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Exploratory Randomised Trial of Tranexamic Acid to Decrease Postoperative Delirium in Adults Undergoing Lumbar
Bradley J Hindman1, Catherine R Olinger2, Royce W Woodroffe3
1Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Medrxiv : the Preprint Server for Health Sciences
|November 1, 2024
Summary
Tranexamic acid (TXA) did not significantly reduce postoperative delirium in lumbar fusion patients. However, TXA showed potential in decreasing delirium severity by impacting astrocyte activation markers.
Area of Science:
- Neuroscience
- Pharmacology
- Anesthesiology
Background:
- Postoperative delirium may be linked to systemic and neuroinflammation.
- Tranexamic acid (TXA), by inhibiting plasmin, may reduce inflammation and subsequently, postoperative delirium.
Purpose of the Study:
- To investigate the hypothesis that intraoperative TXA reduces postoperative delirium in patients undergoing elective posterior lumbar fusion.
- To explore the effects of TXA on systemic cytokines and astrocyte activation markers.
Main Methods:
- A randomized trial involving adults undergoing elective posterior lumbar fusion, with participants receiving either intraoperative intravenous TXA or placebo.
- Collection of blood samples pre- and post-operatively to measure systemic inflammation biomarkers (cytokines) and astrocyte activation (S100B).
- Twice-daily delirium assessments using the Confusion Assessment Method and pre- and post-discharge cognitive function tests.
Main Results:
- Delirium incidence was 22% in the TXA group versus 33% in the placebo group, a difference that was not statistically significant (P=0.408).
- In the placebo group, delirium severity correlated with instrumented levels and postoperative interleukin concentrations, and with S100B concentration.
- TXA did not significantly alter the association between delirium severity and cytokines but decreased the strength of the association between delirium severity and S100B.
Conclusions:
- While not statistically significant, a 33% relative decrease in delirium incidence suggests a potential benefit of TXA.
- Further adequately powered clinical trials are warranted to confirm if intraoperative TXA can decrease delirium in patients undergoing lumbar fusion.
