Efficacy and safety of blood loss with different dose of tranexamic acid in lumbar stenosis surgery for elderly patients

English Keywords:Lumbar stenosis  Tranexamic acid  Dosage  Hidden blood loss  Safety

English Abstract:

  【Abstract】 Objectives: To investigate the efficacy and safety of different dose tranexamic acid protocol on perioperative blood loss in elderly patients with multi-segmental lumbar stenosis. Methods: This was a prospective cohort study conducted on 135 patients over 60 years of age undergoing posterior lumbar decompression and interbody fusion (≥2 segments) with multi-segment lumbar spinal stenosis. According to the preoperative dosage of tranexamic acid (TXA), all the patients were randomly divided into four groups, 10mg group (10mg/kg), 30mg group (30mg/kg), 50mg group (50mg/kg), and control group (equivalent saline). The surgery-related data were compared, including intervertebral fusion levels, decompression levels, fixation levels and operation time. Intraoperative and postoperative blood loss as well as the total blood loss and hidden blood loss, blood transfused, D-dimer changes, hemoglobin(HGB) and hematocrit(HCT) changes and the thrombotic complications were recorded. Results: Finally, 10 cases were lost to follow-up, 5 cases were not strictly implemented drug protocol, 120 patients were included and each group had 30 patiets. There were no significant differences in the average intervertebral fusion levels, decompression levels, fixation levels and operation time between the groups(P>0.05). The intraoperative blood loss in the 30mg group and the 50mg group was significantly less than those in the other two groups, and the differences were statistically significant(P<0.05), while those in the 10mg group and the control group were not significantly different (control group 816.67±192.56ml, 10mg group 722.33±153.32ml, 30mg group 593.00±120.61ml, and 510.00±89.67ml in the 50mg group). There were significant differences in the hidden blood loss and total blood loss separately between the control group, 10mg group, 30mg group, and 50mg group (P<0.05, hidden blood loss 825.25±197.22ml, 657.07±118.29ml, 437.38±153.29ml, 324.66±90.34ml; total blood loss 1919.18±458.65ml, 1588.67±396.68ml, 1264.11±443.03ml, 992.84±276.28ml). In terms of perioperative blood transfusion volume, that in the 30mg group and the 50mg group(246.67±266.18ml, 146.67±181.44ml) was significantly lower than that in the control group and the 10mg group (720.00±304.45ml, 568.00±232.15ml), and the difference was statistically significant(P<0.01), while there was no significant difference between the control group and the 10mg group(P>0.05). The postoperative hemoglobin(HGB) and hematocrit (HCT) in each group were compared separately, and the differences were statistically significant(P<0.01). The D-dimer value in the 30 mg and 50 mg groups at 1 and 3 days postoperatively was significantly lower than that of the other groups, and the differences were statistically significant(P<0.01). There was no significant difference in the incidence of lower extremity venous thrombosis between the groups within the 3 months follow-up by ultrasound examination. Conclusions: The high-dose protocol of 30 mg/kg or 50 mg/kg tranexamic acid can reduce estimated blood loss distinctly than the low-dose protocol of 10 mg/kg for elderly patients with lumbar stenosis undergoing posterior multi-segment fusion, without increasing the incidence of lower extremity venous thrombosis and other complications.