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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, IA, USA.
Tranexamic acid (TXA) did not significantly reduce postoperative delirium in patients undergoing lumbar fusion. However, a potential 33% relative decrease warrants further investigation in a larger clinical trial.
Area of Science:
- Neurosurgery
- Anesthesiology
- Pharmacology
Background:
- Postoperative delirium may be linked to systemic and neuroinflammation.
- Tranexamic acid (TXA) may mitigate delirium by inhibiting plasmin's proinflammatory effects.
Purpose of the Study:
- To investigate the hypothesis that TXA reduces postoperative delirium.
- To explore TXA's effects on inflammation and cognition alongside delirium.
Main Methods:
- Adults undergoing elective posterior lumbar fusion received intraoperative TXA or placebo.
- Delirium, cognition, systemic inflammation, and astrocyte activation were assessed.
Main Results:
- TXA group showed ~38% less postoperative blood loss (P=0.013).
- No significant difference in delirium incidence between TXA (22%) and placebo (33%) groups (P=0.408).
Conclusions:
- While not statistically significant, a potential 33% relative decrease in delirium suggests further study.
- An adequately powered trial is needed to confirm TXA's efficacy in reducing delirium after lumbar fusion.
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