Efficacy and safety of high-dosage of tranexamic acid during spine correction surgery

English Keywords:Spine deformities  Spine correction surgery  Posterior vertebral column resection  Tranexamic acid  Blood loss  Blood transfusion

English Abstract:

  【Abstract】 Objectives: To assess the efficacy and safety of high dosage of tranexamic acid(TXA) during spine correction surgery, especially in posterior vertebral column resection(PVCR) procedures. Methods: Sixty-six patients undergoing posterior spine correction surgery from February 2009 to October 2010 were selected in this study. Seven patients with bleeding disorder or taking medicine which possibly affected coagulation were excluded in the current study. Finally, fifty nine(59) patients were enrolled in the current study. The patients with severe rigid spine deformity underwent PVCR and the others underwent simple posterior spine correction surgery, all procedures were performed by the same surgeon. Patients were divided into two groups: TXA group and control group. 8 patients treated with PVCR and 18 patients treated with non-PVCR were in TXA group; 9 patients treated with PVCR and 24 patients treated with non-PVCR were in control group. In the TXA group, an intravenous loading dose of TXA at 100mg/kg was given over a 20 minute period before skin incision followed by a continuous infusion of 10mg·kg-1·h-1 until the skin closure. The equal amount of normal saline(NS) was given to the patients in control group. The role of TXA on the blood loss(BL), real blood loss(RBL)[RBL=BL/BV(blood volume)] was studied, as well as the amount of acquired blood transfusion, coagulation indexes, hemoglobin，hematocrit and the drug adverse reaction, such as potential liver damage, renal toxicity, deep vein thrombosis(DVT) at upper/lower extremities, pulmonary embolism(PE), myocardial infarction(MI) and seizure. Results: There were significantly less BL(4219±1386ml), RBL[(134.2±36.4)%] and blood transfusion(2986±1458ml) in patients treated with PVCR in TXA group compared with those[9906±5251ml, P<0.05; (332.9±191.8)%, P<0.05 and 6255±3401ml, P<0.05] in control group. The BL, RBL and blood transfusion were also less in patients treated with non-PVCR procedure(P<0.05). High dose of TXA decreased by 57.4% of BL in the patients receiving PVCR and decreased by 39.8% of BL in the patients receiving non-PVCR. The greater benefit of TXA was observed in these patients who had PVCR procedure. There were no differences in liver and renal function between the two groups. And no thrombus at upper/low extremities, PE, MI, seizures and acute renal failure detected in TXA group. Conclusions: High dose of TXA can effectively decrease BL and the amount of blood transfusions in spinal correction surgery, especially in PVCR procedure. Meanwhile, high dose of TXA is safe in spinal correction surgery.