.
• Understanding HBL is crucial for optimizing patient outcomes and transfusion strategies.

Purpose of the Study:

• To investigate the efficacy of topical tranexamic acid (tTXA) in reducing hidden blood loss (HBL) during primary posterior lumbar spinal fusion.
• To evaluate the impact of tTXA on total blood loss (TBL), postoperative blood loss (PBL), and hemoglobin (HGB) levels.
• To assess the safety and complication profile of perioperative tTXA use in this patient population.

Main Methods:

• A prospective study involving 100 adult patients undergoing primary posterior lumbar instrumented spinal fusion.
• Patients were randomized into two groups: one receiving topical TXA (1g in 100mL saline) and a control group receiving normal saline.
• Primary outcome was HBL; secondary outcomes included TBL, PBL, intraoperative blood loss (IBL), HGB levels, and allogeneic blood transfusions.

Main Results:

• The tTXA group demonstrated significantly lower TBL, PBL, and HBL compared to the control group (P < .001).
• Hemoglobin levels were significantly higher in the tTXA group on postoperative day 1 and showed a slower decline on subsequent days.
• No significant differences in IBL or perioperative blood transfusion requirements were observed between the groups.

Conclusions:

• Topical tranexamic acid (tTXA) effectively reduces hidden blood loss (HBL) in posterior lumbar spinal fusion surgery.
• tTXA administration is associated with improved postoperative hemoglobin levels and a slower decline.
• The study found no significant complications related to the topical use of TXA, suggesting it is a safe and effective adjunct in spinal fusion procedures.