Efficacy and safety of combined intravenous and local application of tranexamic acid in cervical expansive laminoplasty

English Keywords:Tranexamic acid  Local application  Cervical expansive laminoplasty  Efficacy  Safety

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy and safety of combined intravenous and epidural local application of tranexamic acid(TXA) in reducing postoperative blood loss and accelerating recovery after cervical expansive laminoplasty(ELAP). Methods: In this retrospective cohort study, 175 patients with multilevel cervical spondylotic myelopathy underwent ELAP. There were 127 males and 48 females, aged from 26 to 76 years old, with an average of 55.1±10.3 years old. All these patients had intravenous TXA administration, and were divided into observation group(n=102, October 2019 to September 2020) and control group(n=73, from January to September, 2019) depending on whether applying TXA(1.0g) locally during the surgery. The following data were collected, including demographic profiles, preoperative hematologic data, intraoperative and postoperative blood loss, operating time and length of hospital stay, and complications(deep vein-thrombosis, cerebral infarction and wound hematoma). Results: There were no statistically significant differences in demographics, preoperative haematologic data, the operation time and intraoperative blood loss. Postoperative blood loss during the 1st and 2nd day after operation was reduced significantly in the observation group compared with that of the control group(42.1±32.1ml vs 52.5±35.0ml, P=0.017; 23.2±32.5ml vs 42.0±34.9ml, P<0.001). The perioperative drainage time of the observation group was less(1.6±0.8 days vs 2.1±0.8 days, P<0.001) with shorter postoperative hospital stay(3.3±1.2 days vs 4.2±1.1 days, P<0.001). No major intraoperative complications related to hematoma and thrombosis was observed. Conclusions: Combined intravenous administration and local epidural application of tranexamic acid could safely reduce postoperative blood loss and shorten the hospital stay with accelerating recovery after cervical ELAP.